NY Office - 516-352-7000

NJ Office - 973-257-5558


New York News


UHC/Oxford Broker News Update Newsletter including
o    Updated Risk MGMT Website/Features
o    Oxford NJSG Updates
o    IDEA Group/Member Enrollment Reminder
o    Health and Fitness Concepts Updates
o    Saint Mary’s Hospital Participation Status Update
o    Oxford CTSG UW Updates
o    Ancillary Update
o    Heart Disease Risk Factors PDF


LIA HIP Small Group Discontinuance EmblemHealth recently sent out a Broker eNewsFlash regarding the discontinuance of certain HIP Small Group plans, effective January 1, 2013.   (Click here to view the Broker eNewsFlash on the EmblemHealth website.)  Some of your clients may have received letter already.


HealthPass 4th Quarter 2012 HIP Updates

New Business:
•    Effective 11/1/12: HIP EPOcs 30/50-1500 New is no longer offered
•    Additional portfolio options are being discussed


In Emblem's ongoing effort to streamline and simplify their product portfolio, EmblemHealth will be discontinuing certain HIP/HIPIC Small Group products effective January 1, 2013. They will replace them with plans that provide more contemporary benefit designs and cost-sharing arrangements. Existing HIP Prime® HMO, HIP Classic, and HIP Select® PPO plans will not be affected.  Alternative Coverage Offered.


UHC Broker Connection Grandfather Certification Form Deadline is Friday, Sept. 7, 2012. As a reminder, Grandfather Certification Forms are required for any 1-99 group policies that are in a grandfather position, and must be postmarked no later than Friday, Sept. 7, 2012.

Click here to find out your Required Action:


For groups concerned with costly hospital bills, HealthEssentials is an affordable plan that can give members peace of mind.

Key Features*
• A hospital-only plan that covers in-network services provided in and billed by
network hospitals or ambulatory surgical centers.
• In order for hospital-related doctors’ fees to be covered, the treating physician
must be employed by the hospital or facility and cannot bill the member separately
for their services.
• Preventive services are covered in full in network, in or out of a hospital

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.

3/9/12 - 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

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


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.