Healthfirst has released affordable new 2019 plans for NY small businesses and not a moment too soon. With the recent exit of popular CareConnect of NY the market is starving for an affordable option.
About HealthFirst
Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.3 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.
The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilingual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.
Value
Healthfirst’s new January 2019 rates are in fact virtually the same as 4th Q 2018. Example, a single rate is approximately $16 or 1.7% higher. Todays largest networks with popular in-network only GOLD are priced at $900/single monthly. By comparison the Healthfirst Gold plan is $732 annually or 18% less expensive. For platinum the price gap jumps are even higher – $1100/single vs $896/single.
Members have access to a broad network of providers and dozens of industry-leading hospitals.
Community locations throughout New York City, Long Island and parts of Westchester.
All Metal Levels will be included for all size groups including 1-99 market. Referral’s are not needed to visit a Specialist MD but one must select a Primary Care Physician on the enrollment form.
Network Overview:
Healthfirst EPO Pro Network – Provider count expanded to 30,000 from 20,000 2 years ago. Geographic network coverage for NYC 5 Boroughs, Nassau/Suffolk and Southern Westchester. 136+ Urgent Care locations and 50+ hospitals included. Examples:
Free 24/7 Telemedicine Through Teladoc –Members can speak to a doctor anytime, anywhere, with a $0 copay.Telemedicine accessed via phone call or video chat.
Gym Reimbursement – Annual $400/member and $200/spouse reimbursement
Accupuncture Covered Benefit
CVS/Caremark – 7,998 CVS and 22,302 Local Pharmacies. †2X copay for Mail Order 90 days supply.
Free Flu Vaccine
Pro Plus EPO plans Option
Dental – Preventive Care covering Dental Exam, X-Rays, Fillings †& Cleaning †every 6 months. Emergency Dental. Major Dental covering periodontal services, endodontic services plus 6 months follow up care and limited orthodontia.
Vision – Exams, Lenses, Frames or Contacts covered every 12 months
SHOP Credits – SMB groups can enroll on tax credit program directly with our Brokerage
A business must have fewer than 25 employees
Average salary must be less than $53,000 per year Health insurance coverage must be offered to all full-time employees *Based on the New York State of Healths Small Business Health Options Program eligibility nystateofhealth.ny.gov/employer
Empire Blue Cross Blue Shield has announced the new Empire Blue Access Network for 2019. This networks pairs with the long successful industry leading Empire PPO/EPO network. The Blue Access plan unifies the Pathways and Priority Network and adds 5,000 more providers. Additionally, the Blue Access network offers access to the national BlueCard PPO program. As a result of Empire Blue Cross participation in the BlueCard PPO program members enjoy unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of 28 plans below.
PPO/EPO Network – traditional non-gatekeeper large network of approximately 85,384 physicians, 160 facilities and the BlueCard PPO
Blue Access Network – hybrid of broad PPO/EPO 160 facilities and similar Pathway’s 71,000 physicians network. BlueCard PPO Access from home. Examples of hospitals:
Hospital for Special Surgery
NY Columbia Presbyterian
NYU Langone
Mt Sinai Health System
Montefiore
Westchester Medical Center
Maimonides
Staten Island University Hospital
SUNY Stoneybrook
Northwell Health (formerly North Shore LIJ)
Winthrop
LI Health Network
Bon Secours
Additional Features:
Telemedicine will be Free on all products except H.S.A. which will cost $49.
Vision – Empire Blue View Vision will be available on all products at no additional cost. 38,000 doctors and 27,000 locations.
Dental – price competitive plans with 127,000 Dentists and 385,000 locations.
Pharmacy – All plans use their large BCBS formulary Except Blue Access Plans. They will be utilizing what they call the Select Formulary. No Pharmacy deductibles.
Preventive drugs included in all Small Group H.S.A Plans. NO DEDUCTIBLES on certain maintenance drugs for conditions like asthma, diabetes, osteoporosis, high cholesterol, heart health clots and stroke.
Clinical Programs – health coaching/advocacy, disease management, behavioral health, maternity and Gaps in Care
Online Resources – wellness coaching, discounts, health assessments and The Weight Center.
Cash Rewards andHealthy Support – Wellness program offers easy ways to earn up to $700 per member, per year. Gym Reimbursement of $400 single + $400 for dependents 18+, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150 and $50 Tobacco-free certification online.
Ask us about Empire’s flexible low participation voluntary group dental, vision, disability and life insurance plans. Stay proactive and contact us today for a customized consult on how your organization can prepare ahead for ACA, Benefits, Payroll and HR @ (855) 667-4621 or info@medicalsolutionscorp.com.
Contact Us Now Learn how our Agency is helping buinsesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621.
The Google of health insurance?Oscar entered the NY market on Jan 1, 2014 and had around 16,000 members. In 2015, it expanded coverage to New Jersey and grew to about 40,000 members. In 2016, Oscar had 145,000 members in New York, New Jersey, California, and Texas. Oscar’s cutting edge technology and pioneering benefits have simplified the consumer health insurance experience propelled easier access and understanding of health plans. Examples of success have been ease of physician locator, online appointment setting and no cost telemedicine 24/7. Additionally, some plans have $0 Copay generics and annual 3 free office visits
The Numbers:
NY based with 900+ employees
260,000 members across 6 states
$890M raised from top investors (Fidelity, Goldman Sachs, Google, etc.)
$375M investment from Alphabet Inc. (Google parent company)
After doubling footprint for 2018,Oscar is on-track for 3x growth
Oscar Member Engagement:
27% of Oscar members utilize DocOnCall vs. industry average of 3%
35% of first time doctor appointments start with Oscar
3x customer satisfaction score vs. the industry average
48% of all Oscar members use the Oscar app, compared to 7% of other health insurance carriers
Doctor on Call has led to approximately $600 in savings per member
Concierge Team has led to an approx. $3,600 in savings in member OON claims
Pre-medicare population almost 2x Concierge Team utilization vs. the “younger” demographic
The Oscar Member Experience
Concierge Service: Every member is placed on a team of 5 care guides and 1 nurse that help members achieve better health outcomes and lower costs.
Doctor on Call: 24/7, free and unlimited telemedicine that works nationwide. This is a great way to care of basic primary care at the member’s convenience
New Oscar 2019
Oscar’s current network will be rebranded as Circle Network
15 plans across 4 metal tiers
NEWCircle Plus Network include:
Northwell (formerly North Shore LIJ)
Memorial Sloan-Kettering
Multiplan National Network for out of state
Westchester Expansion – Northern Westchester Hospital (Mt. Kisko), Phelps Hospital (Tarrytown) and the Westmed Medical Gorup added.
NEW: Only $0 deductible required Silver Plans!
Transitioning before 2019. Groups enrolling 11/1/19 can upgrade 1/1/19 to Circle Plus Network
New York State has released drafts of its model policy, model complaint form, model training, and FAQs available on its website. The draft model documents and FAQs will be open for public comment through September 12, 2018, after which revisions will be considered and the documents ultimately finalized. The draft documents and FAQs make clear that all employees must complete the model training or a comparable training that meets the minimum standards by January 1, 2019 and all employees who start after January 1, 2019 must complete the training within 30 calendar days of their start date.
New York City released the required Spanish version of the poster, which must be posted along with the English version by September 6, 2018.
NYS Passes Sexual Harassment law
NYS passed the law in April 2018 which contains assortment of provisions aimed at preventing sexual harassment as well as the silencing of victims.The law goes into effect October 9, 2018. Additionally, on May 9th, Mayor DiBlasio also signed the STOP SEXUAL HARASSMENT in NYC ACT.
Policy and Training
The new law requires all employers to adopt and distribute a sexual harassment prevention policy and provide interactive sexual harassment prevention training to all employees.
The state will be developing a model policy and a model training, so employers will not need to create their own. They will, however, need to administer both the policy and the interactive training. We will provide additional information in our clients HR Support Center Portal as well as via newsletter as it becomes availabl and released by the state.
Employers do have the option of creating their own policy and training program, so long as it meets the requirements set by the state.
No Mandatory Arbitration or Confidential Settlements
The new law bans contract provisions that require arbitration for claims of sexual harassment. Any such provision in a contract entered into after July 11, 2018, will be null and void. The rest of the contract will remain enforceable, assuming it was drafted correctly. However, this provision of the new law may be unenforceable under the Federal Arbitration Act. Until this question is resolved, we encourage employers to operate as if contract clauses that require arbitration of sexual harassment claims will not hold up in court or to consult with legal counsel before continuing to use them.
Confidential settlement agreements with respect to claims of sexual harassment are also prohibited by the new law, unless a confidential agreement is the preference of the person who brought the claim. If the claimant does not want confidentiality, employers will not be able to include language that prevents the disclosure of the underlying facts and circumstances of the claim when it involves sexual harassment. This provision of the new law also takes effect July 11, 2018.
Protections for Non-Employees
In addition to the requirements and prohibitions above, the law also gives non-employees—such as vendors, contractors, and consultants—the ability to file a complaint with the Division of Human Rights if they feel they have been sexually harassed in an employer’s workplace. This expansion of the current law has already taken effect.
Employers Next Steps
New York employers can take several steps to prepare for the new requirements created by the Budget.
Employers, initially, should evaluate existing sexual harassment prevention policies and education regarding non-employees in the workforce, including independent contractors.
Employers should review existing sexual harassment policies and training programs for compliance with the Budget’s minimum standards, and revise them accordingly if necessary.
New York employers should review standard settlement and arbitration agreements in connection with sexual harassment complaints, and revise them in light of the Budget’s requirements.
Learn how our Agency is helping buinsesses thrive in today’s economy. Check out PEO Case Studies here and learn how they can apply to you. Please contact us at info@medicalsolutionscorp.com or (855)667-4621.
This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, legal or tax advice. If you have any legal or tax questions regarding this content or related issues, then you should consult with your professional legal or tax advisor.
The New York State Department of Financial Services (DFS) announced the updated Paid Family Leave premium rate and covered payroll limit for 2019. The NY DFS publishes a new employee contribution rate and wage cap each September 1st for the upcoming year to accommodate the graduation of benefits in from 2018 to 2021.
The following chart can be used to help explain these changes to your employees:
Year
Max Annual Covered Payroll
Premium
Rate
Maximum Annual EE Contribution
Benefit %
Max Weekly Benefit
Benefit Duration
2018
$67,908
.00126
$85.56
50%
$652.96
8 Weeks
2019
$70,570*
.00153
$107.97
55%
$746.41
10 Weeks
HOW TO CALCULATE CONTRIBUTIONS?
• EMPLOYEE EARNING: $200,000 OR $3,846.15 WEEKLY WAGE.153% x $3.846.15 = $5.88 (Paid up after 19 weeks) *
• EMPLOYEE EARNING: $100,000 OR $1,923.07 WEEKLY WAGE.153% x $1,923.07 = $2.94 (Paid up after 37 weeks) *
• EMPLOYEE EARNING: $70,569 OR $1,357.10 WEEKLY WAGE.153% x $1,357.10 = $2.08 (Paid up after 52 weeks) *
• EMPLOYEE EARNING: $38,812.80 OR $746.40 WEEKLY WAGE.153% x $746.40 = $1.14 (Paid up after 52 weeks) *
Note: Employers may not collect contributions in excess of $107.97
* Such employee will have satisfied their maximum annual contribution
NYS has approved 2019 Final Rates last Friday. Small group rates will increase 3.8% and 8.6% for individuals.
As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2019 Rate Requests. Despite only 3 months of mature claims data experience for 2018 health insurers’ original requests were noticeably below average 7.5% for small group and 24% for individuals. Ultimately NYS reduced this request substantially by approximately 50%.
Experts are concerned over the long term effects. Example, the Individual mandate was removed last December by Presidential order. Without the Mandate anyone can drop insurance without penalty. A comparable take away for similar auto insurance industry would be something like this -Drivers ought not be mandated to buy auto insurance as its a profit scheme by Insurers. While a popular decision this will hardly bend the curve long term and reduce competition. Furthermore, the new order of Selling Across State lines makes NYS most unwelcoming.
OTHER STATES
Insurers have been filing to sell Obamacare plans that will go into effect in 2019, and in some states they appear to be pricing in for the fact that the mandate is going away next year. Other states are seeing mild increases, but that is in part because they saw significant hikes for the previous year.
Insurers have concluded that fewer people will enroll without the mandate than otherwise, so in some places they are pricing their plans higher based on the assumption that sicker people will be left behind, which will increase medical costs for those left. It is well worth pointing out that in recent years the loss federal risk reinsurance corridor funds account for 5.5 percent of the rate increase.
How are neighboring States doing?
In NJ, not that bad. Last year the average increase were 5.5% for small groups and some popular plans such as Horizon Blue Cross Blue Shield’s OMINA increasing only 4.8% increase. This year the increase is only 5.2. Other insurers offering EPO and HMO plans in the individual market for 2019 include Oscar Health and Oxford Health Plans.
With individual mandate repeal fewer people will buy health insurance raising the prices for those who do. NJ Banking and Insurance Department officials said premium prices would have increased, on average, by 12.6 percent.
For CT market, on the other hand, things are much worse at least for the individual marketplace with average 25% rate increases last year. The 2019 proposed rate increases for both the individual and small group market are, on average lower, than last year: The proposed average small group rate increase request is a 10.22 percent and ranges from -5.0 percent to 21.1 percent. This compares to the average increase request of 18.06 percent requested last year.The proposed average individual rate increase request is 12.3 percent and ranges from -10.9 percent to 31.0 percent. This compares to the average increase request of 25.51 percent requested last year.
Final plan rates in New Jersey & CT will be finalized and released in the fall, state officials said. ACA open enrollment begins Nov. 1
Trend: Trend is a factor that accounts for rising health care costs, including the cost of prescription drugs, and the increased demand for medical services.
Uncertainty in Washington:
Removal of penalty for individual mandate: The elimination of the penalty means that individuals who are typically younger and healthier would have no inducement to participate in the insurance pool, which could further destabilize the market. Lack of participation shrinks the pool and increases the cost of insurance to the remaining members.
Short-duration health plans and Association Health Plans: Still pending are final federal regulations on non-ACA compliant short-duration plans, which may have implications for the ACA risk pool. Also, Connecticut along with other state insurance regulators, are awaiting clarification from the federal government on new federal regulations allowing association health plans, which could further shrink the ACA risk pool.
A bipartisan group of congressional representatives has discussed an agreement to extend and guarantee the payments, but it’s unclear whether they could do so by the new filing deadline of Sept. 5. A lawsuit filed by Congress against the Obama administration to challenge the payments is still pending. In addition, Trump has repeatedly threatened to withhold payments to insurers that reduce cost-sharing – deductibles, copays and coinsurance – paid by low-income customers. More than half of New Jersey’s marketplace customers receive that assistance, and without it, most would be unable to afford coverage.
Finally, a tax on health insurance premiums has been reinstated in 2018 after a one-year “tax holiday” approved by Congress for 2017. That contributed 2.3 percent to the rate hikes that insurers requested for 2019 and for 2019
SMALL GROUP MARKET VS. INDIVIDUAL MARKET
Importantly, small group market is still more advantageous than individual markets unless one gets a sizable low-income tax credit. Overall, about 350,000 individual plan consumers will be affected by the price hike, while more than a million users will be hit by higher small group fees. Last year, Blue Cross Blue Shield released a study showing Obamacare user costs were 22 percent higher than people with employer-sponsored health plans, while UnitedHealthplans to exit most Exchanges see – Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017.
The correct approach for a small business in keeping with simplicity is a Private Exchange and with our large buying group PEO partnerships. This is a true defined contribution empowering employees with a choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll. Both employee and employers still gain tax advantage benefits under the business. Also, the benefits, rates and network size are superior under a group plan as the risk are lower for small group plans than individual markets.
Learn how a Private Exchange and our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.
DOCTOR SEARCH: CLICK HERE
