test MMS quoting

by Admin. | Oct 18, 2016

messages[“SELF”] = “Employee Only”;

messages[“SELF_SPOUSE_DEPENDENT”] = “Employees and Dependents”;

messages[“medical”] = “Medical Insurance”;

messages[“dental”] = “Dental Insurance”;

messages[“vision”] = “Vision Insurance”;

messages[“HRA”] = “HRA”;

messages[“HSA”] = “HSA”;

messages[“FSA”] = “FSA”;

messages[“DCFSA”] = “DCFSA”;

messages[“LPFSA”] = “LPFSA”;

messages[“BASICLIFE”] = “Basic Life Insurance”;

messages[“SUPPLEMENTALLIFE”] = “Supplemental Life Insurance”;

messages[“BASICADD”] = “Basic AD&D Insurance”;

messages[“SUPPLEMENTALADD”] = “Supplemental AD&D Insurance”;

messages[“STD”] = “Short Term Disability Insurance”;

messages[“LTD”] = “Long Term Disability Insurance”;

messages[“commuter”] = “Commuter”;

Empire Strikes Back – 2017 Plans

by Admin. | Oct 13, 2016

Empire Strikes Back 2017 Plans

Empire Strikes Back 2017 Plans. Empire 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.

Network Overview

3 distinct networks:

PPO Network Savings

1.  PPO/EPO Network – traditional non-gatekeeper large network of approximately 85,384 physicians, 160 facilities and the BlueCard PPO
2. Blue Priority Network – hybrid of broad PPO/EPO 160 facilities  and similar Pathway’s 65,796 physicians network.
3. 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: OXFORD Platinum, Gold, Silver AND Bronze

Small Group Rates:  1st Quarter 2017

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.

Medicare Part D Employer Notice

by Admin. | Oct 12, 2016

Medicare Part D Employer Notice

Medicare is a federal health insurance
program- funded in part by employers through a payroll tax- that is
divided into four parts. Part A is hospital insurance; Part B is medical
insurance; Part C is Medicare Advantage; and Part D is prescription
drug coverage.

Special Update: Medicare is no longer prevented from recognizing same-sex marriages for determining entitlement to, or eligibility for, Medicare.
The Social Security Administration is now processing requests for
Medicare Part A and Part B Special Enrollment Periods, as well as
reductions in late enrollment penalties, for certain eligible
individuals in same-sex marriages. Click here for more information.

Medicare Payroll Tax

Through the FICA payroll tax, employers and employees fund Medicare’s Hospital Insurance (HI) program.

• Tax rates under the HI program are 1.45% for employees and employers, each, and 2.90% percent for self-employed persons.

Employer Notice Requirements under Medicare Part D (Creditable Coverage)

• The Medicare Modernization Act (MMA) requires entities (whose
  policies include prescription drug coverage) to notify Medicare eligible
  policyholders whether their prescription drug coverage is creditable
  coverage, which means that the coverage is expected to pay, on average,
  as much as the standard Medicare prescription drug coverage. For these
  entities, there are two disclosure requirements:
  • The first disclosure requirement is to provide a written disclosure notice
    to all Medicare eligible individuals annually who are covered under its
    prescription drug plan, prior to October 15th each year and at various
    times as stated in the regulations, including to a Medicare eligible
    individual when he/she joins the plan. This disclosure must be provided
    to Medicare eligible active working individuals and their dependents,
    Medicare eligible COBRA individuals and their dependents, Medicare
    eligible disabled individuals covered under your prescription drug plan
    and any retirees and their dependents. The MMA imposes a late enrollment
    penalty on individuals who do not maintain creditable coverage for a
    period of 63 days or longer following their initial enrollment period
    for the Medicare prescription drug benefit. Accordingly, this
    information is essential to an individual’s decision whether to enroll
    in a Medicare Part D prescription drug plan.
  • The second disclosure requirement is for entities to complete the Online Disclosure to CMS Form
    to report the creditable coverage status of their prescription drug
    plan. The Disclosure should be completed annually no later than 60 days
    from the beginning of a plan year (contract year, renewal year), within
    30 days after termination of a prescription drug plan, or within 30 days
    after any change in creditable coverage status.

   

Medicare Model Disclosure Notices 

• Disclosure to CMS Guidance and Instructions
• Disclosure to CMS (Online) Form
• Model Individual Creditable Coverage Disclosure Notice (PDF)
• Model Individual Creditable Coverage Disclosure Notice – Spanish (PDF)
• Model Individual Non-Creditable Coverage Disclosure Notice (PDF)
• Model Individual Non-Creditable Coverage Disclosure Notice – Spanish (PDF)

For additional information, see the CMS Medicare pages.

Oxford Metro FAQ

by Admin. | Jun 27, 2016

Oxford Metro FAQ

Oxford Metro Network

Frequently Asked Questions

The Oxford Metro NetworkSM is a new network option available to businesses based in New York. The Oxford Metro

Network was developed specifically for the needs of New York employers and is made up of physicians and other health

care professionals in New York and New Jersey.

1. What kind of access does the Oxford Metro Network provide? 

The Oxford Metro Network consists of over 30,000 physicians and 84 hospitals1 throughout the Oxford New York

service area.2 Members enrolled in an Oxford Metro Network plan will also have access to over 18,000 physicians

and 62 hospitals1 in New Jersey.

2. Is the Oxford Metro Network available to small (1-100) and large (101+) group employers in New York? 

Yes, the Oxford Metro Network plan designs are available to both small and large group employers.

3. What types of plan designs are available with the Oxford Metro Network? 

There are eight gated, in-network only plan designs. The same plan designs are available for large and small groups.

4. What license are Oxford Metro Network plans on?

Oxford Metro Network plans are written on the Oxford Health Insurance, Inc. (OHI) license.

5. Can we offer this product alongside other Oxford products? 

Yes, you can offer Liberty and Freedom Network plan designs, which include plan designs that offer out-of-network

benefits, alongside Oxford Metro Network plan designs. To make it easier to offer these plans, we have updated our

Idea Management SystemSM (IDEA) tool. You can use it to enroll in up to three OHI plans.

If you wish to enroll in more than three plan designs, you must submit a completed paper application with the

required documents. Please refer to our New York Small Group Underwriting Guidelines for required documentation.

A complete copy of our New York Small Group Underwriting Guidelines may be found by logging in to the Employer

portal of oxfordhealth.com. From there, click on “Tools & Resources” and then “Forms” in the drop-down menu of

“Your Benefit Coverage” under the “Practical Resources” menu.

Enrollment is required in each plan design that is offered.

6. Do my employees have to live in New York to enroll in a product offered with the Oxford Metro Network? 

No, employees do not have to live in New York to enroll in a product offered with the Oxford Metro Network as long

as they work for a New York-based company and live in New York or New Jersey.

7. Is there coverage outside of the service area? 

No, these plan designs offer access to Oxford Metro Network providers in the service area only. Members will not

have access to the UnitedHealthcare Choice Plus Network or to the Freedom and Liberty Networks in New York,

New Jersey or Connecticut. Emergency care is always covered, in or out of the Oxford Metro Network service area.

8. How does the non-embedded family deductible benefit work? 

All Oxford Metro Network plan designs will include a non-embedded family deductible. When a member enrolls

in family, couple or parent/child coverage, the entire family has one deductible that must be met before the full

insurance benefits begin. The deductible can be met by one family member or by a combination of family members.

Once the family deductible is met, all family members will be considered as having satisfied their deductible for the

remainder of the benefit year.

9. Do Oxford Metro Network plan designs require referrals? 

Yes, all plan designs offered with the Oxford Metro Network require referrals. Upon enrolling in an Oxford Metro Network

plan design, members will need to select a participating primary care physician (PCP) to coordinate their care.

10. Are specialty products like dental and vision available with the Oxford Metro Network? 

Yes, pre-packaged specialty benefit options through Oxford Benefit Management (OBM) or stand-alone dental, vision

and disability products may be purchased with Oxford Metro Network plan designs. For ease of administration,

when a group has Oxford medical benefits, we do not require tax documentation or a binder check when they

add specialty lines of coverage. Only two enrolled subscribers are needed for voluntary dental, and one enrolled

subscriber for voluntary vision.

11. How can my employees find a participating Oxford Metro Network provider? 

There are several ways that employees can search for a participating Oxford Metro Network physician.

If they already have a username and password for oxfordhealth.com:

1. Log in to the Member portal of oxfordhealth.com.

2. Click on “Find a Physician or Facility” on the home page.

3. On the next page, click the “Network” drop-down menu and choose “Metro.”

4. Enter additional criteria and click “Search.”

If they do not have a username and password, or want to search without logging in:

1. Go to oxfordhealth.com and click on “Members.”

2. Click on the “New Metro Plan – Important information for members” link.

3. On the next page, click the “Provider Search” link.

4. On the “Find a Physician” page, click the “Network” drop-down menu and choose “Metro.”

5. Enter additional criteria and click “Search.”

OR:

1. Go to oxfordhealth.com and click the “Browse our Provider/Facility Resources: Search for an Oxford doctor,

hospital or lab” link at the bottom of the home page.

2. Under “It’s in the details” on the right-hand side, click on “Doctor Search.”

3. On the next page (“Find a Physician”), click the “Network” drop-down menu and choose “Metro.”

4. Enter additional criteria and click “Search.”

Employees may also call the toll-free phone number on the back of their health plan ID card (if they are currently

enrolled in an Oxford plan) or 1-800-444-6222 to have a paper copy of the directory mailed to them. TTY users can

dial 711. Si usted necesita ayuda en español llame al número de teléfono en su tarjeta de identificación, 若需中文協

助， 請致電1-800-303-6719, 한국어로 도움이 필요하시면1-888-201-4746, or the phone number on their ID card

for help in English and other languages.

12. What pharmacies are available with the Oxford Metro Network? 

The Oxford Metro Network provides access to retail pharmacies including major chains, mass merchants and

supermarkets. Among others, members can fill prescriptions at Duane Reade, Walgreens and Walmart.

13. How can my employees find a participating pharmacy? 

Employees can search for a participating pharmacy from the Member portal on oxfordhealth.com by following the

steps below:

1. Go to oxfordhealth.com and click on “Members.”

2. Click on the “New Metro Plan – Important information for members” link.

3. On the next page, click the “Pharmacy Search” link.

4. Enter search criteria on the following “Find a Pharmacy” page and click “Search.”

Employees may also call the toll-free phone number on the back of their health plan ID card (if they are currently

enrolled in an Oxford plan) or 1-800-444-6222 to find out if a pharmacy is participating. TTY users can dial 711. Si

usted necesita ayuda en español llame al número de teléfono en su tarjeta de identificación, 若需中文協助， 請致

電1-800-303-6719, 한국어로 도움이 필요하시면1-888-201-4746, or the phone number on their ID card for help in

English and other languages.

14. What other resources and tools are available to members enrolled in an Oxford Metro Network plan? 

• Oxfordhealth.com offers a convenient, secure way for members to search for doctors, check referrals, get a new

ID card, and access benefits.

• Online health and wellness tools such as Rally™, which is an interactive health and wellness enhancement to

oxfordhealth.com. With Rally, members receive personal lifestyle plans that focus on goals, competition, tracking

progress and healthy living. Rally offers a personalized interactive experience with step-based Challenges,

discussion Communities, individual action plans called Missions, health information and more.

• Oxford On-Call® nurses are available 24 hours a day, seven days a week by phone to give members helpful

information about illness or injury.

• Access to a fully-credentialed network dedicated to complementary and alternative medicine that includes more

than 5,900 providers.3

Oxford Benefit Management, Inc. acts as the distribution company for products. Oxford Benefit Management packages are not available in all states and state-specific 

requirements may cause limitations or variations to the plans. Packaged Savings is not available for this product. Benefit options may vary by group size. Components 

subject to change. Oxford Benefit Management products are provided by: UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located 

in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. The New York Select Managed Care Plan is 

underwritten by UnitedHealthcare Insurance Company of New York, located in Islandia, New York. UnitedHealthcare vision coverage provided by or through UnitedHealthcare 

Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Life and Disability 

products are provided by Unimerica Life Insurance Company of New York. Life and Disability products are provided on policy forms LASD-POL-LIFE NY (05/03) and LASD-

POL-ADD/DIS NY (05/03). Unimerica Life Insurance Company of New York is located in New York, NY. These policies may include exclusions, limitations, reductions of 

benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or 

the company.  

Oxford insurance products are underwritten by Oxford Health Insurance, Inc. 

For more information on the Oxford Metro Network, please contact Millennium Medical Solutions Corp. at (855)667-4621.