NY Paid Family Rate & Benefit 2023

NY Paid Family Rate & Benefit 2023

NY Paid Family Rate & Benefit 2023

The New York Department of Financial Services has released the 2023 PFL benefit and rates.

The PFL rate to .455% of taxable wages. The maximum an employee will contribute in 2023 will be: $399.43/year

The PFL maximum benefit will increase to:  67% of the average weekly wage to a maximum $1131.09/week. 

Duration remains the same at 12 weeks.

The Statewide Average Annual Wage cap increases to $87,785.88 ($1688.19 per week).

Learn more about how we are successfully helping navigate SMB for 20+ years. If you have any questions or would like additional information, please contact us at 855-667-4621 or info@medicalsolutionscorp.com.

For information about transparency providers and new tech tools contact us at info@medicalsolutionscorp.com or (855)667-4621.

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NYS 2023 Final Rates Approved

NYS 2023 Final Rates Approved

Yesterday, NYS Dept of Financial Services approved 2023 health insurance rate requests yesterday. Small group rates increased by 7.9% and  9.7% for individuals.

As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –2023 NY Small Group Carrier Rate Filings.  Despite only 3 months of mature claims data experience for 2022  health insurers’ original requests were noticeably above the average of 16.5%/individuals and 19% for small groups. For example, regulators last year approved average rate increases of 3.7% for individuals and 7.6% for small group plans. Over 1.1 million New Yorkers are enrolled in individual and small group plans impacted by the rate increases, the state agency noted.  

The recent COVID-19 surge irony reflected a lower cost utilization due to COVID-19. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% in recent years years. That said, in an anticipation of spikes in claims submissions + overall inflation, a larger than average increase is needed. This is in addition to increases in pricing by hospitals, consolidated IPA groups, and pharmaceuticals.

Rate Factors

The state noted that the premiums increase main drivers are medications.  “Rising medical costs and inflation continue to put upward pressure on premiums,” said Superintendent Harris. “With our rate actions announced today, we continue to prioritize the financial wellbeing of consumers while ensuring that New Yorkers have access to a robust, stable health insurance market.”  Also, DFS, recognizing the continued uncertainty of the pandemic’s effect on consumers’ health care costs and the economy, held insurers’ profit provisions to a historically low 0.5%. 

Health Insurers

Oxford/Unitedhealthcare, notably, got only a 6% rate increase approval for next year. This is a sharp reduction from the original 16.8% request in part by disagreed anticipated costs, held reserves, overall market pricing, and reinsurance gained from ACA’s Risk Corridor.  See more info here, https://www.medicalsolutionscorp.com/risk-adjustment-reinsurance-and-risk-corridors/.

Small Group Market   

Almost 850,000 New Yorkers are enrolled in small group plans, which cover employers with up to 100 employees. Insurers requested an average rate increase of 16.5% in the small group market, which DFS cut by 52% to 7.9% for 2023, saving small businesses $632.4 million. A number of small businesses also will be eligible for tax credits that may lower those premium costs even further, such as the Small Business Health Care Tax Credit.

DFS SMALL GROUP MARKET RATE ACTIONS   

NYS DFS Approval 2023 Health Insurance Rates

*Indicates the Company will offer products on NY State of Health Marketplace in 2023.

PEO Alternatives to Small Group

Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEO’s are large-group markets underwritten.  With the right PEO, you will be able to manage your business’s demand for growth and your employees as well.

Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

Learn how a PEO can make a difference for your group. For more information on how Employer-Sponsored Insurance and a PEO can make difference for your small business please contact us at info@medicalsolutionscorp.com or 855-667-4621.

 

 

 

 

Put You & Your Employees in Good Hands

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For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

2023 NY Small Group Carrier Rate Filings

2023 NY Small Group Carrier Rate Filings

Last month NYS received the rate filing requests below as per annual Dept of Financial Services requirements. Your insurer has mailed notices about their rate filings (requested rates) to impacted New York small business certificates and policyholders with renewal dates in 2023.

Below is a listing by carrier of requested rates for 2023 and a link to their sample notification letters.

Note: These are just the requested rate changes filed with the DFS and are not final.

Carrier

Requested Rate Change

Link to sample notices

Aetna30.60%Aetna Link
Emblem (HIP)19.00%Emblem Link
Empire BCBS17.60%Empire BCBS Link
Healthfirst15.00%Healthfirst Link
Oscar19.40%Pending
Oxford/UHC16.80%Oxford/UHC Link
Weighted Average19.73%N/A

Final approval is expected next month. Join our newsletter to stay updated on the latest news.

For more information on how Employer-Sponsored Insurance and a PEO can make difference for your small business please contact us at info@medicalsolutionscorp.com or 855-667-4621.

Summary

Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEO’s are large-group markets underwritten.  With the right PEO, you will be able to manage your businesses’ demand for growth and your employees as well.

Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

 

 

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

Healthfirst Plan Discontinuance

Healthfirst Plan Discontinuance

Select Gold EPO plans will no longer be offered

Heakthfirst Discontinuing Gold Plans

Starting immediately, Healthfirst will no longer market these Gold plans.

Discontinued Plans

-Gold Pro EPO
-Gold Pro Plus EPO
-Gold 25/50/0 Pro EPO
-Gold 25/50/0 Pro Plus EPO
-Gold 1350 Pro EPO

Effective Date

Starting 10/1/2022, groups renewing with one of these discontinued plans will be automatically mapped to the Platinum Pro EPO, or Platinum Pro Plus EPO.
Small-Group policyholders will receive notice 90 days in advance of renewal (July 1 for October 1 renewals)

We will continue to share additional communication tools as they become available from Healthfirst.

 Learn more about how we are successfully helping navigate SMB for 25+ years. If you have any questions or would like additional information, please contact us at 855-667-4621 or info@medicalsolutionscorp.com.

For information about transparency providers and new tech tools contact us at info@medicalsolutionscorp.com or (855)667-4621.

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

Montefiore and Oxford Reach Agreement

Montefiore and Oxford Reach Agreement

​Good news Bronx/Westchester.  Oxford and Montefiore Health System announced moments ago that they have reached an agreement effective December 1, 2021 for UnitedHealthcare and Oxford employer-sponsored plans, as well as UnitedHealthcare’s Medicare Dual Special Needs Plan.  

This resolves a split since Jan 1, 2021 which affected a significant percentage of local residents as both companies have a critical size of the market. Westchester and Bronx populations total nearly 2.5 million people. While this contract is resolved with titanic and a few Hospital Systems and Insurers left in the market we expect to see this trend to continue.

See below the official press release. 

 

UnitedHealthcare and Montefiore Health System Renew Relationship

UnitedHealthcare and Montefiore Health System have reached a multi-year agreement that restores access to Montefiore’s hospitals and physicians for people enrolled in UnitedHealthcare and Oxford employer-sponsored plans as well as UnitedHealthcare’s Medicare Dual Special Needs Plan, effective Dec. 1, 2021.

We recognize that the care Montefiore provides is not only important but also personal to our members and we also know the negotiations process may have been difficult for them. Our top priority throughout this process was ensuring the people and employers we’re honored to serve in New York have access to quality, more affordable health care, and this new agreement helps accomplish that goal.

We thank our members and customers for their support and patience throughout this process. We are honored to continue supporting the more than 3.7 million individuals across New York who depend on us for access to quality and affordable health care.

Montefiore Hospitals & Health System

Facility NameCounty
Montefiore Hospital (Moses Campus)Bronx
Children’s Hospital at MontefioreBronx
Garnet Health MedJack D. Weiler Hospital (Einstein Campus)ical CenterBronx
Montefiore Wakefield Hospital (Wakefield Campus)Bronx
Burke Rehabilitation HospitalWestchester
Montefiore Mount Vernon HospitalWestchester
Montefiore New Rochelle HospitalWestchester
Montefiore Nyack HospitalRockland
Montefiore St Luke’s Cornwall HospitalOrange
White Plains HospitalBronx
Montefiore Hutchinson CampusBronx
Montefiore Medical GroupWestchester
Montefiore Medical Specialists of WestchesterWestchester

 

Neighboring Hospitals

Facility NameCounty
Bon Secours Community Hospital
BronxCare Hospital Center
Garnet Health Medical Center
Good Samaritan Hospital of Suffern
New York Presbyterian Hudson Valley Hospital
New York Presbyterian Lawrence Hospital
NYC Health + Hospitals Jacobi
NYC Health + Hospitals Lincoln
NYC Health + Hospitals North Central Bronx
St. Anthony Community Hospital
St. Barnabas Hospital
St. John’s Riverside Hospital
Westchester Medical Center
Orange
Bronx
Orange
Rockland
Westchester
Westchester
Bronx
Bronx
Bronx
Orange
Bronx
Westchester
Westchester

Leading Health Insurers 

2021 Empire Blue Cross Blue Shield
2021 EmblemHealth 
2021 Healthfirst Plans
2021 New Oscar Circle Plus

 

Resources:

KeepMontefiore.Org

https://www.uhc.com/montefiore

For information about transparency providers and new tech tools contact us at info@medicalsolutionscorp.com or (855)667-4621.

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a customized quote please submit your contact. We will be in touch ASAP.

NYS 2022 Final Rates Approved

NYS 2022 Final Rates Approved

Yesterday, NYS has approved 2022 health insurance rate requests yesterday. Small group rates increase 7.6% and  3.7% for individuals.

As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2022 Rate Requests.  Despite only 3 months of mature claims data experience for 2021  health insurers’ original requests were noticeably below average.

The 2021 small group rate increase was the third-lowest ever approved at 4.2% vs. 2020s approval at 7.9%. This reflects a lower cost utilization due to COVID-19. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% last year in the individual market nationwide. The state Department of Financial Services said medical claims decreased significantly in 2020 due to the postponement of elective and non-emergency services, but medical claims have increased this year as New Yorkers catch up on medical appointments and postponed services.

Rate Factors

The state noted that the premiums increase main drivers are medications.  “The drug costs account for the largest share of medical expenses, followed by inpatient hospital costs, and outpatient hospital costs.” Drug costs account for the largest share of medical expenses (38.7%), followed by inpatient hospital costs (17.3%), primary care (8.1%), outpatient hospital costs (7.9%), and radiology (5.7%).

Nearly 1 million New Yorkers are enrolled in small group plans, which cover employers with 1 to 100 employees. Insurers requested an average rate increase of  11.4% in the small group market.  DFS cut the weighted average requested rate increases by 63% for 2020, saving small businesses over $565 million. About 264,000 New Yorkers are enrolled in individual plans.

Health Insurance Tax is Back

The HIT (Health Insurance Tax) is back. For Small businesses, this translates to an estimated 2.5%-3% added surcharge. For States like NYS where there is already approx. 16% added surcharge to high premiums, this becomes daunting.  It is no surprise the unpopular HIT was suspended. In 2017, payers escaped making $13.9 billion in payments due to the moratorium, according to a 2018 analysis by Oliver Wyman, commissioned by UnitedHealth Group.  This may have saved consumers billions on their insurance coverage.“The taxes on health insurance are non-deductible for federal tax purposes for health insurers,” the report explained.

Website Stop The Hit calculates $5,000 as the average tax for a 10-man small business for example. Calculates how the HIT affects your State and your business, here. Take action now: tell Congress to repeal the HIT! Join small business owners across the country in stopping the HIT. Sign the petition here.

 

NYS 2020 Final Rates Approved

Summary

Before you consider renewing automatically, you should first find out what is a PEO so that you can know exactly what to expect from it. PEO’s are large-group markets underwritten.  With the right PEO, you will be able to manage your businesses’ demand for growth and your employees as well.

Clients on average save 15-40% off the small group market. If you are looking for a complete insurance solution for your business, go to our website and check out our business insurance solutions. Contact us for more information today.

 

 

Put You & Your Employees in Good Hands

Get In Touch

For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP.