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Off-Cycle Plan Changes for New York Small Group (1-50) Employers

Story Content Provided by UnitedHealthcare on 11/1/13

The Department of Financial Services (DFS) posted a reminder to its website about early renewals that are not allowed. DFS is concerned that some small groups in New York may seek to renew health insurance coverage in 2013 that would otherwise not renew until 2014 in order to avoid the requirements of the Affordable Care Act (ACA) that take effect on Jan. 1, 2014.

The notice states that in accordance with New York State Insurance Law Sections 3221(s) and 4303 (nn), insurers and producers are not permitted to renew a small group policy which provides hospital, surgical or medical expense coverage that renews on or after Jan. 1, 2014 but before July 1, 2014, prior to the policy's annual renewal date, for the sole purpose of evading the requirements of the ACA and regulations promulgated thereunder.

To view the DFS reminder, please refer to the Department of Financial Services website.

In the New York small group (1-50) market, we only allow off-cycle renewals for certain employers enrolled in an Oxford product for buy-down purposes due to financial hardship. Small employers who request this type of off-cycle change are required to submit a Notice of Termination and Employer Certification form and a letter explaining the financial hardship. Please contact your sales representative to obtain a copy of this form. In general, we experience approximately 100 requests per year for this exception process. We have been monitoring requests for off-cycle changes since the law changed. If we see an unusual increase in requests for exceptions, we may be required to shut down this off-cycle plan change request process until after Jan. 1, 2014.

In addition, we will be monitoring groups that seek to terminate existing coverage and purchase similar or other coverage with us with no break in coverage. We will consider these requests as an off-cycle renewal request violating New York law. Small employers who request this type of off-cycle change must have at least a one month break in coverage to be considered new business eligible to purchase a new plan.

If you have a client that is requesting an off-cycle renewal, please contact your Oxford sales representative for details. Thank you for your continued support.