by Admin. | Jun 3, 2018 | family health insurance, group health insurance, Health Care Reform, NY News, Tax
NYS 2019 Rate Requests
Last Friday, June 1, 2018, the NYS 2019 Rate Requests filings were released. Great news for SMB! The total weighted average increases were a modest 7.5% small groups but 24% for the individual market. This early filing request deadline request requirement is not an Obamacare requirement. As per NY State Law carriers are required to send out notices of rate increase filings to groups and subscribers.
These are simply requests and the state’s Department of Financial Services has authority to modify the final rates. But they are the first indication of what New Yorkers can expect when shopping for health insurance on the individual marketplace at the end of this year. The news comes as insurance companies across the country brace consumers for another year of large rate hikes, owing in part to the composition of the individual market, and in part to the uncertainty over the future of the law under the Trump administration.
Background:
By contrast last year’s NYS 2018 Rate Request early filing request were higher at 11.5% small group but much lower 16.6% for individuals. The NYS final August 2018 rate approval are expected to be lower. For example, the final filing rates were aproved NYS 2018 Final Rates at 9.3% small group and 13.9% for individuals. Incidentally, the NYS 2017 Rates final rates were 8.3% small group and 12.3% for individuals. Using these past figures one projects a 2019 Final Rates of 6.5% small groups and 19% individuals.
With only 3 months of mature claims in 2018 to work of off Insurance Actuaries have little experience to predict accurate projections. Simply put the less credible information presented to actuarial the higher the uncertainty and higher than the expected rate increase. The national rate trend, however, has been much higher than in past years due to higher health care costs and the loss of Federal reinsurance fund known as risk reinsurance corridor.
Summary of 2019 Requested Rate Actions
Individuals:
Individual rates are expected to be higher than the small group market. The national rate trend, however, has been much higher than in past years due to higher health care costs Like other states throughout the nation, the 2019 rate of increase for individuals in New York is higher than in past years partly due to the termination of the federal reinsurance program. The loss of the program’s aka federal risk reinsurance corridor funds accounts for 5.5 percent of the rate increase.
The single biggest justification offered by insurers for the requested increases is the recent repeal of the individual mandate penalty –Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019. The individual mandate, a key component of the Affordable Care Act, helped mitigate against dramatic price increases by ensuring healthier insurance pools. Insurers have attributed approximately half of their requested rate increases to the risks they see resulting from its repeal. Without the federal action, the average requested rate increase would be 12.1%. As DFS reviews all of the submissions, we will continue to ensure that any rate increases are fully and actuarially justified by appropriate medical cost increases and are not inadequate, excessive or unfairly discriminatory, in accordance with New York law.
Small Groups:
Most encouraging to see the average rate requests for the small group market reflect the increased stability of that market in New York State. The combination of 2-50 and 51-100 market underscores the stability for msall bsuinesses under 50 employees. Prior to the NYS regulatory combination, the 2-50 market was running an average 12-13% trend.
The Obamacare health insurance tax, aka The HIT, is responsible for approximately 2.5%. Whiel the HIT moratorium was approved it had indeed come back last year. The total projection is $14 Billion. Notably, Empire Blue Cross has filed a modest 6% increase as their portfoliio is running stable. Additionaly, Oscar’s inbdustry low 3% filing is practially at break-even considering the HIT.
THE THREE R – RISK CORRIDOR, RISK ADJUSTMENT & REINSURANCE designed to mitigate the adverse selection and risk selection. The problem, according to many insurance companies, is that the formula is flawed, and CareConnect executives have consistently complained that they are at an unfair disadvantage. The Cuomo administration has taken steps to ameliorate some of those problems, giving the DFS the authority to essentially overrule the federal numbers. In its first-quarter financial report, executives made clear that the risk adjustment penalty was a threat to its business.
| Company Name |
2019 Requested Rate Change |
| Aetna Life |
16.2% |
| CDPHP |
6.7% |
| CDPHP UBI |
6.1% |
| Crystal Run Health Insurance Company |
11.5% |
| Crystal Run Health Plan, LLC |
12.5% |
| Emblem |
12.0% |
| Empire Healthchoice Assurance |
6.0% |
| EmpireHealthchoice HMO |
5.2% |
| Excellus* |
3.8% |
| Healthfirst Health Plan, Inc. |
21.0% |
| Healthfirst Insurance Company, Inc. |
7.0% |
| Healthnow New York |
-0.1% |
| IHBC* |
3.8% |
| MetroPlus* |
4.7% |
| MVP Health Plan |
7.0% |
| MVP Health Service Corp* |
10.3% |
| Oscar |
3.0% |
| Oxford Health Insurance Inc* |
8.3% |
| UnitedHealthcare Ins Company of New York |
7.2% |
| Weighted average: |
7.5% |
Conclusion
Defined Contribution Choice: Instead, the correct approach for a small business in keeping with simplicity is a defined contribution model using a Private Exchange. This is a true defined contribution empowering employees with the 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 OUTLINED ABOVE ARE HIGHER FOR INDIVIDUAL MARKETS THAN SMALL GROUP PLANS.
To be clear: These trends affect a small subset of the insurance market—non-group plans that cover less than 2 percent of the population. Many qualify for tax credits that lower their net costs and reduce or eliminate the impact of year-to-year rate increases.However, non-group customers with incomes above 400% of the poverty level ($48,560 for a single adult) get no subsidy—and feel the full brunt of any hikes.
Resource
- You may view the NYS 2019 Rate Requests DFS press release, which includes a recap of the increases requested and approved by clicking here.
- For a custom analysis detailing YOUR upcoming 2018-2019 renewal please contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with Medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
- See Health Reform Resource
*These averages may change based on DFS’s review of the rate applications.** Empire submitted a filing that DFS is evaluating.
Learn how a Private Exchange and our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.
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by Admin. | Jan 29, 2018 | Hospitals, NY News, Obamacare
$700 Million for Struggling Brooklyn Hospitals
Gov. Andrew Cuomo announced Wednesday that One Brooklyn Health — a conglomeration of Interfaith Medical Center, Kingsbrook Jewish Medical Center and Brookdale Medical Center — will receive a substantial share of the $700 million that the administration has held for more than two years with the promise that it would one day be used to transform health care in central Brooklyn.
Why it matters:
Brookdale alone has cost $100-$150M annually. The state spends $250 million a year keeping the lights on in these hospitals. That’s tax money that could be spent on anything else if the state can somehow figure out how to make these three hospitals more financially sound.
With state and federal reforms they are exposed. Adapting to a reimbursement landscape in which payment is increasingly linked to performance has become a fail. Ironically, the very reason for this fail is that the State links performance with Medicaid funding.
In other words if you are a hospital already in need of a lifeline Medicaid was paying you ‘X,’ now the managed Medicaid people come and say we are going to pay you $2000 less per discharge. The new reimbursement shift to pay per performance vs a fee for service reimbursements consistent with Obamacare. Its designed to reward value over volume with financial incentives to keep patients healthy through preventive care and early disease detection rather than running up expenditures.
The downward spiral continues as Medicaid Patients are likely to select a more prestigious hospital whenever possible. See how your Hospital ranks here. 40 percent of Brookdale Hospital patients indicating that they would definitely recommend the hospital. Wyckoff Heights and Interfaith also scored poorly – less than 50 percent of their patients reported that ‘they would definitely recommend the hospital. Sadly, with such low scores a State spending strategy alone has not solved the problem in the past nor likely in the future.
by Admin. | Dec 21, 2017 | NY News, Small Business Group Health
Empire Strikes Back – 2018 Plans
Empire Blue Cross Blue Shield recently announced their re-entry back into the New York small group market for 2017. A legendary broad networked PPO is welcome news especially in the NY small group market of 1-100 employees. Recently, the broad national networks have diminished to only 2 national health insurers, Aetna and Oxford. 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.
3 distinct networks:
PPO Network Savings
- PPO/EPO Network – traditional non-gatekeeper large network of approximately 85,384 physicians, 160 facilities and the BlueCard PPO
- Blue Priority Network – hybrid of broad PPO/EPO 160 facilities and similar Pathway’s 65,796 physicians network.
- Pathway Network – HMO value based narrower gatekeeper referral network of 109 facilities and 60,535 physicians. Limited to 28 NYS Counties.
Additional Features:
- Telemedicine will be available on all products
- Vision – Limited adult vision will be available on all products at no additional cost.
- Pharmacy – All plans use their large BCBS formulary Except the HMOs, and the Silver and Bronze Blue Priority Plans. They will be utilizing what they call the Select Formulary.
- 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.
- Healthy Support – Wellness program offers easy ways to earn up to $900 per member, per year. Gym Reimbursement $400 single/$600 couple, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150 and $50 Tobacco-free certification online.
DOCTOR SEARCH: Click Here
BENEFITS SUMMARY: Empire Blue Cross 2018 Top Plans 
Small Group Rates: 2018 EMPIRE BLUE CROSS Plan Grid
Drug Formulary: Click Here
Blue Priority FAQ: Click Here
Pathway FAQ: Click Here
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.
by Admin. | Sep 29, 2017 | group health insurance, NY News, Small Business Group Health
NYS DFS Announces CareConnect Exit
Join us for Oct 25th Webinar.
We have been informed that the NY DFS has recently approved the following measures in the process of CareConnect exiting the market:
- For individuals the market exit date is 12/31/2017.
- For Small Group the market exit date is 11/30/2017.
All groups renewing starting 12/1/17 will no longer be accepted. Currently active group business will end on the last day of their policy year (For example, a 9/1/17 effective will remain in force until 8/31/18).
With recent announcement “CareConnect Withdraws from NYS Market” a Healthfirst addition to the NY Small Business market is especially important. In many instances the Healthfirst plans have a more robust network than CareConnect for NYC and LI. Namely, they have the same hospitals North Shore LIJ(Northwell), Maimonides, but additionally key hospitals such as Mt. Sinai, NYU, Lenox Hill + urgent cares such as CityMD and GO-Health. Rates are approximately $100/month higher for singles for example than CareConnect and would not be an automatic decision to move to Healthfirst.
DOCTOR SEARCH: Click Here
HEALTHFIRST HOSPITAL NETWORK 2017
HEALTHFIRST BENEFITS SUMMARY
DEC 2017 HEALTHFIRST PRO EPO PLANS
JAN 2018 HEALTHFIRST PRO EPO PLANS
RSVP a FREE web-meeting below.
Learn how a Healthfirst EPO on your very own Private Exchange can help your group.Please contact us at info@medicalsolutionscorp.com or (855)667-4621.
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NEW 2018 Healthfirst for NY Small Business
Healthfirst has released affordable new 2018 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 1.2 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 multilin
gual 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
Healthifrst’s new January 2018 rates are in fact virtually the same as 4thQ 2017. Example, a single rate is approximately $2-$3 higher. Today’s largest networks with popular in-network only GOLD are priced at $857/single monthly. By comparison the Healthfirst Gold plan is $717 annualy or 15% less expensive. For platinum the price gap jumps are even higher – $1050/single vs $850/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.
- Dental and vision coverage, 24/7 telemedicine access, acupuncture, exercise reward programs.
All Metal Levels will be included for all size groups including 1-99 market. Referral’s are not needed to vsisit a Specialist MD but one must select a Primary Care Physician on the enrollment form.
by Admin. | Sep 29, 2017 | group health insurance, NY News, Small Business Group Health
Healthfirst has released affordable new 2018 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 1.2 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 multilin
gual 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
Healthifrst’s new January 2018 rates are in fact virtually the same as 4thQ 2017. Example, a single rate is approximately $2-$3 higher. Today’s largest networks with popular in-network only GOLD are priced at $857/single monthly. By comparison the Healthfirst Gold plan is $717 annualy or 15% less expensive. For platinum the price gap jumps are even higher – $1050/single vs $850/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.
- Dental and vision coverage, 24/7 telemedicine access, acupuncture, exercise reward programs.
All Metal Levels will be included for all size groups including 1-99 market. Referral’s are not needed to vsisit a Specialist MD but one must select a Primary Care Physician on the enrollment form.
Attention CareConnect Clients:
Join us for Oct 25th Webinar.
We have been informed that the NY DFS has recently approved the following measures in the process of CareConnect exiting the market:
- For individuals the market exit date is 12/31/2017.
- For Small Group the market exit date is 11/30/2017.
All groups renewing starting 12/1/17 will no longer be accepted. Currently active group business will end on the last day of their policy year (For example, a 9/1/17 effective will remain in force until 8/31/18).
With recent announcement “CareConnect Withdraws from NYS Market” a Healthfirst addition to the NY Small Business market is especially important. In many instances the Healthfirst plans have a more robust network than CareConnect for NYC and LI. Namely, they have the same hospitals North Shore LIJ(Northwell), Maimonides, but additionally key hospitals such as Mt. Sinai, NYU, Lenox Hill + urgent cares such as CityMD and GO-Health. Rates are approximately $100/month higher for singles for example than CareConnect and would not be an automatic decision to move to Healthfirst.
DOCTOR SEARCH: Click Here
HEALTHFIRST HOSPITAL NETWORK 2018
HEALTHFIRST BENEFITS SUMMARY
2018 3Q HEALTHFIRST PRO EPO PLANS
Learn how a Healthfirst on your very own Private Exchange can help your group. Please contact us at info@medicalsolutionscorp.com or (855)667-4621.
Newsletter Sign Up Now
by Admin. | Sep 22, 2017 | group health insurance, NY News
Healthpass Adds HealthFirst 
HealthPass New York, a private health insurance exchange for small businesses, announces that it will offer Healthfirst insurance plans to small business employers in the metropolitan New York City area. Healthfirst, a provider-sponsored health plan serving more than 1.2 million members in New York City and on Long Island, offers small employer group EPO plans to fit the needs of hardworking New Yorkers.
HealthPass will offer Healthfirst Pro EPO plans to eligible employers that employ between one to 100 employees. These plans are available to small businesses with employees who live, work, or reside in New York City and Nassau County. Eligible employers and their employees can begin enrolling in the Healthfirst plans now for coverage that would take effect as early as December 1, 2017.
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.
About HealthFirst
Healthfirst had entered the small business market Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 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.
Attention CareConnect Clients:
With recent announcement “CareConnect Withdraws from NYS Market” a Healthfirst addition is especially important. In many instances the Healthfirst plans have a more robust network than CareConnect for NYC and LI. Namely, they have the same hospitals North Shore LIJ(Northwell), Maimonides, but additionally key hospitals such as Mt. Sinai, NYU, Lenox Hill + urgent cares such as CityMD and GO-Health. Rates are approximately $100/month higher for singles for example than CareConnect and would not be an automatic decision to move to Healthfirst.
Next Step:
Please register for Oct 25, 2017 1:00PM Webinar or set up a one on one online meeting here.
