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New York News

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Oscar has announced that they have a new team member...Oscar's new Vice President of Sales - industry veteran Louis DeStefano.   To find out more about Louis and what the plans are with his new role at Oscar, please click below.

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As of 9/17, your clients will have access to Oscar through HealthPass!   If you don't know Oscar, you will now.   Click the link below to find out what plans area being made available through HealthPass, along with some important "quick facts" about Oscar.

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Mark your calendars. Care Connect will be hosting Broker Open Enrollment Seminars in September.  Locations include Long Island, New York City and Westchester.  Details below.

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Care Connect has released an updated facilities list that reflects City  MD's departure from the CareConnect network. Please download the document below for the  most up to date information.

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HealthPass Urgent Care Connect Update  - Care Connect has released an updated facilities list that reflects City MD's departure from their network.  Please be advised that as of August 1, 2017, CityMD will no longer be a part of the CareConnect network. Note that this CareConnect Network Update impacts HealthPass members as well. Details are available below.

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UnitedHealthcare Broker Connection 7/16/17  - The most recent UHC Broker Connection covers the following: July 31 PCORI Fee Due; 2018 Medical Necessity Requirement, Updates for N, Broker training and much more.

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CareConnect Broker Alert - CareConnect has released their Small Group (1-100) 4th Quarter Rates on their Broker Sales Materials page.

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HealthPass September 2017 Renewal Window is Now Open! - The HealthPass Online Portal (HOP) is now open to accept September 2017  renewal applications! If your group is not making changes at renewal,  their policy will be automatically renewed and you do not need to take  action. If you wish to make changes, please refer to the instructions below. Changes to the following group criteria will require you to submit the renewal application and most recent notated NYS45/Quarterly Wage & Tax Statement on the HOP:
 

 

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Updated ACA Small Group new case submission dates.  Aetna is implementing updated 4th quarter new business submission deadlines for Small Group Affordable Care Act (ACA) plans: This applies to:

States included in the updated ACA new sales submission dates are: Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Missouri, Nebraska, Nevada, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina,  Tennessee, Texas, Utah, Virginia, West Virginia and Wisconsin.

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 Updated Participation Requirements - HealthPass New Particpation Guidelines - Effective 10/1/2017 there will be an additional requirement to enroll or renew a group with the HealthPass New York Exchange. Click below to view the updated Eligibility Guidelines.
 

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To keep you informed about current and future changes in health care,  Emblem is providing you the most recent information about key federal and state developments. Senate Still Aiming For Pre-Holiday ObamaCare Repeal and Replace Vote - Senate Republican leaders are still hoping to vote on legislation to repeal and replace the Affordable Care Act (a.k.a. Obamacare) before July 4. However, legislative language has not been made public and several key Republicans said they had not yet reviewed the text.

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Action Required forNew York Small Groups: : Enroll July 1, 2017 OHP HMO Groups in an OHI Plan by June 30, 2017 As a reminder, New York small groups currently offering only an Oxford Health Plans (NY), Inc. (OHP) HMO plan with a coverage end date of July 1, 2017 need to purchase a new  Oxford Health Insurance, Inc. (OHI) policy before their current OHP plan ends. These groups did not receive a renewal package from us and need to apply as a new group.

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UHC Broker Connection 6/15/17 UnitedHealthcare has released their Broker Connection Newlsetter,  covereing the 2017 Medical Loss Ratio (MLR) report schedule and key dates are now available. MLR only applies to fully insured plans. See how your fully insured clients may be affected. Other topics include:

Broker & Client Resources
Plans & Services
Sales Support and Employee Wellness

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We have exciting news from HealthPass.  Oscar and Healthpass have formed a new partnership and Oscar is offering 8 plans, available through HealthPass. This is great news. Click below to read the details and access the press release. This will be going into effect 9/1/17,

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Oxford through HealthPass - Use this informative and convenient guide to choose the right care center for services: Doctors offices, covenience clinic, urgent care or ER. Click below:
 
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UHC -Broker Connection Newsletter - View the process to be used by new business clients for submitting the required 1095-B information, PCORI Notice Scheduled for All Savers® Clients, New Vision Network Includes Target and Sears and much more. Click below.
 
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Aetna Life Insurance Company has submitted a rate change request to the New York State Department of Financial  Services (DFS) for new and renewing Small Group plans effective January 1, 2018.  Proposed rate changes have been submitted for groups with 100 or fewer full-time equivalent employees in New York.While the exact rates requested will vary by plan and region, they have requested rate increases ranging from -2.54% to 39.98%.

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Technology Upgrade at EmblemHealth - To better serve you and our members, EmblemHealth is upgrading our internal technology. This will affect HIP Small Groups/Members renewing between July 2017 and June 2018 and HIP Large Groups/Members renewing between August 2017 and July 2018. This upgrade will not affect GHI Large Groups/Members until 2018.

See exactly how this will impact you.This change starts with HIP Small Group July renewals.

  • Group numbers are changing to a 11-digit format
  • Member ID numbers are changing to a 11-digit alpha-numeric format
  • Emblem Health will be contracting ALL selling agents directly, which means Emblem will pay selling agents directly
  • Brokers will need to fill out new Emblem Health contracts, the target date is 6/17 for all contracts to be back in Emblem's office (Watch for new forms as soon as they are finalized).
  • All Brokers need to complete the new forms regardless of group’s renewal month.
  • Lock Box will be changing. Emblem will provide new information as soon as possible.
  • Old HIP/EH group and member ID numbers will be on the portal for 18 months.

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July 2017 Renewal Window is Now Open! The HealthPass Online Portal (HOP) is now open to accept July 2017 renewal applications!
 
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UnitedHealthcare Oxford Connecticut Rate Filings

Initial Notices to Mail May 4 to Impacted UnitedHealthcare and Oxford Customers Renewing in 2018  Following Connecticut Insurance Department guidelines, we are mailing notice of our rate filings on May 4, 2017 to our affected Connecticut commercial small group, fully insured customers with renewal dates in 2018.
 
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Effective immediately, Healthfirst will extend our small group new business deadline from the 15th to the 23rd of the month. Please note that Healthfirst only accepts 1st of month effective dates.
 

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The Ancillary Charge Program
Guiding you to lower-cost generic medication options, while preserving choice and access.The Ancillary Charge Program from UnitedHealthcare. Guiding you to lower-cost generic medication options, while preserving choice and access. The materials have been revised for NY.

"Upon your 2017 policy effective or renewal date, the ancillary charge will not apply toward your maximum out-of-pocket amount unless through our review process we determine that the lower-tier prescription drug is not medically appropriate for you."

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Empire Producer On Line News - Small Group Application and Binder Payment - Binder payments must be submitted before we can activate small group benefits coverage. Beginning with April 15, 2017 effective dates, if we don’t receive payment within 5 days of our receiving the completed group application, the case will not be processed, and group implementation may be delayed. Be sure to reach out to your FNA Representative to make sure you do not delay your client's application.
 
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An important Message from Oscar CEO Mario Schlosser:  We are excited to announce that we’ve removed participation requirements for Oscar for Business plans, effective immediately. This means that any employer can offer Oscar side-by-side with another carrier. We will accept even a single employee from a group, provided the group meets all of our other underwriting requirements. MORE