Category Archives: Uncategorized

New York releases Paid Family Leave Claim Forms

New York State has released generic claim forms for the Paid Family Leave Act.  There are different claim forms for bonding, care-giving, and military.  Call your DBL carrier or our office with any questions.

 

Download Generic PFL claim forms from the State of New York here:

PFL Claim Form  – Bonding

PFL Claim Form – Providing Care

PFL Claim Form – Military Exigencies

CVS Agrees To Buy Health Insurance Giant Aetna

The pharmacy chain CVS Health has agreed to buy Aetna in a $69 billion deal that could transform the health care industry. If the deal, which was announced by the two companies on Sunday, is approved by regulators, it would bring a large health insurance company and pharmacy provider under one umbrella.

The agreement is expected to close in the second half of 2018. The terms of the merger agreement were approved by the board of directors of both companies on Sunday.

“This transaction fills an unmet need in the current health care system and presents a unique opportunity to redefine access to high-quality care in lower cost, local settings whether in the community, at home, or through digital tools,” the two companies said in a joint announcement.

In the statement, the companies said they will become a trusted community partner who will help consumers better manage the cost of the health care they need.

As part of the deal, CVS plans to use its pharmacy locations to provide consumers with “community health-hubs” where patients can get answers to questions about their health, prescription drugs and health coverage. Pharmacy locations will also includes space for wellness, clinical and pharmacy services, vision, hearing, nutrition, beauty, and medical equipment.

The two companies touted the merger as a better opportunity to utilize local care solutions by connecting Aetna with greater consumer access through CVS’ 9,700 pharmacies and 1,100 MinuteClinic walk-in clinics. By connecting patients with community health-hubs, the companies say it will help them reduce hospital readmission costs as patients can stop at these local facilities to assess their needs.

Several news reports on the deal note that a big driving factor in the acquisition is potential competition from Amazon as it seeks to enter the pharmacy market. Corporations from all industries are dealing with the threat of Amazon and most recently the e-commerce giant entered the grocery business with its acquisition of Whole Foods.

Oxford expands the Garden State Network

We’re pleased to announce that we will be expanding the Oxford Garden State Network to include access to physicians and hospitals that participate with the Oxford Metro NetworkSM in New York.

Timing.

New and existing Garden State Network members will be able to receive in-network care from Metro Network physicians on Jan. 1, 2018.

More than double the provider access.

The Garden State Network offers easy, no-tiered access to more than 22,000 doctors and 62 hospitals throughout New Jersey. Enhancing the Garden State Network with the Metro Network allows members to receive care from an additional 28,000 physicians and 76 hospitals in the Oxford New York service area.

How to find a participating provider.

To help provide easier access to available New York doctors and hospitals, current or prospective Garden State Network members can find a participating New York physician or hospital within the Garden State Network online search tool. The steps to locate a provider are below.

  1. Go to oxfordhealth.com and select “Members.”
  2. Under Links and Tools, select “Find a Physician or Facility.”
  3. On the next screen, select “Garden State.”
  4. Enter the search location.
  5. Complete the search criteria on the next page and select “Search.” Or, use the supplied categories to narrow the search.

$200,000 to sign up on person on ObamaCare

From CNBC 11/22/17.  For the full article click here.

 

A group that is supposed to help Native Americans sign up for Affordable Care Act coverage in South Dakota received $200,000 in federal funds to support its efforts — and managed to sign up just one person in an Obamacare plan, the Trump administration said Wednesday.

The group, the Great Plains Tribal Chairmen’s Health Board, had better luck in North Dakota — where it assisted 67 people in shopping for and enrolling in an Obamacare plan that went into effect in 2017.

But in that state, the board received another $154,000 in federal cash for its efforts.

That works out to nearly $2,300 per enrollee in North Dakota.

—–

COMMENTARY:  Compare this to the fact that I get $14 a month for renewing someone in South Carolina, and only 1 carrier in New York even pays commissions for our work.  Where do I sign up for this deal?!? – Reeve

NYU Participants File Second Excessive Fee Complaint

From Plan Sponsor Compliance Section 11/20/17.  For the full article, click here.

 

Participants in the New York University and related plans are making a second attempt to sue fiduciaries for excessive fees.

After a federal district court judge found most claims in an earlier complaint were not plausibly alleged by the plaintiffs, they filed a second complaint in the U.S. District Court for the Southern District of New York. This case was filed against NYU Langone Hospitals, NYU Langone Health Systems, the retirement plan committee, and several named defendants.

As with the first case, which included the university’s Faculty Plan, the participants allege that instead of using the plans’ bargaining power to reduce expenses and exercising independent judgment to determine what investments to include in the plans, the defendants squandered that leverage by allowing the plans’ conflicted third-party service providers—TIAA-CREF and Vanguard—to dictate the plans’ investment lineup, to link its recordkeeping services to the placement of investment products in the plans, and to collect unlimited asset-based compensation from their own proprietary products.

In the new complaint, the plaintiffs attempted to offer more evidence that their claims were plausible.

For example, previously, U.S. District Judge Katherine B. Forrest dismissed all of the plaintiffs’ loyalty claims, finding that the plaintiffs failed to plead sufficient facts to support the loyalty-based claims. “A plaintiff does not adequately plead a claim simply by making a conclusory assertion that a defendant failed to act ‘or the exclusive purpose of’ providing benefits to participants and defraying reasonable administration expenses; instead, to implicate the concept of ‘loyalty,’ a plaintiff must allege plausible facts supporting an inference that the defendant acted for the purpose of providing benefits to itself or someone else,” she wrote in her opinion.

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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