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New York News

EmpireBCBS

Starting April 1, 2018, Small Group brokers will have the ability to exchange health plan enrollment data through an Electronic Data Interchange (EDI). This new feature makes it possible for you to electronically process and administer enrollments, terminations and changes at an employee level using EDI.

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OSCAR

Oscar is excited to share that they have raised $165 million to deepen the investment in our technology platform and accelerate expansion. Oscar is grateful to have you as a partner during this exciting time of growth!

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emblemhealth2014

Emblem discovered an error on the benefit summary for Silver Value plan for small groups that was posted on HealthConnect.  It involved advanced radiology and if there was a deductible applied to this service.  Click the link below for further details.

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healthpass

HealthPass is introducing the AccidentGuard Adv Plan, effective June 1st, 2018.  This plan affords a level of financial protection to help cover out-of-pocket medical expenses related to an accident. 

 

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EmpireBCBS

Empire is extending the April 1st new-case submission deadline through this upcoming Monday (3/26) by COB. Also, this is a reminder that Empire now provides dedicated support to accounts with 20+ enrolling employees. Groups of this size will be provided an additional layer of service from our team.

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OSCAR

Oscar has extended their April 1st deadline to Thursday, April 5th for NY and NJ due to the holidays next weekend.

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healthfirst

Brokers, please be advised that the broker and employer portals will be down for scheduled maintenance from Friday, March 23 at 7:00p.m. to Tuesday, March 27. 

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OSCAR

Last week Oscar told you about how your clients can get the best value for their money by using their app. This week, they want to show you. Click the link below and show your clients how they can use their Oscar app to the fullest!

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healthfirst

Healthfirst wants to make it easy for your clients to find the right provider to fit their needs. That’s they are they are proud to offer access to more than 29,000 primary care providers (PCPs), pediatricians, and specialists throughout New York City and Long Island.  Click the link below to read more and download the most up-to-date Healthfirst Pro EPO & Pro Plus EPO plan network.

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healthpass

HealthPass has updated their correspondence for recertification audits. Going forward, the General Agent and Brokers will receive an email notification prior to each mailing.  The mailing will be in addition to the hard copy mailed to the General Agent, Broker, and gorup.  For more information on this recertification update, click the link below.

 

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EmpireBCBS

Beginning June 1, 2018, online is the Empire Small Group Standard for issuing bills and receiving payment. They will issue bills (invoices) online and accept premium payments online through Employer Access.

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United Healthcare

UnitedHealthcare has made a decision to implement Point of Sale Discounts for members enrolled in fully insured group health benefit plans as part of a broader enterprise effort to lead the industry in simplifying pharmacy benefits, expanding transparency, lowering drug costs for members, and improving the member experience.  

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healthpass

HealthPass wants Brokers to know that Healthfirst members have better than average employee benefits.  This includes Telemedicine, no-cost flu vaccines, accupuncture, and much more!

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UHC Oxford 2015

Oxford knows that dealing with a diagnosis of cancer can be overwhelming.  That's why they have created their Cancer Support Program for members with cancer and their caregivers so they can get cancer information, support and guidance in navigating the health care system. Brokers, remind your clients of this great program to help them get through this challenging time in their lives. 

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healthfirst

With the Healthfirst Pro EPO and Healthfirst Pro Plus EPO plans, your clients have access to $0 copays for recommended in-network preventive care services, such as annual checkups and vaccinations, as well as coverage for the 10 Essential Health Benefits below:

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OSCAR

 When your clients invest in an Oscar plan, make sure that they’re getting the best value for their money by downloading the Oscar app - a single place for everything they need.

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healthpass

Effective March 1st, 2018, HealthPass made some updates to their eligibility guidelines. These updates affect eligibility guidelines for sole proprietorships & partnerships and new hires.

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OSCAR

Oscar knows switching health carriers can be stressful for your clients.  That is why they have prepared this Q2 plan-mapping sheet to help you guide your CareConnect clients to find plans that best fit their needs.

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Aetna

Aetna has made some changes to their 2018 New York Employer Certification/Verification Form.  New York defines “small employer” as a group with 100 or fewer full-time equivalent employees. In order to obtain a 2018 Small Employer Health Benefits Plan, plan sponsors must certify their status as a small employer on Aetna’s Employer Verification Form EVF to obtain new or renewing small group coverage with Aetna.

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United Healthcare

You're invited! Join United Healthcare on Monday, March 5th for their Winter Specialty Webinar.  Learn about what's new for 2018, New York product overview, and much more.  Click the link below to learn more and register for the webinar.

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United Healthcare

 UHC has released their February Newsletter with important updates, news about webinars and refreshers that include the recently released UW Guidelines. Please be sure to review the February Newsletter.

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healthpass

HealthPass has announced that the renewal window for March groups will close on 2/20/2018.  March renewal applications submitted after this date will require a manual process to re-open the window and may subject the entire gorup to delays of up to 2-3 business days from receipt.

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OSCAR

As a reminder, Oscar is introducing a 51% small group participation requirement for all New york groups effectuating on and after March 1, 2018.  Oscar would also like to  share with you a one-pager that you can take use you to better educate our clients about Oscar's footprint, projected revenue in 2018, and more!

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UHC Oxford 2015

**Important Broker Alert**

UPDATES to Oxford’s Underwriting Guidelines to meet DFS Guidance - We received the following up updates from UHC Oxford regarding changes to the underwriting guidelines for new and renewing groups for coverage starting on 1/1/18.  We have posted them to our website for you to review.  The most important details in order to comply with DFS guidance are as follows:

UHC has recently updated their 2018 underwriting guidelines for new and renewing groups for coverage starting on 1/1/2018 they are available from the link below  for your reference.  Below you will find detail on the items that have been updated in order to comply with DFS guidance.

To qualify as a group eligible for coverage under Employee Retirement Income Security Act (ERISA), a group must have at least one common law employee who is both eligible for and enrolled in the coverage.  If no "employees" are covered by the plan, an employee benefit plan does not exist.

As a reminder, the following individuals are not eligible employees and if enrolled, do not satisfy this requirement:
a.    a person who does not meet the common law employee definition under Department of Labor and Internal Revenue Code rules.
b.    a former employee who is covered through retiree benefits, COBRA or state continuation;
c.    an employee who does not live, work or reside in the  United States;
d.    individual proprietors/owners and their spouses (“sole proprietors” or “partnerships”).  

Sole props must have at least one other eligible employee that also enrolls.

The New York Department of Financial Services (DFS) also provided additional guidance surrounding the small group annual open enrollment period.  A link to the DFS guidance is included below:

http://dfs.ny.gov/insurance/health/market-rules-guide.pdf

NOTE that The IDEA portal will be updated to reflect this guidelines in the near future.

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