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New York News

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12/9/11 - For your reference please find the new 2012 Rx PDL's - Advantage and Traditional. Oxford Rx Advantage & Traditional PDL for 2012. 

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12/6/11 - Easy Choice (Formerly Atlantis) has released an updated hospital listing for your reference.

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12/6/11 - HealthPass was informed by Emblem that the 1Q rates for EPO+ 40-1000 was incorrect and has been updated.

11/10/11 NY Orders Insurerers to Give Refunds. Bloomberg News reported that "WellPoint Inc. (WLP), the largest U.S. insurer by enrollment, and Aetna Inc. (AET), the third biggest, are among 11 insurers ordered to refund money to almost 600,000 New Yorkers who were charged too much for health insurance. New York Governor Andrew M. Cuomo told the insurance companies they had to give back $114.5 million to policyholders because the carriers failed to spend the minimum 82 cents of each premium dollar on health care as required by the state, Cuomo said today in a statement. The mandate to spend a certain amount on medical care also is a federal requirement under the 2010 U.S. health overhaul law."

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11/8/11 - The LIA has shared the news that they have again partnered with Health Connect.

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11/2/11 - Atlantis has Renewed their commitment to being a quality health care provider. They have announced that Atlantis Health Plan has been rebranded as Easy Choice Health Plan of New York ("Easy Choice"). In the coming weeks, all members will receive new member ID cards with the Easy Choice Health Plan logo on it.   The website was pdated by Monday, November 7, 2011.

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11/2/11 - HealthPass has released a rate update concerning a rate error on the Comprehealth plan. This has caused them to relase new rate sheets.

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11/2/11 Oxford has released streamlined Rate Sheets for their Small Group Plans for ease of use.

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10/12/11 - HealthPass Announces New Ancillary Products For New and Renewing groups as of 12/1/11. HealthPass has two new dentalplans, Guardian VisionGuard and EverGuard Dual Option.

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10/31/11 - New Select Designated Pharmacy Program for Oxford New York Groups. As drug costs continue to rise, Oxford continues to strive to create innovative ways for members to maintain affordable access to a variety of medications. Their Select Designated Pharmacy Program, for example, focuses on providing members with access to lower cost alternatives to a select number of Tier 3 (high-cost) medications. This program will be implemented for Oxford commercial fully insured New York large groups (51+) on January 1, 2012. The program does not apply to Healthy NY plans and is optional for self-funded groups.

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10/27/11 - UnitedHealthcare/Oxford has released follow-up communications regarding New York rate filings. As previously communicated, they submitted rate applications with the New York State Insurance Department (NYSID) seeking rate increases for 2012. An initial notice was sent to all impacted policy and certificate holders at the time of the rate filing, as required by the New York state prior approval law. They are now sending the required second notice advising of the increases approved by the NYSID for customers renewing in 2012.

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9/26/11 - To meet the evolving business needs of today's marketplace, EmblemHealth will be streamlining its existing Consumer Direct EPO and PPO product portfolio. Selected Consumer Direct plans will be discontinued and replaced with ones that have a more relevant benefit design and cost-sharing structure. These changes will take affect at renewal* (for small groups/sole proprietors) beginning with January 2012 renewals and continuing through year end. The replacement coverage is comparable to Consumer Direct EPO and PPO benefits.

•    Samples of the communications we will send to affected group and sole proprietor customers.
•    Samples of the communications we will send to the affected members.

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9/26/11 -This is an exciting time for Cigna, and we want to share our news with you. Cigna is taking a bold step to become a decidedly different health care company –  unmatched in our commitment to help every individual make the most of their health...so they can get the most out of life.


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9/26/11 UnitedHealthcare has been notified that voicemails are being left for members by a caller claiming to be from Medco.  The voicemail is stating, “This is Medco, please call us back at 800-331-0835 and refer to this message”.

When members called the number on the voicemail the following occurred:
•    The person answering stated they were from Medco.
•    When the member questioned if there were issues on prescriptions/reason for the call, the person answering the call avoided these questions.
•    They instead offered to send the member a $100.00 gift card & $500.00 grocery gift card for a processing fee of $16.99 and asked for the member's credit card information.
Note: The number the member called to reach this call center is one number different from one of Medco's actual customer service numbers:

Actual Medco Customer Service – 800-311-0835
Fake Medco Customer Service – 800-331-0835

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9/22/11 - Effective July 24, 2011, a new law enacted in New York allows for same-sex couples to legally marry. The Marriage Equality Act provides that in the state of New York, marriage is a fundamental human right and, therefore, same-sex couples should have the same access as others to the protections, responsibilities, rights, obligations, and benefits of civil marriage. Marriages of same-sex and different-sex couples must be treated equally in all respects under the law. What does this mean for your New York policy clients? For health insurance coverage, this means if different-sex couples are covered under the plan, same-sex couples must also be covered as a subscriber and spouse—and their children as dependents.

The New York Department of Insurance already required carriers in New York to recognize same-sex marriages performed in jurisdictions that allow such. This new law makes New York one of those states and, therefore, same-sex marriage is a qualifying event under a New York policy. This applies to all fully insured, ASO – non ERISA, and individual plan members. ASO groups should consult their own legal counsel. UnitedHealthcare and Oxford commercial plans already are in compliance so there is no impact to our clients or their employees.

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9/21/11 - Yes, we know you have seen these plans before! We thought you should know about the 2 plans that have been our consistent top sellers since January 2011!

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9/16/11 Welcome to The Big Picture. The Big Picture reports for CIGNA® business enterprise-wide, so you may find that details in the “Latest News” updates may not always be relevant to your business or apply to all health plans.

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9/14/11 - Prescription Drug List Updates for January 2012  Effective January 1, 2012, the attached Prescription Drug List (PDL) and pharmacy benefit updates will take place on our Advantage and Traditional PDLs. (Click the link)Oxford Advantage PDL and Benefit Plan Updates Summary   Oxford Traditional PDL and Benefit Plan Updates Summary
Please review these summaries to determine which changes affect your clients. You may also access this information in the Broker Highlights section of our broker website at www.oxfordhealth.com.

9/14/11 - New Health Reform Videos Help Explain Provisions of the Bill View new videos on our United for Reform Resource Center explaining key provisions of the health care reform act including Preventive Care, Dependent Child Coverage to Age 26, FSA and HSA changes.

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8/10/11 - Notice to Tri-State Brokers: Pharmacy Benefit Mail Order Cost Correction. It was recently discovered that certain members were undercharged for their pharmacy mail-order benefit.
Please note that the error has been corrected and several documents have been sent out to the members. The three documents are as follows:  The official communication from UnitedHealthcare/Oxford, the member letter and the letter to the employers. Affected members will not be required to pay retroactive payments but they will be charged the correct amount the next time they use their pharmacy mail-order benefit.

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8/2/11- Important notice from UnitedHealthcare Regarding Commission Structure Changes for NY Sitused business.  Effective October 1, 2011, for new and renewing New York sitused business, United Healthcare will be making two important changes to their commission structure for the following group business:

New York Small Group (2-50 eligible employees) - The new standard commission structure will be 3.5% of the premium paid.
New York Large Group (51 or more eligible employees) - The new maximum commission will be 4% of the premium paid.

Be sure to review the Notice and the Letter for additional details and guidelines.


8/1/11 -  - Employee count is now required for some new business applications. Aetna will now need one more piece of information with their new business applications for smaller customers. They are asking employers for their average total employee count. We need this number to comply with the Medical Loss Ratio (MLR) requirements of the Accountable Care Act.


8/1/11 - Follow-up communications regarding New York rate filings. As previously communicated, we submitted rate applications with the New York State Insurance Department (NYSID) seeking rate increases for 2011. An initial notice was sent to all impacted policy and certificate holders at the time of the rate filing as required by the New York state prior approval law. We are now sending the required second notice advising of the increases approved by the NYSID for customers renewing in the fourth quarter of 2011.


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7/28/11 - Aetna Small Group Communications Broker Alert -  Improving Communications With New Small Group Clients. Effective with cases sold for 9/1/11, we will now collect and store plan sponsor email addresses from our employer application. The company email address is an existing field on the Aetna Small Group Employer Application. Please ensure that your clients include their email address when they are filling out the necessary information to purchase Aetna group health plans.