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New York News

healthpass

The 1/1/2019 Oscar Special Open Enrollment (SOE) is now closed. SOE submissions received by the end of day yesterday (1/7/2019) have been processed.  To confirm that your SOE submission has been processed, please review the Employee Benefits Snapshot report on the HOP.

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emblemhealth2014

Brokers, Emblem would like to bring to your attention that some 2018 Small Group ID cards needed to be reissued due to incorrectly listing 2019 product names on the cards. Yesterday approximately 4,200 cards were reissued with a cover letter advising members to please use the new member ID card and discard the first one that went out. If members have any questions, they can call the Customer Service phone number on the back of their ID card. If you have any questions, please feel free to reach out to your Emblem Rep.

Cigna logo

As you may have heard, Express Scripts is now part of Cigna.  With combined medical, clinical, pharmacy, behavioral and wellness insights, they will deliver more connected, personalized and innovative solutions that advance whole person health and maximize the value of health care services.  Learn more about this partnership and how it will positively affect your clients below.

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OSCAR

Oscar is excited to share that they have extended their on-exchange payment deadline and your on-exchange members are still eligible for reinstatement until January 31, 2019. Also, if you want to learn more about member onboarding for Individual and Family plans join Oscar for a webinar that will cover what happens after your clients enroll. They'll walk through the online onboarding flow that your clients experience, including how to set up payments, as well as where to find client information within your Broker account. Click below for more details!

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UHC Oxford 

United Healthcare is pleased to announce that they have reached an agreement with CityMD.  Members may continue to use CityMD on an in-network basis, with no disruption in care. Below are sample letters for reference.

UHC Oxford Oxford has extended their 1/1/19 effective date to 1/7/19. This new business extension deadline is for Online NYSG ONLY  (submitted through IDEA).

Empire Anthem 

Empire wants to provide the good news that they have extended its cutoff for January 1st new business until December 31st.

emblemhealth2014

With the volume Emblem is experiencing with the new January small groups, they have extended their January submission date to January 4th, 2019. Please remember when submitting your new small groups via the portal, to make sure all of the necessary information and documentation is uploaded in order for your groups to be approved quickly.  Missing information or missing documentation only causes delays.

healthpass

Effective 1/1/2019 NEW Solstice Dental EPO S700B & Solstice Dental EPO S800B plans will replace our current Solstice EPO and Solstice EPO Value.  Click below to learn about the benefits and what's included in these rich plans.

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healthfirst

This is to remind you that Healthfirst has extended their small group new business deadline for January 1 effective date to January 7th, 2019.  Please click the link below for a chart and for further details.

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Cigna logo

On Dec. 14, 2018, U.S. District Judge Reed O’Connor issued a ruling that determined the Affordable Care Act (ACA) is unconstitutional because of last year’s change to the federal tax law that zeroed out the ACA’s individual mandate penalty.  Get the full report from Cigna below including what the ruling means for the ACA today.

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healthpass

HealthPass wants to remind brokers that the 11/1/2018 & 12/1/2018 Oscar members who wish to continue to access the Circle Plus network after 12/31/2018 can voluntarily select a new plan via the SOE. HealthPass will process SOE form submissions until 1/7/2019. To process your own Oscar SOE election(s), the SOE window is available 12/15/2018 through 1/7/2019. Click below to view the chart that illustrates available options and the impact on coverage.

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Aetna

In Aetna's international newsletter "Coverage", read about Aetna's International current affairs, news and thought-leading opinions from around the region and beyond.  This month's newsletter dicusses a recap from the annual Healthcare Revolution conference, a look at the challenges employers face with an increasingly mobile workforce, and more!

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United Healthcare

UnitedHealthcare is pleased to tell you that their Sweat Equity physical fitness reimbursement program is now available to UnitedHealthcare members enrolled in New York large group (101+) plans, beginning with members of plans that renew or become effective in December 2018.  Start the new year off right by getting paid to sweat!

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emblemhealth2014

Hi brokers!  Please see the attached letter being sent to Individual and Small Group members who will have a change of network upon 2019 renewal from Prime to Select Care. Please note members were already notified of this change in their renewal letters in October, so this will serve as a second reminder.  Please feel free to send to any of your Individual & Small Group members.

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UHC Oxford 2015

It has been uncovered that the Oxford Connecticut Small Group New Business Cover Letter in our online enrollment tool, IDEA, contains an incorrect email address for documentation submission. In order to advise impacted brokers and clients the attached blast will be going out to CT brokers and clients.  We truly apologize for the inconvenience and are working to have the email address corrected on the letter in IDEA. In the meantime, please note that the correct email address for new business documentation submissions is: oxfordnewbusinesssubmissions@uhc.com.

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emblemhealth2014

As the 2019 selling season gets underway, EmblemHealth wants to be sure you're fully equipped to present their plans to your clients. Emblem's small group plans fit the needs and budgets of small businesses. Each plan offers quality coverage with comprehensive benefits and network access. Click below for plan highlights and first quarter rate information on the various Emblem plans available. 

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Empire Anthem

More security measures are being added to Producer Toolbox.  Next time you log into the Producer Toolbox, a new two-factor authentication security process will prompt you to enter a one-time password.  Read about this and more in Empire's December newsletter.

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United Healthcare

Motion members can use their current Apple Watch, purchase a new one or choose to "Walk-it-Off" and pay in steps.  Read more about this great benefit offered through UnitedHealthcare and more in last  month's BrokerConnect newsletter.

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UHC Oxford 2015

We wanted to ensure that you were aware of the 12/15/2018 deadline to submit enrollments for New York Essential Plan members for an effective date of 1-1-19. As a reminder the New York Essential Plan offering is a gap product for individuals above the Medicaid threshold and below the ACA Bronze affordability threshold. It may be a great opportunity for clients with a large population of part time employees. This product allows qualified individuals to enroll if they earn between 138% and 200% of the federal poverty level. 


Please also note that it is commissionable to brokers at $15PEPM if you are appointed on the New York individual exchange. 

  • Premium either $20, or $0 (depending upon income)
  • Eligible for ages 19-64
  • Must be an NY resident
  • Part Timers, 1099’s, Hourly Employees are eligible if they fit income requirements
  • Dental and Vision rider available for additional premium
  • Not eligible for Medicaid or minimum essential coverage
  • $200 Gym reimbursement
  • Network is “Essential Plan Program” on provider search (mirrors our Medicaid network with the exception of no Stonybrook)

Below, please find the NY Essential Plan Proposal, Fact Sheet, & and an "At A Glance" look at the plan. For any questions please let us know.

UHC Oxford 2015

As a reminder, effective January 1, 2019 Oxford will be changing the pharmacy access for the Oxford Garden State Network to the OptumRx Value Pharmacy Network. This change is one more way we are seeking to provide more cost-effective solutions for New Jersey employers. To help manage costs, the OptumRx Value Pharmacy Network allows access to select pharmacies, including major chains like Walgreens, Rite-Aid®, and Walmart, as well as mass merchants and supermarkets. All new and existing Garden State Network members will have access to the OptumRx Value Pharmacy Network beginning January 1, 2019. 

Here is how to find a participating pharmacy:
Current or prospective Oxford Garden State Network members can search for a participating pharmacy on the oxfordhealth.com Member website:

  1. 1. Under Messages, select “Pharmacy Locations for Oxford Members.” 
  2. 2. On the next screen, select “OptumRx Value Pharmacy Network Search.” 
  3. 3. Complete the search criteria on the next page and select “Search.”

Below, please find the Oxford Broker eBulletin that fully explains this network update, the Oxford Garden State Network Pharmacy Options Flyer, Employer Letter and Member Letter

healthfirst

Effective immediately John T. Mather Memorial Hospital is now in-network with Healthfirst’s Commercial EPO plans, further supporting our expansion into Suffolk County. I have attached an updated network listing that shows this for your convenience. Click below for Healthfirst's Updated Small Group EPO Network flyer.

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Empire Anthem

Empire BlueCross BlueShield and NewYork-Presbyterian have agreed in principal on a new multiyear agreement. The agreement will allow Empire BlueCross BlueShield members who receive care at any NewYork-Presbyterian hospital, or from NewYork-Presbyterian Medical Groups, ColumbiaDoctors or Weill Cornell Medicine clinicians, to continue to be covered at the in-network level of benefits without disruption.  Please click below for the full update from Empire.

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