by Admin. | Aug 9, 2019 | healthcare, individual health insurance, NY News, Obamacare, Small Business Group Health
NYS has approved 2020 health inusrance rate requests today. Small group rates increase 7.9% and 6.8 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 2020 Rate Requests. Despite only 3 months of mature claims data experience for 2019 health insurers’ original requests were noticeably below average. Ultimately NYS reduced this request substantially by approximately 55%.
The 2020 small group rate increase was in line at 7.9% vs 2019’s approval of 7.5%. This reflect a stabilizing ACA market. Insurers’ financial performance improved nationwide last year to its highest level since the passage of the law. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% last year in the individual market nationwide. That led to plans paying $800 million in rebates for failing to meet requirements on medical spending, according to the Kaiser Family Foundation.
Rate Factors
The state noted that premiums increases main driver are medications. “The drug costs account for the largest share of medical expenses, followed by inpatient hospital costs, and outpatient hospital costs.”
More than one million New Yorkers are enrolled in small group plans, which cover employers with 1 to 100 employees. Insurers requested an average rate increase of 12.2% in the small group market. DFS cut the weighted average requested rate increases by 4.3 percentage points, or 35%, from 12.2% to 7.9% for 2020, saving small businesses over $313 million. The federal ACA Health Insurance Tax, which was reimposed for 2020, accounts for approximately 3% of these rates. Without this tax, the increase would have been 4.7%. A number of small businesses will also be eligible for tax credits that may lower those premium costs even further.
The HIT (Health Insurance Tax) is back. For Small business, this translates to an estimated 2.5%-3% added surcharge. For States like NYS where there is already approx. 16% added surcharge to high premiums, this becomes daunting. It is no surprise the unpopular HIT was suspended. In 2017, payers escaped making $13.9 billion in payments due to the moratorium, according to a 2018 analysis by Oliver Wyman, commissioned by UnitedHealth Group. This may have saved consumers billions on their insurance coverage.“The taxes on health insurance are non-deductible for federal tax purposes for health insurers,” the report explained.
Website Stop The Hit calculates $5,000 as the average tax for a 10-man small business for example.Calculates how the HIT affects your State and your business, here. Take action now: tell Congress to repeal the HIT! Join small business owners across the country in stopping the HIT. Sign the petition here.
Small Group Market
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by Admin. | May 31, 2019 | healthcare, Individual Exchanges, NY News, Small Business Group Health
The NYS 2020 Rate Requests filings were released today. The total weighted average increases were a modest 8.4% for Individual Market and 12.0% Small Group Market. Final rate approval expected early August. The past reductions averaged 10-50%.
The lower requests reflect a stabilizing ACA market. Insurers’ financial performance improved nationwide last year to its highest level since the passage of the law. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% last year in the individual market nationwide. That led to plans paying $800 million in rebates for failing to meet requirements on medical spending, according to the Kaiser Family Foundation.
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.
Background:
By contrast last year’s NYS 2019 Rate Request early filing request were higher at 7.5% small group and an astounding 24% for individuals. The NYS final August 2020 rate approval are expected to be lower. For example, the final filing rates were approved NYS 2019 Final Rates Approved at a modest 3.8% small group and 8.6% for individuals. Using these past figures one projects a 2019 Final Rates of 5% small groups and 8% individuals.
A spokeswoman for the state Health Plan Association said insurers have worked to control costs, which have been driven up by rising prescription drug prices and state mandates that require coverage of certain services.
“Our member health plans have been committed to making health care more affordable, working hard to rein in rising health care costs and contain their own costs,” she said. “The proposed premium rate requests are reasonable, reflecting the cost of care.”
In the small-group market, insurers asked for a weighted average 12% boost in 2020 after they were granted a 3.8% bump for this year. UnitedHealthcare’s Oxford, which controls more than half of the small-group market, asked for a 15.9% increase, which was the highest among all plans. Oscar, at 15.8%, was close behind. Notably, Healthfirst has requested a 5% reduction.
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 2019-2020 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. | Oct 14, 2018 | healthcare, NY News, Small Business Group Health
2019 Healthfirst Plans
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.
- 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 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:
| Hospital for Special Surgery |
City MD Urgent Care |
| NY Columbia Presbyterian |
Modern MD |
| NYU Langone |
|
Urgent Care |
|
| Mt Sinai Health System |
|
Northwell Go-Health |
| Montefiore |
|
|
PM Pediatrics |
| Westchester Medical Center |
Midtown NY Doctors |
| Maimonides |
|
|
Cure Urgent Care |
| Staten Island University Hospital |
Riverdale Urgent Care |
| SUNY Stoneybrook |
|
Throgs Neck Urgent Care |
| Northwell Health (formerly North Shore LIJ) |
Statcare |
|
| Winthrop |
|
|
Rapid MD |
|
| LI Health Network |
|
Express Medical Care |
| Bon Secours |
|
|
Excel Urgent Care |
Additional Features:
- 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
DOCTOR SEARCH: CLICK HERE
HEALTHFIRST HOSPITAL NETWORK 2018
HEALTHFIRST BENEFITS SUMMARY
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.
by Admin. | Oct 8, 2018 | healthcare, NY News, Small Business Group Health
Empire Strikes Back – 2019 Health Plans
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.
2 distinct networks:
- 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.
- Travel – BlueCard PPO national access and Blue Cross Blue Shield Global Core Program.
- Cash Rewards and Healthy 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.
DOCTOR SEARCH: Click Here 
BENEFITS SUMMARY: Empire Blue Cross 2019 Top Plans
Small Group Rates: 2019 EMPIRE BLUE CROSS Plan Grid
Drug Formulary: 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. | Oct 3, 2018 | group health insurance, healthcare, Small Business Group Health, Wellness
2019 EmblemHealth 
EmblemHealth, formerly GHI and HIP, has recapitalized and reloaded dynamic plan offerings for 2019. They have had recent 3 years of single digit increases. Emblem has added significant new small group plans for 2019 thats fits the needs and budgets of small businesses. Each plan offers quality coverage with comprehensive benefits and network access.
New Expanded Prime Network: Access to a narrow and broad network
NYS – EmblemHealth has expanded small group Prime Network to include both the QualCare Network in New Jersey another ConnectiCare Network in Connecticut. This is in addition to the current HIP Prime Network in New York. Members can choose from over 90,000 private and group practice health professionals, facilities, and 144 hospitals in 28 New York State counties — all five boroughs of New York City (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), plus Nassau, Suffolk, Orange, Rockland, and Westchester counties, and upstate areas that stretch north of Albany.
CT – The ConnectiCare HMO Network has 17,000 primary care providers and specialists, and 33 hospitals in all eight counties in the State of Connecticut.
NJ – The QualCare HMO Network includes 26,000 primary care providers and specialists, and 76 hospitals in all 21 counties across the State of New Jersey.
New Select Care Network
It is a smaller subset of the larger Prime Network. It includes over 41,000 health care professionals, facilities, and hospitals throughout 28 counties in New York State. PRIME vs. SELECT NETWORK: Click Here
New Plan Features
- 3 free copays for PCP on selected plans.
- Urgent Care no deductible
- Labs no deductible
- Adult & pediatric preventive dental no deductible
- FREE Telemedicine through Teledoc. Members can get non-urgent medical care. It’s convenient, immediate, and available 24 hours a day, 365 days a year. Telemedicine doctors can even prescribe certain medicines.
- FREE Acupuncture
- Vision Included – free annual exam and lenses at 20% coinsurance.
- Gym Reimbursements – up to $400 for member and $200 for spouse.
Emblem has been a NYS mainstay for 80 years. They insure 612,000 members. Notable clients are Union plans such as the NYC Teachers Union.
DOCTOR SEARCH: Click Here
PRIME vs. SELECT NETWORK: Click Here
BENEFITS SUMMARY: Platinum Premier, Gold Choice, Silver Plus(gated) and Bronze Plus HSA (gated)
EMBLEMHEALTH SMALL BUSINESS OVERVIEW. Click Here
Group Sample Rates:
Sign up for upcoming webinars and newsletters. Please contact us TODAY for a customized analysis for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
by Admin. | Oct 3, 2018 | Healthy NY, Small Business Group Health, United Healthcare
2019 Oxford Metro Network NY
Oxford has expanded on their successful Oxford Metro Network plan released in 2016. For 2019 the network has expanded with most Metro plans enjoying rate reductions for 2019.
Oxford Metro Network:
The NY network has grown to approx. 12,000 Primary Care Providers, 29,000 Specialists and 71 hospitals. Furthermore, the Oxford Garden State network has been added as well onto the Metro Network. The Garden State network alone has access to 23,000 physicians and 62 hospitals.
All Metal Levels will be included for all size groups including 1-99 & 100+. The new Oxford Metro plan will be limited to NY and NJ Garden State Network Providers. Referrals will be needed to see Specialists. Importantly, most NY Hospitals will be participating with the EXCEPTION of NYU Health System, North Shore LIJ Health System (NorthWell Health) and Maimonides Medical Center. In addition, certain key medical IPA Groups such as Caremount, formerly Mt Kisko Medical Group, are NOT in the network.
Oxford Metro Costs:
Today’s largest networks with in-network only GOLD are priced at $11,000 /single annually. They typically are accompanied with $50 copays and non-office exposures of $1,000 deductibles and coinsurance percent in network. The new Metro network is approximately 25% smaller than NY Liberty network with up to 20% IN SAVINGS. For example, a popular Oxford Liberty HMO Gold is $880 vs.Oxford Metro Gold $735.
New Plan Added
New lower cost Oxford Primary Advantage Plans added. The plan provides in-network coverage with lower copayments and no deductibles when seeking care form PCP’s and OBGYNs and Tier 1 prescription drugs.
The Healthy NY and off-exchange Individuals will use exclusively this new Oxford Metro Network.
DOCTOR SEARCH: Click Here
BENEFITS SUMMARY: OXFORD Platinum, Gold, Silver AND Bronze
Oxford Metro FAQ. Click Here
Drug Formulary: Click Here
Group Sample Rates:
Sign up for upcoming webinars and newsletters. Please contact us TODAY for a customized analysis for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
