HeathRepublic Contracts to End November 30!
- Saturday, 31 October 2015 07:47
As you are likely aware, Health Republic members were recently notified that their coverage would be ending on December 31, 2015. Beginning this evening, all 2015 Health Republic Individual Marketplace enrollees will be receiving a notice from the NY State of Health stating that their coverage with Health Republic will be ending on November 30th, 2015. Starting on Sunday November 1, 2015 the current Health Republic enrollees will be able to log into their Marketplace account and enroll in a new health plan effective December 1, 2015. They will not see the SEP screens and can go straight to the plans tab and select a new plan. Members must make their selection before November 16th in order to have coverage for the month of December.
To select a plan:
- Log in to your Marketplace account before November 16th and visit the “Plans” tab at the top of the screen.
- Select “Find a New Plan” at the bottom of the screen to see your health plan options.
- In the section on receiving assistance, be sure to add my NPN number 1982826
- Once you have chosen your plan, be sure to select “confirm and checkout” to confirm your enrollment in your new plan for December 1, 2015 coverage.
- There is a dedicated NY State of Health customer service helpline to assist consumers who need additional assistance: 1-855-329-8899
NY Presbyterian leaves Oscar Network
- Saturday, 31 October 2015 07:19
From Oscar 10/30/15:
We’re writing to let you know about an important change to our provider network. Effective December 1, 2015, NewYork-Presbyterian facilities and affiliated providers, including New York Methodist and Weill Cornell Medical Center, will no longer be part of the Oscar network.
We made this decision to support our goal of providing affordable plans while maintaining high quality care through our network of top New York hospitals. We will be contacting existing Oscar members who have received care from a NewYork-Presbyterian affiliated provider or facility to help them find care through this transition.
Should you have a question about a doctor’s network status, we encourage you to visit our doctor search or call us at 1-855-OSCAR-55.
CMS sending notices to Employers
- Thursday, 29 October 2015 10:15
Starting in the spring of 2016, the Health Insurance Marketplace (federally facilitated marketplace/FFM) will notify employers who have employees enrolled in Marketplace coverage and are receiving advanced premium tax credits (APTC). Employers will get notices if any employee received APTC for at least one month in 2016 and if the employee entered the employer’s address on his or her Marketplace application.
The notice will identify the specific employee and include a statement that the employee is enrolled in Marketplace coverage with APTC. The notices will not contain the employee’s personal health information or federal tax information.
These notices from the Marketplace are for information only. They do not determine if an employer has any liability under the employer shared responsibility provision. However, the IRS will independently determine if an employer has any such liability, regardless of whether the employer received a notice from the Marketplace or engaged in any appeals process.
An employer may appeal the Marketplace employer notice within 90 days of receiving it. The employer must assert that it provides access to affordable, minimum value coverage or that its employee is enrolled in employer coverage and is therefore ineligible for APTC. If the appeal is successful, the Marketplace will send a notice to the employee asking the employee to update his or her Marketplace application to reflect that he or she has access to or is enrolled in other coverage. The notice will also explain that failure to update the application may result in a tax liability.
For more information, please read the CMS FAQ.
PACE Act changes small group definition back to 50 or less, except in NY
- Wednesday, 21 October 2015 14:47
While almost every state in the country has opted to continue with the current rules – small group is 2-50 employees – New York’s Governor still refused to sign off on legislation. This means that – for the employer with 51-99 employees, you will be considered a large group at renewal time. This could work in your favor, or be to your detriment, depending on alot of factors. Group census, claims experience, and current rates all will play into decisions this coming year.