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Changes for NY Employers Renewing on or after 1/1/14

Story Content Provided by UnitedHealthcare on 10/21/13

As you know, many of the Affordable Care Act (ACA) provisions are being implemented on Jan. 1, 2014 and all New York small group (1-50) plans will change. In 2014, our products will include essential health benefits (EHB) and have different cost-sharing choices.

Changes to New York Small Group (1-50) Plans
Our current Oxford New York small group plan designs will no longer be available upon renewal, beginning with Jan. 1, 2014 effective dates through the end of 2014. We will automatically move these groups into new Affordable Care Act (ACA) compliant plans. Employers may choose to remain in their proposed ACA compliant plan or, if they prefer, may also choose any of the other Oxford plans we offer in the New York small group market. If no action is taken prior to renewal, these employers will be automatically renewed in the alternative plan described in their renewal packet and billed accordingly.

In addition to EHB and ACA required changes, we are making other modifications that may affect your New York small group (1-50) clients upon renewal:

  • Oxford USA: Employees with Oxford USA out-of-area coverage will be transitioned to an alternate Oxford Health Insurance, Inc. (OHI) Freedom Network option that will provide out-of-area coverage.

  • POS Plans: If you have an HMO-based plan with out-of-network coverage, we will be transitioning your coverage to an alternate Oxford Health Insurance, Inc. option product with out-of-network coverage.

  • Dental or Vision Rider: The dental and vision Riders that are available as part of the medical plan will no longer be available upon renewal. UnitedHealthcare offers many stand-alone specialty benefit options as well as pre-packaged specialty benefit options through Oxford Benefit Management (OBM).1

  • Biologically Based Mental Health and Pharmacy Benefits: These benefits are no longer optional Riders and are now part of the standard EHB medical package.

  • Healthy NY: All Healthy NY plans will end. Effective Jan. 1, 2014, small group employers will be moved to a new ACA compliant Gold standard plan with new rates. Small group employers will recertify on their current effective date and will receive updated rates at their next renewal.

Note: The gym reimbursement program was not impacted by EHB and we will continue to maintain the gym reimbursement program for New York clients enrolled in an Oxford product.

Groups will receive their renewal package 60 days in advance of their renewal date. The renewal package will provide a high level comparison of their current plan design and the new, ACA compliant plan design, and updated rate information. We will also include a flier that describes health reform impacts on benefits and coverage. In addition, employers will also be able to view their Summary of Benefits and Coverage (SBC)2 on Idea Management SystemSM (IDEA) 60 days prior to their renewal date, which will give further plan details. As part of our standard protocols, brokers will receive a copy of their New York small group clients' 60 day renewal letter(s).

We have enclosed copies of these materials for your reference.

2014 New York Small Group (1-50) Product Portfolio
In accordance with ACA, all of our 2014 New York small group plans will be identified by "metallic" benefit coverage levels: Bronze, Silver, Gold and Platinum. These designations indicate the relative value of the covered benefits, from Bronze (lowest) to Platinum (highest). All plans must meet standard requirements for affordability, essential health benefits and consumer protections. Each metallic level includes choices of benefits, plan types and price.

Enclosed, for your convenience, is the 2014 New York Oxford small group product portfolio broken out by metallic level. We have also developed a new marketing brochure for this segment to help you explain our portfolio to prospective small group (1-50) employers.

Changes to New York Fully-Insured Large Group (51+) Plans
Employers will see an impact on the health coverage they offer their employees as a result of some of the changes under ACA. As part of our large group renewal process, we will include a flier that discusses several of the provisions and health plan changes that have the greatest impact to employers.

Examples of these provisions include:

  • Expansion of benefits
  • Employer and individual mandates
  • Premium and rating changes
  • Overview of Taxes and Fees Affecting Employers
  • Reporting Requirements

In addition to EHB and ACA-required changes, we will be making other modifications that may affect your large group (51+) clients upon renewal.

Large group changes on the Oxford platform include:

  • Oxford USA: Employees with Oxford USA out-of-area coverage will be transitioned to an alternate Oxford Health Insurance, Inc. option that will provide out-of-area coverage, however we will continue to offer one Oxford USA option in the market.

  • Dental or Vision Rider: For groups that have the added dental or vision rider as part of their medical plan, these options will no longer be available upon renewal. Please note, your account representative will provide you with a quote for similar dental and vision plans through UnitedHealthcare Specialty Benefits.

  • Physical/Speech/Occupational Therapy Accumulation Change: Upon renewal, the benefit will change from a visit limit per condition/per lifetime to a combined visit maximum per calendar year.

  • Removal of Pediatric Dental Benefit: The current pediatric dental benefit for children less than 12 years of age will be removed from Oxford plans upon renewal.

  • Family Multiplier: Many of our current plan designs that have family multipliers of 2.5 or 3.0 will no longer be compliant with ACA deductible or maximum out-of-pocket amounts beginning Jan. 1, 2014. As a result, those options have been removed from our portfolio and we will only offer compliant plan designs with a family multiplier of 2.0.

Note: The gym reimbursement program was not impacted by EHB and we will continue to maintain the gym reimbursement program for New York clients enrolled in an Oxford product.

Large group changes on the UnitedHealthcare platform include:

  • Vision Exam: For groups that have an embedded vision exam as part of their medical plan, this option will no longer be available upon renewal. The Standard Vision Program (SVP) for material discounts will also no longer be included for renewal dates beginning Jan. 1, 2014. Account representatives will provide a quote for vision plans through UnitedHealthcare Specialty Benefits.

Be sure to check with your broker or UnitedHealthcare sales representative to find out about other options available for large group employers at renewal. We have enclosed copies of both the UnitedHealthcare and Oxford large group (51+) ACA renewal fliers for your reference.

For the latest information on health care reform, visit our Resource Center at uhc.com/reform. As always, we thank you for your continued support.

1 Oxford Benefit Management (OBM) packages are not available in all states and state-specific requirements may cause limitations or variations to the plans. Packaged Savings is not available for this product. OBM Benefit options may vary by group size. Components are subject to change. UnitedHealthcare Life and Disability products are provided by Unimerica Life Insurance Company of New York. In New York, the Life Insurance product is provided on Form LASD-POL-LIFE NY (05/03) and the Disability product on Form LASD-POL-ADD/DIS NY (05/03). Unimerica Life Insurance Company of New York is located in New York. UnitedHealthcare Dental plans are provided by or through UnitedHealthcare Insurance Company of New York, NY. The New York Select Managed Care Plan is underwritten by UnitedHealthcare Insurance Company of New York located in Islandia, New York. Administrative services provided by Dental Benefit Providers, Inc. UnitedHealthcare Vision® plans are provided by UnitedHealthcare Insurance Company of New York, NY. UnitedHealthcare Vision® benefits and administrative services are provided by or through Spectera, Inc. UnitedHealthcare Insurance Company of New York is located in New York, NY.

2 As of Sept. 23, 2012, the Affordable Care Act (ACA) requires all health plan issuers and group health plans to provide new and renewing groups and members a Summary of Benefits and Coverage (SBC) for their health benefit plan. This notification provides information regarding when and how SBCs will be made available to your clients and when your clients need to provide it to their employees. All assumed renewal plan SBCs are made available through Idea Management SystemSM (IDEA) and the Employer portal of oxfordhealth.com within 60 days of your client's renewal date. The information related to when your client must provide the SBCs to their employees is found directly on IDEA and the Employer portal. Your clients may request a paper copy by calling Client Services.