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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.

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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 Name County
Montefiore Hospital (Moses Campus) Bronx
Children’s Hospital at Montefiore Bronx
Garnet Health MedJack D. Weiler Hospital (Einstein Campus)ical Center Bronx
Montefiore Wakefield Hospital (Wakefield Campus) Bronx
Burke Rehabilitation Hospital Westchester
Montefiore Mount Vernon Hospital Westchester
Montefiore New Rochelle Hospital Westchester
Montefiore Nyack Hospital Rockland
Montefiore St Luke’s Cornwall Hospital Orange
White Plains Hospital Bronx
Montefiore Hutchinson Campus Bronx
Montefiore Medical Group Westchester
Montefiore Medical Specialists of Westchester Westchester

 

Neighboring Hospitals

Facility Name County
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. 

Update: Oxford/United and Montefiore Health Systems Still Split

Update: Oxford/United and Montefiore Health Systems Still Split

Recently, UHC/Oxford and Montefiore Health System had split effective January 1, 2021.  Since that time there have been state-required cooling-off period and ongoing talks on resolution but that has not yielded a positive outcome yet. 

According to Oxford, Montefiore patient claims are deemed as out-of-network. 

  • Montefiore’s physicians will be out-of-network for all employer-sponsored and individual plans, including Oxford, as well as our Medicaid plan, effective January 1, 2021.

  • Montefiore’s hospitals will be out-of-network for all self-insured commercial plans, effective January 1, 2021.

  • Our members enrolled in fully insured commercial plans as well as our Medicaid plan will continue to have in-network access to Montefiore’s hospitals until March 1, 2021.

Montefiore Hospitals & Health System

Facility Name County
Montefiore Hospital (Moses Campus) Bronx
Children’s Hospital at Montefiore Bronx
Garnet Health MedJack D. Weiler Hospital (Einstein Campus)ical Center Bronx
Montefiore Wakefield Hospital (Wakefield Campus) Bronx
Burke Rehabilitation Hospital Westchester
Montefiore Mount Vernon Hospital Westchester
Montefiore New Rochelle Hospital Westchester
Montefiore Nyack Hospital Rockland
Montefiore St Luke’s Cornwall Hospital Orange
White Plains Hospital Bronx
Montefiore Hutchinson Campus Bronx
Montefiore Medical Group Westchester
Montefiore Medical Specialists of Westchester Westchester

 

Neighboring Hospitals

Facility Name County
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

Both sides need each other as both are market leaders in their fields. It is our hope and most of our clients that they get this resolved soon. In the meantime, please bookmark our site for the latest updates.  And do reach out to us and learn the steps that you can take to smoothen this temporary roadblock.

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.

New York’s 2nd COVID Wave

New York’s 2nd COVID Wave

Over 30,000 New Yorkers died from coronavirus between March and May, prompting the Empire State to lay out some of the most intense restrictions and guidelines in the country. Since then, New York has managed to keep its positivity rate extremely low – less than one percent. Now, hospitalization rates are the highest they’ve been since June as the state reports a one-day total of 5,310 positive cases.

NY COVID Policy

New York has contained the virus by establishing yellow, orange and red restriction zones depending on how severe a COVID-19 outbreak is in a given area. For towns in the yellow zone, large gatherings are limited to 25 people, businesses and schools can remain open, and restaurants can only seat four people per table. In orange zones, large gatherings are limited to 10 people and certain “high-risk businesses” must close (such as gyms and hair salons). In red zones, large gatherings are prohibited, only essential businesses can remain open and restaurants must be takeout-only. In response to the uptick in cases, New York City Mayor Bill de Blasio made the decision to close in-person schooling until further notice. Policy implemented after the city’s deadly spring earlier this year requires schools to close if they reach a three-percent positivity rate across a seven-day average. “We must fight back the second wave of COVID-19,” the mayor tweeted.
 

Cuomo Reaction 

Governor Andrew Cuomo, who (perhaps prematurely) published a book on leadership lessons from the pandemic in October, got into a shouting match with reporters at a recent press conference. The exchange began when Wall Street Journal reporter Jimmy Vielkind pressed Cuomo about whether he would overrule any decision by city officials to close schools. Cuomo was also very blunt when speaking directly to New Yorkers, stating: “If you socially distanced and you wore a mask and you were smart, none of this would be a problem. It’s all self-imposed.” The announcements drew cynical statements from New York City officials, including the public advocate Jumaane Williams. “People are scared and stressed, and need plans and assurances,” he said. “Today, we have only executives governing by haphazard tweets and combative press conferences, from City Hall and the State Capitol to the White House.”
 

The Numbers 

At least 574,072 people have been reported to have COVID-19 in New York since the beginning of the pandemic. According to reports, 34,187 have died. One thing is certain: Governor Cuomo’s ominous message back in March was accurate. “We are your future. What happens to New York is going to wind up happening to California and Washington state and Illinois. It’s just a matter of time.” The country reported a total of 185,000 coronavirus cases in a single day Thursday, the highest since the pandemic began. Both Texas and California recently surpassed over 1 million confirmed cases while cases continue to surge throughout the Midwest.

 

Learn how our PEO Partnership can help your group please contact us at info@360peo.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 2021 Final Rates Approved    

NYS 2021 Final Rates Approved    

NYS has approved 2021 health insurance rate requests yesterday. Small group rates increase 4.2% and 1.8% for individuals.

  1. 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 2021 Rate Requests.  Despite only 3 months of mature claims data experience for 2020  health insurers’ original requests were noticeably below average.  Ultimately NYS reduced this request substantially by approximately 63%.

The 2021 small group rate increase was the second-lowest ever approved at 4.2% vs  2020’s approval of  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.

Rate Factors

The state noted that the premiums increase main driver are medications.  “The drug costs account for the largest share of medical expenses, followed by inpatient hospital costs, and outpatient hospital costs.”

More than one 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.

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.

Small-Group Market

Final Small Groupo Rates NYS 2021

Learn how a Private Exchange and our PEO Partnership can help your group please 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 custiomized quote please submit your contact. We will be in touch ASAP.