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. | Aug 24, 2017 | group health insurance, Health Care Reform, latest health insurance news, NY News, Obamacare, Small Business Group Health, Tax
CareConnect Withdraws from NYS Market
CareConnect today has announced their intent to withdraw from the NYS 2018 market. The ACA Risk Adjustment Program was penalizing CareConnect again $100 Million for 2018 after a $112 million tax in 2017.
The problems CareConnect was facing were not new and was covered in last month blog. This problem has bipartisan recognition and Cuomo Administration Asks Feds for ‘Immediate Changes’ to Risk Adjustment Program. While this tax or “risk adjustment penalty” was intended to increase competition it is blamed as the single largest bankruptcy cause for the 12 of 16 Obamacare Co-Ops such as the Health Republic of NY and for start-ups like Oscar and CareConnect.
The formula used to calculate payments in the risk-adjustment program has been criticized for unfairly favoring larger plans with more claims experience. Smaller companies that sell on the ACA’s exchanges have said they don’t have as many claims data, and therefore their membership base looks healthier than it is. In a twisted way, the young companies in need of help were actually subsidizing mature Insurers with legacy data systems.
Who is CareConnect?
CareConnect is a physician/hospital-owned Insurer by Northwell Health also formerly known as North SHore LIJ. Careconnect manages the health of 400,000 individuals, including 125,000 customers. Outside of the risk adjustment penalty the Insurer was managing population health and would have posted a profit. Their past rate increases were single digits.
Sadly, this is a tremendous consumer market hit. Their growth was predicated on delivering excellence of care while still mindful of consumer affordability, see chart below. Not only were they on average 20-30% less expensive but their benefits were typically enhanced. Example: A Tradition Gold plan member would NOT have a deductible nor coinsurance for surgeries and hospital stays at a time when all competing Gold plans did.
Regrettably, no State appeal has been victorious as of yet. With logger-head federal conflicts in Government today on repairing Obamacare flaws the victims will once again be the middle-class consumer.
See Press release:
https://www.northwell.edu/about/news/press-releases/while-preserving-its-population-health-commitment-northwell-withdraw-careconnect-nys-insurance-market
Next Step:
Please sign up for the Sept 13th webinar below on CareConnect Exit & Next Steps for Your Group.
by Admin. | Aug 20, 2017 | family health insurance, group health insurance, Health Care Reform, healthcare, Individual Exchanges, individual health insurance, latest health insurance news, NY News, Obamacare, Small Business Group Health, State Exchanges
NYS 2018 Final Rates Approved 
NYS has approved 2018 Final Rates last week. Small group rates will increase 9.3% while the individual rate average increase will be 13.9%.
As per NY State Law carriers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2018 Rate Requests. With only 3 months of mature claims, experience for 2017 health insurers’ requests are historically above average. Ultimately the State reduces this request substantially. This year, however, NYS acknowledged that medical costs increased, citing a 7-percent average increase on the individual market and an 8.5-percent increase on the small group market. The administration also acknowledged drug prices have impacted insurers, pointing specifically to blockbuster drugs for Hepatitis C.
OTHER STATES
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 2017 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 a.k.a. federal risk reinsurance corridor funds account for 5.5 percent of the rate increase.
How are neighboring States doing? In NJ, not that bad. According to a review of filings made public last week the expected rate increase will likely be half. Example: Horizon Blue Cross Blue Shield requested a 4.8% increase on their OMINA Plans. For CT market, on the other hand, things are much worse at least for the individual marketplace with average 25% rate increases.
While the individual mandate is still the law, Washington has made it clear that they aren’t going to enforce the mandate. That means fewer people will buy health insurance raising the prices for those who do.
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 is due to be 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 last year.
SMALL GROUP MARKET VS. INDIVIDUAL MARKET
The new premium hikes ranged from as little as .8% percent for Hudson Valley’s Crystal Run Health Insurance Company to a whopping 20.4% percent increase for Albany region’s CDHP. 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 UnitedHealth plans 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.
* All amounts are rounded to the nearest 1/10.
**Indicates that the company makes products available on the “New York State of Health” marketplace.
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. | Jun 14, 2017 | group health insurance, NY News, PEO, Small Business Group Health
HealthPass Adds Oscar
HealthPass New York will start offering OSCAR Health Plans effective Sept 1, 2017 to small employers. Oscar will offer eight plans with varying benefits package with 1 to 100 employees. The plans are available to small businesses located in New York City, Long Island, Westchester and Rockland counties. NJ residents can also access Hospitals & physicians through the NJ Qualcare PPO Network
HealthPass New York, a private insurance exchange for small employers. The addition of Oscar gives small businesses access to 3 health networks – Oxford, CareConnect and Oscar. Also, Guardian is the insurer of record for the ancillary benefits comprising dental, vision, life insurance, disability and accident 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
Why a Private Exchange? The advantage of a Private Exchange is the ability to empower employees with choice. Much like a 401K your employees can use a defined contribution allocation for benefits. As affordable health plan networks are increasingly smaller with specific coverage areas the one size show for all approach to benefits no longer works.
Is a Private Exchange Right For My Group?
If you’re a small business owner who has concerns about payroll, filing paperwork, and complying with government regulations, co-employment may be the service you’ve been looking for. In some cases, a Private Exchange may NOT be right for you. With Health Care Reform your company may qualify for a small business tax credit or a be eligible for a large group discount under a PEO.
Try us on a custom demo, contact us at (855)667-4621.
