Select Page
NYS 2023 Final Rates Approved

NYS 2023 Final Rates Approved

Yesterday, NYS Dept of Financial Services approved 2023 health insurance rate requests yesterday. Small group rates increased by 7.9% and  9.7% 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 –2023 NY Small Group Carrier Rate Filings.  Despite only 3 months of mature claims data experience for 2022  health insurers’ original requests were noticeably above the average of 16.5%/individuals and 19% for small groups. For example, regulators last year approved average rate increases of 3.7% for individuals and 7.6% for small group plans. Over 1.1 million New Yorkers are enrolled in individual and small group plans impacted by the rate increases, the state agency noted.  

The recent COVID-19 surge irony reflected a lower cost utilization due to COVID-19. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% in recent years years. That said, in an anticipation of spikes in claims submissions + overall inflation, a larger than average increase is needed. This is in addition to increases in pricing by hospitals, consolidated IPA groups, and pharmaceuticals.

Rate Factors

The state noted that the premiums increase main drivers are medications.  “Rising medical costs and inflation continue to put upward pressure on premiums,” said Superintendent Harris. “With our rate actions announced today, we continue to prioritize the financial wellbeing of consumers while ensuring that New Yorkers have access to a robust, stable health insurance market.”  Also, DFS, recognizing the continued uncertainty of the pandemic’s effect on consumers’ health care costs and the economy, held insurers’ profit provisions to a historically low 0.5%. 

Health Insurers

Oxford/Unitedhealthcare, notably, got only a 6% rate increase approval for next year. This is a sharp reduction from the original 16.8% request in part by disagreed anticipated costs, held reserves, overall market pricing, and reinsurance gained from ACA’s Risk Corridor.  See more info here,

Small Group Market   

Almost 850,000 New Yorkers are enrolled in small group plans, which cover employers with up to 100 employees. Insurers requested an average rate increase of 16.5% in the small group market, which DFS cut by 52% to 7.9% for 2023, saving small businesses $632.4 million. A number of small businesses also will be eligible for tax credits that may lower those premium costs even further, such as the Small Business Health Care Tax Credit.


NYS DFS Approval 2023 Health Insurance Rates

*Indicates the Company will offer products on NY State of Health Marketplace in 2023.

PEO Alternatives to Small Group

Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEO’s are large-group markets underwritten.  With the right PEO, you will be able to manage your business’s demand for growth and your employees as well.

Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

Learn how a PEO can make a difference for your group. For more information on how Employer-Sponsored Insurance and a PEO can make difference for your small business please contact us at [email protected] or 855-667-4621.





Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

Oxford Liberty National Network Changes

Oxford Liberty National Network Changes

Oxford Liberty National Network Changes

Starting with September 1, 2022 plan effective dates, Oxford members of a Liberty Network plan will have the UnitedHealthcare Core Network for out-of-area coverage. They will no longer use the UnitedHealthcare Choice Plus Network for national network access. This change applies to all Oxford Liberty members. 

UnitedHealthcare Core Network Overview 

  • The Core Network has 90% physicians and 93% of hospitals overlap with the Choice Plus Network
  • The Core Network includes 895,806 physicians and health care professionals and 5,001 hospitals

Click here for the Core Network Availability Map

What this means for New York and New Jersey Oxford members enrolled in a Liberty Network plan

  • The out-of-area network for New York and New Jersey situs businesses with Oxford Liberty Network plans will change from the UnitedHealthcare Choice Plus Network to the UnitedHealthcare Core Network effective September 1, 2022 for new business and upon renewal for existing business
  • In states where the UnitedHealthcare Core Network is not available, Oxford Liberty network members will have access to the full network that mirrors the UnitedHealthcare Choice Plus Network
  • Liberty network access within the Oxford tri-state service area remains unchanged

Provider search

As always, please confirm a provider’s participation in the health plan network prior to seeking care. You can do this online, on, or by calling the phone number on their health plan ID card. Please note:

  • Members should sign in to® to search for Oxford Liberty Network providers
  • Upon renewal, beginning with September 1, 2022 plan effective dates, Core Network providers will appear in the provider search tool when Oxford Liberty members look for out-of-area providers
  • Non-members and affected members whose plan has not yet renewed will also be able to perform a search for Liberty with Core providers prior to September 1, 2022

New Cards

New Liberty Member ID with COREAll Oxford Liberty Network members will receive new member ID cards indicating UnitedHealthcare Core for out-of-area network access.

We will continue to share additional communication tools as they become available from Oxford. 

 Learn more about how we are successfully helping navigate SMB for 25+ years. If you have any questions or would like additional information, please contact us at 855-667-4621 or [email protected].

For information about transparency providers and new tech tools contact us at [email protected] or (855)667-4621.

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

Montefiore and Oxford Reach Agreement

Montefiore and Oxford Reach Agreement

​Good news Bronx/Westchester.  Oxford and Montefiore Health System announced moments ago that they have reached an agreement effective December 1, 2021 for UnitedHealthcare and Oxford employer-sponsored plans, as well as UnitedHealthcare’s Medicare Dual Special Needs Plan.  

This resolves a split since Jan 1, 2021 which affected a significant percentage of local residents as both companies have a critical size of the market. Westchester and Bronx populations total nearly 2.5 million people. While this contract is resolved with titanic and a few Hospital Systems and Insurers left in the market we expect to see this trend to continue.

See below the official press release. 


UnitedHealthcare and Montefiore Health System Renew Relationship

UnitedHealthcare and Montefiore Health System have reached a multi-year agreement that restores access to Montefiore’s hospitals and physicians for people enrolled in UnitedHealthcare and Oxford employer-sponsored plans as well as UnitedHealthcare’s Medicare Dual Special Needs Plan, effective Dec. 1, 2021.

We recognize that the care Montefiore provides is not only important but also personal to our members and we also know the negotiations process may have been difficult for them. Our top priority throughout this process was ensuring the people and employers we’re honored to serve in New York have access to quality, more affordable health care, and this new agreement helps accomplish that goal.

We thank our members and customers for their support and patience throughout this process. We are honored to continue supporting the more than 3.7 million individuals across New York who depend on us for access to quality and affordable health care.

Montefiore Hospitals & Health System

Facility NameCounty
Montefiore Hospital (Moses Campus)Bronx
Children’s Hospital at MontefioreBronx
Garnet Health MedJack D. Weiler Hospital (Einstein Campus)ical CenterBronx
Montefiore Wakefield Hospital (Wakefield Campus)Bronx
Burke Rehabilitation HospitalWestchester
Montefiore Mount Vernon HospitalWestchester
Montefiore New Rochelle HospitalWestchester
Montefiore Nyack HospitalRockland
Montefiore St Luke’s Cornwall HospitalOrange
White Plains HospitalBronx
Montefiore Hutchinson CampusBronx
Montefiore Medical GroupWestchester
Montefiore Medical Specialists of WestchesterWestchester


Neighboring Hospitals

Facility NameCounty
Bon Secours Community Hospital
BronxCare Hospital Center
Garnet Health Medical Center
Good Samaritan Hospital of Suffern
New York Presbyterian Hudson Valley Hospital
New York Presbyterian Lawrence Hospital
NYC Health + Hospitals Jacobi
NYC Health + Hospitals Lincoln
NYC Health + Hospitals North Central Bronx
St. Anthony Community Hospital
St. Barnabas Hospital
St. John’s Riverside Hospital
Westchester Medical Center

Leading Health Insurers 

2021 Empire Blue Cross Blue Shield
2021 EmblemHealth 
2021 Healthfirst Plans
2021 New Oscar Circle Plus




For information about transparency providers and new tech tools contact us at [email protected] or (855)667-4621.

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

2019 Oxford Metro Network NY

2019 Oxford Metro Network NY

NEW 2016 Oxford Metro Network NY Image1

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.


BENEFITS SUMMARY: OXFORD Platinum, Gold, Silver AND Bronze

Oxford Metro FAQ. Click Here

Drug Formulary: Click Here

Group Sample Rates:

New Oxford Metro 2019






Sign up for upcoming webinars and newsletters. Please contact us TODAY for a customized analysis for your group-specific needs at [email protected] or Call (855) 667-4621.

NYS 2017 Final Rates Approved

NYS 2017 Final Rates Approved

NYS 2017 FINAL Rates Approved   2017 Healthcare Costs

NYS has approved  2017 Final Rates.  Small group rates will increase 8.3%, a reduction from the 12.3% average originally requested.  In the individual market, the average increase will be 16.6%, a reduction from the originally requested 19.3%.

As per NY State Law carriers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2017 Rate Requests.  With only 3 months of mature claims experience for 2016  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.


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 lost of the program’s aka federal risk reinsurance corridor funds accounts 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 be likley ve 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 individual marketplace with average 25% rate increases.


The new premium hikes ranged from as little as 5.6 percent for Oxford Small group to a whopping 58.5% percent increase for Crystal Run Health Insurance Company, an insurer that covers parts of the Hudson Valley and Catskills.  Importantly, small group market are 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. Earlier this 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.  This is a true defined contribution empowering employees with 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.Obamacare NYS 2017 Rates

* All amounts are rounded to the nearest 1/10.

**Indicates that the company makes products available on the “New York State of Health” marketplace.

***After rate applications were filed on 5/9/2016, additional information, including the final results of the federal risk adjustment program, prompted several insurers to update their initially filed rates.

 For more information on how a Private Exchange can help your group please contact us at (855)667-4621.

Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017

Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017

Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017  Crains Health Pulse June 27_2016 Oxford Indiv Exit

A neat quote mentioned in yesterday’s Crains Health Pulse.  I only wish it were for better news.
1. Oxford will be leaving NY Individual health plans.  The popular Oxford Metro plan offered off-exchange marketplace will no longer be offered next year.  Notably, this is the only plan that contained par excellence cancer hospitals such as Memorial Sloan Kettering.
Oxford Metro will still be available for NY Small groups.
2.  Oxford Liberty HMO plans will be leaving ALL segments – Individuals to commercial large groups.  For restaurants and retail shops, as an example, this is a very popular platform as this allowed flexibility of NO minimum participation.  If only 1 person wanted to enroll on plan out 20 that was OK.
Oxford will be sending these letters out to Employers starting with Jan 2017 renewals.

Oxford Health Plans (NY), Inc. (OHP) License Withdrawal, Effective January 1, 2017, Upon Renewal

Please note the following:

  • This change does not affect their regular  Oxford Health Insurance, Inc. (OHI) plans. Their OHI portfolio in New York offers a wide range of coverage options for employers of all sizes. 
  • Impacted groups and members will receive a notice from us approximately 180-days prior to their 2017 coverage end date. The notice will outline the actions they need to take and other available coverage options.

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 [email protected].