The New York Health Benefit Exchange

NY State of Health

What is the website for New York’s online health insurance marketplace?

On April 12, 2012, Governor Andrew Cuomo signed Executive Order 42, to establish a statewide Health Benefit Exchange. On August 20, 2013, the New York Health Benefit Exchange issued a press release, New York Health Benefit Exchange Announces New Name and Health and Dental Plans to be Offered, revealing the exchange name, NY State of Health and the insurers that will offer health and dental plans through the exchange. NY State of Health is the official state-based health insurance marketplace where consumers will be able to shop by comparing plans and enrolling in health insurance come October 1, 2013.

What is New York doing to ensure that there are a variety of exchange plan options?

New York has imposed state-specific requirements for QHPs. Those requirements include:

  • Insurers Must Offer:
    • 1 standard product, at every metal level, in every county of their service area that includes the Essential Health Benefits
    • A standard Child only product, at every metal level
    • A standard Catastrophic product
      • If there is more than one catastrophic product offered in a county, the Exchange may allow QHPs the option of not offering this product
    • Pediatric dental benefits, as a separately priced benefit for each standard and non-standard product proposed
      • If sufficient Stand-alone Dental products are available, QHPs may elect not to offer pediatric dental
  • Issuer May Elect to Offer:
    • Up to 2 non-standard plans, per metal level
      • Non-standard product means:
        • Additional benefits not included in the Essential Health Benefits
        • Standard product with a different provider network
        • Variations on standard cost sharing
      • Issuers may elect to offer Non-standard products in a portion of their Service Area

Will coverage and premiums be the same statewide?

While many insurance carriers are approved to offer plans through the online marketplace in New York, most will not be offering plans statewide and instead will only be offering plans in select regions. The 62 counties in the state of New York are divided into eight geographic rating areas. Health insurance costs vary by region and insurance companies can charge different premiums in each of the regions. Here is a look at the breakdown of rating areas in New York:

AREA NAME COUNTIES
1 Albany Albany, Rensselaer, Saratoga, Schenectady, Columbia, Fulton, Greene, Montgomery, Warren, Washington, Schoharie
2 Buffalo Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
3 Mid Hudson Delaware, Dutchess, Orange, Putnam, Sullivan, Ulster
4 New York Queens, Richmond, Rockland, New York, Kings, Bronx, Westchester
5 Rochester Livingston, Monroe, Ontario, Seneca, Wayne, Yates
6 Syracuse Onondaga, Broome, Chemung, Cortland, Schuyler, Tioga, Cayuga, Steuben, Tompkins
7 Utica Chenango, Clinton, Hamilton, Essex, Franklin, Herkimer, Jefferson, Lewis, Madison, Oneida, Oswego, Otsego, St. Lawrence
8 Long Island Nassau, Suffolk

Which insurers will be participating in NY State of Health?

On July 17, 2013, the Department of Financial Services announced that health insurance plan rates for 17 insurers seeking to offer coverage through New York’s Health Benefits Exchange had been approved, including eight new entrants into the market that do not currently offer commercial health insurance plans. Health plans will not have another opportunity to apply for participation in the Exchange until 2015 for Plan Year 2016.

Approved Medical plans:

Affinity Health Plan, Inc. will be offering individual plans in the Mid Hudson, New York, and Long Island regions.

American Progressive Life & Health Insurance Company of New York (Today’s Options of NY, Inc) will be offering individual plans in the Albany, Buffalo, Mid Hudson, Rochester, Syracuse, and Utica regions.

Capital District Physicians Health Plan, Inc. or CDPHP will be offering individual and small group plans in the Albany, Mid Hudson, Syracuse, and Utica regions. Exchange products include commercial PPO and HMO products. CDPHP will also offer high deductible and EPO plans.

Health Insurance Plan of Greater New York (HIP), administered by EmblemHealth will offer exchange plans including: Select Care Platinum, Gold, Silver (4 versions available), Bronze, and Basic (catastrophic plan for people under 30 years of age). HMO plans will use the Emblem Health Select Care Network with doctors available throughout Bronx, Kings, Manhattan, Nassau, Orange, Queens, Richmond, Rockland, Suffolk, and Westchester counties. HIP will also offer a pediatric dental plan, FirstSmiles, for children up to age 19 using the Healthplex dental network.            

Empire HMO (Blue Cross Blue Shield)/Empire HealthChoice HMO, Inc will be offering individual Empire Guided Access plans at the platinum, gold, silver, bronze, and catastrophic metal levels in the Albany, Mid Hudson, New York, Utica, and Long Island regions.

Excellus (Excellus Blue Cross Blue Shield in Central NY and Univera in Western NY) will be offering individual and small group exchange products in the Albany, Buffalo, Mid Hudson, Rochester, Syracuse, and Utica regions. Blue, Univera, and Basset EPO products will be available in different regions and consumers will have tiered network options.

Freelancers Health Service Corporation, dba Health Republic Insurance of New York (HRINY) is New York’s new Consumer Operated and Oriented Plan. The company will be offering statewide individual and small group exchange plans including: Primary Select at the platinum, gold, silver, and bronze metal levels; Primary Select EPO only at the silver level in Nassau, Queens, New York, Bronx, Westchester, Essex, and Hamilton; and EssentialCare is the standard New York plan, available at the platinum, gold, silver, bronze, and catastrophic metal levels. Plans will use the MagnaCareExtra network. With Freelancers, consumers have the opportunity to save up to 30 percent on popular complementary and alternative medicine services and fitness centers through a partnership with the Healthways WholeHealth Network.

Healthfirst New York will be offering individual HMO, Healthfirst Leaf Plans, including: Healthfirst Platinum, Gold, Silver, Bronze, and Green Leaf. Plans will be available in the New York and Long Island regions.

Healthnow New York, Inc. (Blue Shield of NENY; Blue Cross Blue Shield of Western NY) will be offering individual and small group products in the Albany, Buffalo, and Utica regions.

Independent Health, IHBC, will  be offering individual  and small group products in the Buffalo region.

Metro Plus Health Plan (Market Plus) will be offering individual and small group exchange products under the MarketPlus logo; product names will include: SilverPlus, MedPlus, GoldPlus, BronzePlus, and PlatinumPlus. Products will be available in the New York region.

MVP Health Plan will be offering 14 Individual and 23 small group HMO products in the Albany, Buffalo, Mid Hudson, New York, Rochester, Syracuse, and Utica regions. Products will be under the name MVP Premier with standard and non-standard options available.

New York Fidelis Care will be offering individual HMO products including: Fidelis Care Platinum, Gold, Silver (with variations), Bronze, and Catastrophic. Fidelis products will be available statewide.

Northshore LIJ will be offering individual and small group products in the New York and Long Island regions.

Oscar Insurance Corporation is a new entrant in the health insurance market. The start-up was co-founded by Joshua Kushner (Thrive Capital), Kevin Nazemi (formerly with Microsoft Healthcare division) and Mario Schlosser. Oscar was awarded a New York health insurance license in July and will be offering individual exchange products in the New York and Long Island regions.

United Healthcare of New York (United, Oxford) will be offering individual and small group products in the Mid Hudson, New York, and Long Island regions.

Aetna submitted plans to be offered in the New York Health Exchange and the company’s health insurance plan rates were approved by the DFS; however, Aetna withdrew from the New York health insurance marketplace. Aetna has also withdrawn from the exchange market in several other states including: Maryland, Ohio, Georgia, and Connecticut.

Approved Dental Plans:

Delta Dental Insurance Company

Dentcare 

Dentegra Insurance Company 

Emblem 

Empire BlueCross and Empire Blue Cross BlueShield

Guardian 

HealthNow New York, Inc. (Blue Shield of NENY; Blue Cross Blue Shield of Western NY)

Healthplex 

MetLife 

Solstice

New information is being released every day. Follow this blog to receive updates as new information is released in New York.

Jillian Carlile
Research Analyst & Health Exchange know-it-all
Strenuus
jcarlile@strenuus.com

About Strenuus

Strenuus® is the industry leader in delivering network competitive intelligence services. We are the largest collector of managed care data in the country. With a singular focus on the managed care industry, we provide services to support payors, brokers, consultants and healthcare IT companies. Whether you represent employer-based coverage, Medicare, Medicaid, dental, work comp or specialty networks, we have the data and insights you need.

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