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New York News

Health Fitness Concepts RN, LLC (HFC) would like to reward Brokers for referrals. HFC has partnered with Oxford Health Plans to provide “Free” Flu shots for Oxford members along with free follow-up
wellness services with a 2-year flu commitment. Recommend Value-Add Wellness Services to your Employer Groups and Win! If you have ANY 20+ Oxford Groups that haven't booked their Fall Flu Event Call   Nikki Macaluso at 914-684-6064 Today!

We are finalizing our calendar for September/October Flu Events, dates and times are Limited!  Attached you will find Oxford Flu Promotion which includes Complimentary Wellness for your groups as well as Broker Reward Program that we just rolled out.

If you don't have time to call, email nikki@tryhfc.com the following and our Scheduler Amy Panko send you available dates for your clients:
1.    Company Name:
2.    Address:
3.    How many employees:
4.    Expected # of shots (typically 40% of total Employee # unless they have prior Flu shot History)
5.    If you want us to contact group directly, please include group contact & #


8/10/12 - UnitedHealthcare - Important Information regarding Contraceptive Coverage - UHC has sent a follow up. As a follow up to the letter you received, we are notifying you that the Patient Protection and Affordable Care Act, or "health care reform law," requires pharmacy benefit contraception coverage of FDA-approved contraceptive methods for women at 100 percent, without charging a copayment, coinsurance or deductible, when filled at a participating retail pharmacy or the mail order pharmacy. Coverage will begin for new and renewing groups on or after Aug. 1, 2012.


Oxford New York rate filings: Second notice to impacted groups, group subscribers and associations. With renewal dates in Q4 2012. As previously communicated, we submitted rate applications with the New York State Insurance Department of Financial Services (DFS) 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. We are now sending the required second notice advising of the increases approved by the DFS for impacted customers renewing in the fourth quarter 2012.


7/26/12 - MLR Rebates for Oxford Customers to Mail by Aug. 1. Review your online account for impact information. Your Oxford customers who are eligible for a Medical Loss Ratio (MLR) rebate will receive their rebate check by Aug. 1, 2012. You can access Oxford customer-specific MLR rebate details in your account on the broker portal of oxfordhealth.com. Log in and click "Federal MLR Rebate Detail" under the Check heading. You can also access this information from the Transactions tab. If you see the message, "There is no Federal MLR Rebate detail available for you," this means none of your customers are eligible for the 2011 rebate.


7/10/12  Watch Here! Vince Ashton – President & CEO of HealthPass New York – who appeared on Errol Louis’ segment Inside City Hall on New York 1 in response to the Supreme Court healthcare decision and the essential role brokers will play in a successful Health Benefits Exchange.

7/9/12 -   EmblemHealth COnsumerdirect EPO For Sole Proprietors— 3rd Quarter 2012 Rates Affordable Premiums, Great Network-Only Benefits, Plus Ta x Advantages. With its low premiums, this network-only highdeductible health plan helps you offset your overall costs with taxsaving Health Savings Accounts (HSAs).


7/2/12 -Notifying Policyholders About MLR Requirements and Rebates. The federal Affordable Care Act's Medical Loss Ratio (MLR) provision requires health insurers to spend most of the premiums they receive on medical care and activities that improve the quality of care. If the insurer's costs are lower than the minimum required to be spent on these services, the insurer will issue policyholders a rebate. This rebate will be based in part on whether the recipient is classified as a small or large group (as defined by the federal government) or as an individual (including sole proprietors). In addition, the MLR rebate issued depends upon the policyholder's specific plan.


HealthPass has released their HOT Plans sheet with "4 Plans Under $400!" Be sure to check it out.


4/25/12 - Oxford - A broker notice was sent out by Oxford, Wed., April 25, 2012, to New York brokers  who support the Oxford platform. Highlights from the Oxford Commuinication "We are updating our policy on termination for non-payment of premiums for New York employer groups with Oxford[1] products."The new policy is consistent with that of their other commercial plan designs and serves to streamline processes in order to provide clients with the most  consistent service and best service experience possible.

Beginning with payments due on or after June 1, 2012, employer groups with Oxford coverage will be terminated retroactively to the last paid date of coverage if no payment is received during the grace
period. Previously, Oxford employer groups would be terminated at the end of the 30-day grace period,  following their last paid premium.

Although this policy applies to all Oxford New York employer group clients, it primarily impacts  Oxford small group (2-to-50) clients. To advise small group clients of this change, they are mailing
them a notice by May 1, 2012, 30 days prior to implementing the change.

4/20/12 - LIAHA Small Group New Business Participation Requirements. With some of the current changes in carrier participation requirements, the LIAHAwould like to remind you that the LIA Health Alliance's
participation requirement for Small Group Health Insurance remains at 50% after waivers, with a minimum participation requirement of 2 enrollees. HMO's are excluded from this requirement. Their newly introduced Guardian Dental & Vision products require only one participating employee, as long as the employer group has 2 or more eligible employees. Our newly introduced Guardian Multi-Guard Protection Plans (Bundled Life & Disability) also require only one participating employee, as long as the employer group has 3 or more eligible employees. Please contact our marketing department at 631-493-3052 if you have any questions regarding participation requirements.


Changes to the EmblemHealth Small Group Formulary - Starting June 1, 2012, your small group clients with EmblemHealth-, GHI- and HIP-branded plans, including sole proprietors and GHI HMO groups, will have a new drug formulary (list of covered drugs). We made changes to the formulary to make sure that our members have access to the prescription drugs they need at the lowest possible cost. The changes were made after careful review of each drug's safety and effectiveness.


4/5/12 -  Effective Immediately ALL Emblem BOR’s MUST have a broker code or license number on the letters.


Reminder for New York brokers:
Aetna will require 60 percent participation for Small Group business.  This is to remind you that our new guideline requiring 60 percent participation for new and existing Small Group medical business (2-50 lives) in New York is effective May 1, 2012.

10 New Plan Options Available for HIP and Emblem Health effective 4/1/2012


•    Are you a small business or non-profit? 
•    Do you offer health insurance coverage to your employees?
If so, you may be eligible for a small business tax credit. Speak with your accountant today - after all, who doesn't need more money!

Looking for additional information on the tax credit?  Check out the HealthPass Small Business Tax Credit Toolkit - click here.

3/8/12 -  Easy Choice has released the HOT plans for the 2nd Quarter. Please keep in mind:  there are No participation requirements • No contribution requirements • 1099 Groups & Sole proprietors accepted  • $0 Co-pay at the affiliated AMG Medical Groups (1 in each Borough) • $0 Co-pay for mail order generic prescriptions through vendor Healthwarehouse • Over 43 Physician locations

3/9/12 - UHC Broker Update PDL and Pharmacy Benefit. Prescription Drug List and Pharmacy Benefit Updates for July 1, 2012. Note: This applies to customers who use UnitedHealthcare Pharmacy to manage their pharmacy benefits. Customers with Prescription Solutions pharmacy benefits should contact their UnitedHealthcare representative for more information.  Prescription Drug List (PDL) and benefit coverage updates will take place on our Advantage and Traditional PDLs on July 1, 2012


Waiver Forms required effective 3/15/12 for ALL products For groups that are selecting OHP products (HMO and POS) only, we will relax the requirements for paper copies or uploads of valid waiver forms. For future reference, please remember that valid waivers are defined as Spousal, Medicare, Medicaid and Veterans, and must be submitted.

Please note, all new business received for March 15, 2012 effective dates forward will need to use the updated applications and submit valid waivers for ALL products. Lastly, we will not be making any exceptions to the above, so please be sure to submit the proper documentation to avoid delays in obtaining approval. If you have questions about this information or the following Special Notice, please contact your Oxford sales representative.


3/13/12 - Broker Notice: Webinar on IDEA process changes impacting new Oxford small group submissions. A Special Broker Notice (Special Notice for Producers) was distributed March 9, 2012, at 5:30 PM, to New York and New Jersey brokers.

  • Highlights

To help brokers better understand changes that have been implemented recently in the Idea Management SystemSM (IDEA) tool and provide instruction to help ensure that their New York and New Jersey new small group application submissions are processed timely, we have scheduled a webinar for March 14, 2012.

A high volume of new Oxford small group applications are being pended since the implementation in February of enhancements to IDEA and other process changes to enforce underwriting guidelines, including minimum participation guidelines. The March 14 webinar will provide clarity, in addition to recent informational broker notices on this topic, and give brokers a forum for questions. The webinar will also be offered on March 21, 2012.


Tired of Leaving Money on the Table?

•    Are you a small business or non-profit? 
•    Do you offer health insurance coverage to your employees?
If so, you may be eligible for a small business tax credit. Looking for additional information on the tax credit?  Check out the HealthPass Small Business Tax Credit Toolkit

3/5/12  Oxford - Important Reminder. Please review these key steps to help ensure timely processing of new small group applications This notice is a follow-up to the one we sent on January 25, 2012 entitled "Changes for Groups Enrolling in Oxford Small Group Products." Due to the high volume of new group applications that are being pended, we are re-communicating key process steps to help ensure timely turnaround of your new group submissions. New York small group applications have changed. The updated versions are required for New York small group coverage requests. All previous versions of New York small group applications are no longer valid and will not be accepted. New submissions on outdated applications will be delayed until the correct application is submitted. To help ensure prompt review of applications for new group coverage, please submit your new group application through Idea Management SystemSM (IDEA), which will automatically generate a signed, correct New York small group application upon completion of the online process. If you do not upload all required forms, submit, AND authorize the application and other related documentation in IDEA, you must provide a complete, signed
paper application by mail to Oxford Enrollment Department, 14 Central Park Drive, Hooksett, NH 03106 along with any other required documentation that you did not upload
in IDEA. The updated New York small group applications are available in IDEA, at www.oxfordhealth.com, and are included below for your convenience.


3/5/12 - FNA Announces Partnership to Distribute Assura Group’s IncomeAssure Supplemental Unemployment Insurance Coverage to be Available Through  FNA’s New York and New Jersey Network

(New Hyde Park, LI.... March 1, 2012)  First National Administrators (FNA) has announced an agreement with Assura Group of NY, Ltd, for the marketing and distribution of one of the newest and most innovative products in the financial marketplace, IncomeAssure.  IncomeAssure enables policyholders to insure against loss of income if their job is lost. The policy provides substantial income in addition to regular unemployment insurance.

FNA, one of the largest general agencies in the northeast with more than 5,000 brokers in New York and New Jersey, and Assura Group, the New York City-based provider of IncomeAssure, have partnered together to give FNA brokers and their clients, access to this new and most timely product.  IncomeAssure is unique in the marketplace in that it provides executives the ability to purchase private unemployment insurance to hedge the risk of loss of a substantial income source should the policy holder be laid off or released.

“We believe that the IncomeAssure product is one of the brightest products in the marketplace today”, says Larry Lynch, president of FNA, “That it is serviced through the renowned Sterling & Sterling brokerage will help our 5,000 brokers reach the marketplace effectively and provide this most valuable product to their clients across New York and New Jersey. We look forward to this arrangement.”
“We are tremendously excited to be rolling out through FNA as their brokers are exactly the kind of professionals we can trust with our product,” stated Leslie Nylund, CEO of Assura Group. She continued, “One of the reasons we elected to work with FNA is that they truly understand the value that IncomeAssure brings to the client.  The FNA team understood that IncomeAssure offers not only financial protection, but also enables policyholders to have real peace of mind and less stress even while they are employed. And in the unfortunate event of a lay off, policyholders have the financial resources to live normally while looking for the right job.” 
Policy details:
IncomeAssure payments supplement state unemployment benefit payments that are received due to involuntary unemployment, so that the combined amount received from both state benefits and IncomeAssure is 50% of former pay. Benefits begin two weeks after state benefits start and continue for a maximum of 24 weeks.

What it costs:
Plans are tailored to individual situations, with a quick website quote giving the exact cost. To give an example, a policy for a person earning $90,000 a year working in the Financial Services industry in New York, would cost $21 a month. And since these premiums may well be tax deductible, the real cost could be far less.  Individuals should check with their accountants or other tax advisors as IncomeAssure premiums may be tax deductible.

How it works:
An IncomeAssure policy lasts for one year, and is usually renewable. If the policyholder becomes unemployed, IncomeAssure verifies the claim and then sends a check (or direct deposit) so that the policyholder receives a total of 50% of their former income for every week that he or she cannot find work and is receiving government benefits.  For full details, see IncomeAssure.com.

About First National Administrators (FNA)
First National Administrators (FNA) is comprised of a group of affiliated companies dedicated to providing brokers with one-stop shopping for a range of insurance needs including health, dental, vision, long-term care, disability insurance, a newly expanding life unit and more. First National Administrators also acts as a billing administrator processing enrollments, terminations and all aspects of administrative responsibilities for broker's clients. The Company has a number of subsidiaries, including Greater Metro Agency, a health insurance brokerage, Independent & Retail Business Associates (IRBA), a business association for small business owners, and Prestige Employee Administrators, Inc., a professional employer organization (PEO) to name a few.  The Company has offices in New Hyde Park, Long Island, Parsippany New Jersey, Las Vegas and Michigan.

About IncomeAssure and Assura Group of NY, Ltd.
Assura Group was founded in 2006 to address a critical unmet need in the market – private unemployment insurance.  Assura Group's unemployment insurance product, IncomeAssure, is currently available in 44 states and the District of Columbia, with remaining states pending approval. IncomeAssure is underwritten by Great American Insurance Company, a member of Great American Insurance Group and a subsidiary of American Financial Group, Inc. (AFG). Great American Insurance Company has maintained an “A” (Excellent) rating or higher from A.M. Best Company for over 100 years (rating affirmed as of February 14, 2011).
To learn more about IncomeAssure, visit IncomeAssure.com.


3/8/12 - Good news.  EmblemHealth will be reintroducing the $5,800 H.S.A. plan to the market for new sales. The plan has a $5,800 Single / $11,600 deductible and 100% coinsurance.  Rx covered at 100% once deductible is met. Rates are outlined below:

Rates for 3/15/12 are:

Single:  $291.37
Family: $844.97

4 Tier

Single:  $291.37
Ee/Ch:  $539.04
Ee/Sp:  $699.29
Family: $874.11

Rates for 2nd Quarter are:

2 Tier

Single:  $300.11
Family: $870.31

4 Tier

Single:  $300.11
Ee/Ch:  $555.20
Ee/Sp:  $720.27
Family: $900.32

Rates are on HealthConnect.


3/6/12 - You are cordially invited to
NYMAHU’s 1st Annual Convention
Thursday, March 29, 2012

At The Lighthouse at Pier 60 in New York City
Please click here to download the updated agenda.
Please click here to register.

If you’d like to be a sponsor or purchase a booth, please e-mail downstatenyahu@yahoo.com.
Thank you and we hope to see you there!