Tag Archives: Oxford

Oxford Network Updates

oxford health plan with logo

Oxford, a subsidiary of United healthcare, continues to experience network growth in NY and NJ.  Here are the growth rates and raw numbers by network:

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Oxford pulling HMO and POS from NY Market

Beginning with January renewals, Oxford will no longer make the Oxford HMO and POS plans available.  the PPO and EPO plans will continue to be available.  This impacts a lot of groups, as the LIberty HMO was the “affordable” alternative for a company that wanted to keep Oxford.

The company also has indicated it is leaving the individual off-exchange market in NY as well.




Oxford Health Plans (NY), Inc. (OHP) License Withdrawal,
Effective January 1, 2017, Upon Renewal

We have conducted a review of our entire portfolio, which has led us to the decision to exit the commercial market on our Oxford Health Plans (NY), Inc. (OHP) license in 2017. This change will result in withdrawal of our individual and small group OHP New York HMO products and our large group OHP New York POS product. This change will occur on your clients’ 2017 renewal date, beginning January 1, 2017. Please work with your affected clients to ensure they have selected a new OHI group plan before their current coverage ends.

This change does not affect our Oxford Health Insurance, Inc. (OHI) plans. Our OHI portfolio in New York offers a wide range of coverage options for employers of all sizes.

Impacted groups and members will receive a notice from us approximately 180-days prior to their 2017 coverage end date. The notice will outline the actions they need to take and other available coverage options. Samples of the 180-day communications are enclosed. The first mail drop to January 2017 renewing groups, their members, and individual policy holders will be postmarked by July 1, 2016, with subsequent mailings issued monthly thereafter to renewing groups and their members through June 2017.

What this means for your clients

Are you being forced to use mail order?

We have been hearing some issues pop up on this so we wanted to send it back out again.  Members for NY Oxford groups (small and large) are not required to use Mail Order, they are being gently nudged to do so.   If they want to opt out they can either call the Oxford number on their card or log into the oxford website.  Here is the information from Oxford again:


We are extending the Mail Service Member SelectSM program to our Oxford fully insured commercial group members in New York, effective October 1, 2015. The program will be implemented with these members beginning on their group’s renewal date, on or after October 1, 2015. Mail Service Member Select is intended to help members better manage the medication they take on a regular basis through use of the OptumRx® Mail Service Pharmacy. Oxford New York self-funded clients are not affected at this time, although they may elect the program at renewal. Additionally, Mail Service Member Select is not available in New Jersey or Connecticut. 



  • Employers: In addition to the postcard mailing approximately 45-days prior to the affected customer’s renewal date with us, and Account Management email outreach, this information will be posted to the Messages section of the oxfordhealth.com Employer portal. The employer flier will be posted to the Tools & Resources section of the oxfordhealth.com Employer portal.
  • Members: Approximately 30-days prior to the affected group’s renewal date with us, we will inform members who are taking a maintenance medication about the Mail Service Member Select Program.



  • Broker eBulletin
  • Employer Postcard
  • Employer Flier

The program requires members to make a choice – switch to mail service or stay at retail pharmacy

∙       OptumRx will promote the value of Mail Service (Convenience, Safety, Potential Savings and Adherence)

∙       This is NOT mandatory mail and NO financial penalties for staying at retail


Members allowed to fill prescription twice at retail pharmacy while they decide

∙       Initial notification of program and value of mail service sent 30 days prior to effective date for existing customers

∙       Multiple communications with members instructing them to contact OptumRx

∙       At any time, members can move to mail or disenroll from program by either calling customer service or via the web


If member has not notified OptumRx by third fill of a prescription, the pharmacist will instruct member to contact OptumRx before the prescription can be filled

∙       Once member contacts OptumRx and chooses mail service or retail, the third fill prescription can be completed real-time

∙       If member switches to mail, OptumRx will provide a one-time 30 day fill to allow enough time until first OptumRx fill arrives in mail”

Oxford now enforcing drug card rules

As you may be aware, in 2014 Oxford small group NY and Conn went to a mandatory generic Rx card, which they called the “Ancillary charge program”.  If you wanted a name brand drug and there was a generic available you were supposed to pay the difference (the ancillary charge) in cost between the name brand and the generic, even if the doctor write DAW (dispense as written).  This was never properly adjudicated by Optum Rx, so members in some instances have been getting name brand drugs for the 3rd Tier copay instead of paying the difference in price between the name brand and the generic.

They have caught the error and are correcting it  now as of Jan 1st, 2016 to adjudicate scripts as they had set it up originally to do.  So now it’s more important than ever to make sure members discuss Rx options with their provider  so they are best prepared for this.  Oxford reports that “Impacted members received {a} letter in December of 2015 – outlining the drug(s) they are currently taking, that will be enforced as part of the program.



Stonybrook NOT in Oxford Metro

Despite assurances to the contrary, Oxford has now announced that Stonybrook University Medical Center will not participate in the Oxford Metro Network.  This announcement of course, comes far too late for everyone who had to choose their individual plan by 12/15….

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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