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What are Association Health Plans (AHPs)?
• Association Health Plans (AHPs), under the Department of Labor’s rule, are group health plans that associations will offer to provide health coverage for mostly sole proprietors, owner only groups, and individuals.
• AHPs allow these very small employers and individuals to band together to purchase the types of coverage that are available to small and large employers, which can be less expensive and better tailored to their needs vs current options.
• The rule allows more associations to form AHPs, based on common geography or industry.
• For the first time, working owners without other employees (including sole-proprietors) and their families will be permitted to join AHPs, creating a new path for these hardworking Americans to access affordable, quality health coverage. Currently, most partnerships, sole proprietors, and owner only businesses are forced into the Individual Health Insurance market, which limits their choice of carrier and provider network.

While the idea of association health plans (AHPs) is to give more flexible options to individuals and sole proprietors, there are many who counter that there was widespread fraud and insolvency when these types of plans were around in years past. While they promise to bring down cost, they will likely also remove some of the protections and coverage features required of current affordable care act policies, which could ultimately end up reducing their allure.

We believe that the ultimate beneficiary of these plans will be individuals, owner only businesses, and sole proprietors who are now stuck with quasi ‘expanded Medicaid’ plans that do not offer much doctor choice and severely limit the hospitals they can go to.

Small Businesses in NY are comprised of groups with 1-100 employees, and these businesses won’t likely benefit from these AHPs because they are already ‘pooled together’ with other businesses to get the lowest rates possible. It is the sole proprietors, businesses without a common law employee, and individuals who will benefit from more choice of plans and providers under AHPs.

Please check back often as we will be updating this page as we get new information. NY has sued to block this new Executive Order, so we are sure there will be many updates to come.

The post 2018 Association Health Plan Information appeared first on Peak Advisors, Inc..

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NY Department of Financial Services has released the requested 2019 Proposed NY Health Insurance Individual Rates for both small groups and individuals for plans renewing in 2019.

While these are not approved rates but just requests, it gives you a sense of where the carrier rates will be going in 2019.

You will notice that individual health insurance rates are expected to once again see a sharp increase in premiums. We also expect some of the other individual insurance carriers to exit the NY market.

INDIVIDUAL MARKET

Company Name 2019 Requested Rate Action
Oscar 25.2%

For more information on Individual Health insurance click here

 

 

The post 2019 Proposed NY Health Insurance Individual Rates appeared first on Peak Advisors, Inc..

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The proposed 2019 New York Small Group Health Insurance Rates were recently released, and we have compiled a list of several carriers for the small group market. Please note these are just the proposed rates and as soon as the NYS DFS finalizes the rates we will release an updated post.

Company Name 2019 Requested Rate Change
Aetna Life 16.2%
Emblem 12.0%
Empire Healthchoice Assurance 6.0%
EmpireHealthchoice HMO 5.2%
Healthfirst Health Plan, Inc. 21.0%
Healthfirst Insurance Company, Inc. 7.0%
Oscar 3.0%
Oxford Health Insurance Inc* 8.3%
Oxford Health Insurance Inc* 8.3%

Feel free to or call (631) 207-1800 for your own custom quote.You can get additional information about these carriers and their other plans on our website.

The post 2019 Proposed New York Small Group Health Insurance Rates appeared first on Peak Advisors, Inc..

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Here is an update to our blog originally posted April 20,2018. HealthFirst has updated their small group guidelines to be in line with most other carriers. HealthFirst will now require one common law employee enrolled for a group which has only 1 owner. They will allow for LLC, S and C corps with 2 or more owners to enroll only 1 owner if they are not husband and wife.

NY Small Group Health Insurance Owner Only Guidelines

Originally posted 4/20/2018
There are new updates to NY Small Group Health Insurance Owner Only Guidelines that might affect your ability to maintain small group health insurance for your business.

NY Department of Financial Services (DFS) has recently instructed health insurance carriers in NY State to abide by new guidance regarding the ongoing eligibility of OWNER ONLY enrolled health insurance groups. This guidance is being used to clarify what constitutes a small group under the Affordable Care Act (ACA) as well as the Employee Retirement Income Security Act (ERISA).

This new small group eligibility rule is to clarify that at least one common law employee must ENROLL into medical coverage in order to qualify for small group health insurance when the sole enrollee is the business owner. This aligns with the ERISA definition of employer sponsored group health insurance coverage and clarifies that a group may NOT consist of only a sole business owner.  To qualify for group health insurance, there must be at least one enrolling employee who meets the common law employee definition under federal rules. A common law employee is defined as someone OTHER THAN the Owner or the Owners Spouse.

If no “common law employees” are ENROLLED on the health plan other than the sole owner (100% shareholder), an employee benefit plan does not exist. The ‘owner’ or the ‘owner’s spouse’ of the business, whether paid via W2 or K1, do NOT qualify as employees under federal rules (although they can join the health plan as an employee IF there is a common law employee also enrolled or if 2 or more ‘owners’ who are not married enroll).

In essence, if your company does not qualify for an employee benefit plan, you will LOSE YOUR GROUP HEALTH COVERAGE upon renewal and be forced into the individual market where there are very limited carriers, higher premiums, and more volatility.

How does this affect you? – this new guidance is different than how insurance companies currently handle ‘owner only’ enrolled groups. Before, as long as there was a common law employee eligible, they did not have to enroll as long as the group met the participation guidelines (usually 60% after valid waivers). Now, a common law employee must enroll, and the group as a whole must meet participation, if the only enrolling person on the plan is the business owner.

How can you become compliant when only an owner(s) are enrolling on a group health plan? It depends on how your company is incorporated, how employees and owners are paid, and which insurance company you are enrolled with.

K1 only groups with 2 or more Owners on K1: This is a group with only owners paid on K1s, and no W2 employees.  These are NO LONGER ELIGIBLE for coverage under SOME carrier scenarios going forward. Notable exception is Emblem (this could change soon)…or with Oxford as long as there are 2 or more K1 owners, or with Oscar as long as 2 or more owners are ENROLLED.

K1 owner(100%) and W2 employee(s): These are NOT allowed going forward unless W2 employee ENROLLS under most scenarios, with Emblem as a noted exception. Must have at least one common law employee enrolled.

Partnerships/Sole Proprietors: No longer eligible unless a common law employee is enrolled. Partnerships file a Form K1 1065, and are treated as sole proprietors unless there is a common law employee ENROLLED.

S-Corp or C-Corp W-2 only groups: This is tricky, especially if only one member enrolling. These groups have owners listed on the NYS45. Rule is that group must have at least one common law employee enrolled, but there are some exceptions and workarounds. Emblem is notable exception.

There might be some workarounds if you don’t otherwise qualify under the guidelines above so call us to start the process of protecting your ability to stay in the small group market.

Please provide us with the following information if you want to call and discuss your specific company eligibility:
– Type of Business (S-Corp, C-Corp, LLC, LLP, Sole Proprietor)
– type of proof of employment available (NYS45, Sch C and NYS45, K1, etc)
– if you file K1s, how many owners are there in the business (needs to add up to 100% of outstanding shares)?
– Are owners listed on the NYS45, or only on the K1s?
– How many employees (including owners) are ENROLLED on the health plan?
– How many employees (including owners) have signed WAIVERS declining the health insurance?

 

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When shopping for health insurance, you might ask why should you use a health insurance broker. While you can certainly go it alone, the benefits of working with a professional health insurance broker are many.

You can use a broker’s services for free. Brokers make money through commissions that are already included in the cost of every health insurance plan, no matter where you buy it or whether a broker was involved. A health insurance plan never costs more because you use a broker. In fact, most states have filed rates that are fixed and non-negotiable, so if a broker can help advise you while you pay the same amount, you have nothing to lose and a lot to gain by using a broker.

An independent broker can help you compare plans and companies, help devise a strategy for covering different classes of employees, and advise on each carrier’s specific enrollment requirements to make sure you qualify for coverage. They will work with you throughout the year to maintain the policy in terms of assisting with new enrollments and terminations. They also help explain plan benefits to new and existing employees.

At renewal time, they will assist in reviewing the new plan rates and any benefit changes, and can review alternative carrier plans when/if rates change. They also assist when you get an audit or need to verify compliance which can be overwhelming for a business.

Some things to consider when looking for a broker:

– Do they have any professional credentials in this field? Commitment in the field shows knowledge and  experience.

– How long have they been in the business for? With time comes experience, and the more the broker has the better.

– Do they have happy customers? Testimonials are a good way to judge approval of a broker’s work.

Health Insurance Brokers are a no lose decision. Health insurance rates are non-negotiable for small groups, so having a trusted advisor in your corner that can assist in the day to day administration of your plan, help compare carriers and benefit options, and assist in enrolling new employees onto your plan all for no cost should certainly answer the question: Why should you use a health insurance broker!

James Eckardt, RHU is the President of Peak Advisors Inc. in Holtsville NY, and the opinions above are his own.  You should review your broker carefully and request references as needed.

The post Why should you use a health insurance broker? appeared first on Peak Advisors, Inc..

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There are new updates to NY Small Group Health Insurance Owner Only Guidelines that might affect your ability to maintain small group health insurance for your business.

NY Department of Financial Services (DFS) has recently instructed health insurance carriers in NY State to abide by new guidance regarding the ongoing eligibility of OWNER ONLY enrolled health insurance groups. This guidance is being used to clarify what constitutes a small group under the Affordable Care Act (ACA) as well as the Employee Retirement Income Security Act (ERISA).

This new small group eligibility rule is to clarify that at least one common law employee must ENROLL into medical coverage in order to qualify for small group health insurance when the sole enrollee is the business owner. This aligns with the ERISA definition of employer sponsored group health insurance coverage and clarifies that a group may NOT consist of only a sole business owner.  To qualify for group health insurance, there must be at least one enrolling employee who meets the common law employee definition under federal rules. A common law employee is defined as someone OTHER THAN the Owner or the Owners Spouse.

If no “common law employees” are ENROLLED on the health plan other than the sole owner (100% shareholder), an employee benefit plan does not exist. The ‘owner’ or the ‘owner’s spouse’ of the business, whether paid via W2 or K1, do NOT qualify as employees under federal rules (although they can join the health plan as an employee IF there is a common law employee also enrolled or if 2 or more ‘owners’ who are not married enroll).

In essence, if your company does not qualify for an employee benefit plan, you will LOSE YOUR GROUP HEALTH COVERAGE upon renewal and be forced into the individual market where there are very limited carriers, higher premiums, and more volatility.

How does this affect you? – this new guidance is different than how insurance companies currently handle ‘owner only’ enrolled groups. Before, as long as there was a common law employee eligible, they did not have to enroll as long as the group met the participation guidelines (usually 60% after valid waivers). Now, a common law employee must enroll, and the group as a whole must meet participation, if the only enrolling person on the plan is the business owner.

How can you become compliant when only an owner(s) are enrolling on a group health plan? It depends on how your company is incorporated, how employees and owners are paid, and which insurance company you are enrolled with.

K1 only groups with 2 or more Owners on K1: This is a group with only owners paid on K1s, and no W2 employees.  These are NO LONGER ELIGIBLE for coverage under SOME carrier scenarios going forward. Notable exceptions are HealthFirst and Emblem (this could change soon)…or with Oxford as long as there are 2 or more K1 owners, or with Oscar as long as 2 or more owners are ENROLLED.

K1 owner(100%) and W2 employee(s): These are NOT allowed going forward unless W2 employee ENROLLS under most scenarios, with HealthFirst and Emblem the noted exceptions. Must have at least one common law employee enrolled.

Partnerships/Sole Proprietors: No longer eligible unless a common law employee is enrolled. Partnerships file a Form K1 1065, and are treated as sole proprietors unless there is a common law employee ENROLLED.

S-Corp or C-Corp W-2 only groups: This is tricky, especially if only one member enrolling. These groups have owners listed on the NYS45. Rule is that group must have at least one common law employee enrolled, but there are some exceptions and workarounds. HealthFirst and Emblem are notable exceptions.

There might be some workarounds if you don’t otherwise qualify under the guidelines above so call us to start the process of protecting your ability to stay in the small group market.

Please provide us with the following information if you want to call and discuss your specific company eligibility:
– Type of Business (S-Corp, C-Corp, LLC, LLP, Sole Proprietor)
– type of proof of employment available (NYS45, Sch C and NYS45, K1, etc)
– if you file K1s, how many owners are there in the business (needs to add up to 100% of outstanding shares)?
– Are owners listed on the NYS45, or only on the K1s?
– How many employees (including owners) are ENROLLED on the health plan?
– How many employees (including owners) have signed WAIVERS declining the health insurance?

 

The post NY Small Group Health Insurance Owner Only Guidelines appeared first on Peak Advisors, Inc..

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Oxford small group health insurance alternatives CareConnect for groups in NY who are losing their coverage. In fact, you can find savings opportunities on many Oxford plans from United Healthcare, with their Oxford Metro Network plans among the most competitively priced small plans in the New York service area.

Benefits of Oxford:
Although there are lots of changes happening in the New York market, what has not changed is UnitedHealthcare’s commitment to New York thru their small group health offerings with Oxford.

3 plan networks available to small groups : Freedom, Liberty, and Metro. Flexible plan designs allow small groups to offer up to 3 plans side by side, from any combination of these three networks and across all Metal tiers. This allows groups to mix and match plans to appeal to many price points and give employee choice.

Lower-cost options thru Metro network :

  • Lowest-priced Oxford plans of all three networks available in the New York service area.
  • Access to over 29,000 physicians and 75 hospitals in New York, including: Hospital for Special Surgery, Long Island Health Network, Memorial Sloan Kettering Cancer Center, Montefiore Medical Center, Mount Sinai Health System, New York Presbyterian Health System, Westchester Medical Center.
  • Access to an additional 14,500 physicians and 62 hospitals in New Jersey.

Flexible plan designs :

  • Referral and non-referral plan designs to help employers better manage costs.
  • 46 plan options in total, including options with health savings account (HSA) and a variety of deductible and coinsurance amounts.
  • Ability to offer both top of the line network options alongside the most competitively priced small group plans in NY…all with the same carrier.

See if your doctor’s participate in Oxford – When selecting plan, choose Liberty, Metro or Freedom network depending on plan you are choosing.

Visit our Group Health Insurance page,   or call us TODAY at (631) 207-1800 to discuss how Oxford can help your small business provide a first in class benefit package that is affordable for both you and your employees.

The post Oxford Provides Small Group CareConnect Health Insurance Alternatives appeared first on Peak Advisors, Inc..

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The 2018 2Q New York Small Group Health Insurance Rates were recently released, and we have compiled a list of Gold plans across several carriers for the New York City and Long Island markets. Carriers include: Aetna, Emblem Health, Empire BC/BS, HealthFirst, Oscar, Oxford (Freedom, Liberty & Metro).

Click here to view the 2018 2Q SG Gold Rates for Long Island

Click here to view the 2018 2Q SG Gold Rates for NYC

You can get additional information about these carriers and their other plans on our website.

Feel free to or call (631) 207-1800 for your own custom quote.

The post 2018 2Q New York Small Group Health Insurance Rates appeared first on Peak Advisors, Inc..

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There are new updates to NY Small Group Health Insurance Owner Only Guidelines that might affect your ability to maintain small group health insurance for your business.

NY Department of Financial Services (DFS) has recently instructed health insurance carriers in NY State to abide by new guidance regarding the ongoing eligibility of OWNER ONLY enrolled health insurance groups. This guidance is being used to clarify what constitutes a small group under the Affordable Care Act (ACA) as well as the Employee Retirement Income Security Act (ERISA).

This new small group eligibility rule is to clarify that at least one common law employee must ENROLL into medical coverage in order to qualify for small group health insurance when the sole enrollee is the business owner. This aligns with the ERISA definition of employer sponsored group health insurance coverage and clarifies that a group may NOT consist of only a sole business owner.  To qualify for group health insurance, there must be at least one enrolling employee who meets the common law employee definition under federal rules. A common law employee is defined as someone OTHER THAN the Owner or the Owners Spouse.

If no “common law employees” are ENROLLED on the health plan other than the sole owner (100% shareholder), an employee benefit plan does not exist. The ‘owner’ or the ‘owner’s spouse’ of the business, whether paid via W2 or K1, do NOT qualify as employees under federal rules (although they can join the health plan as an employee IF there is a common law employee also enrolled or if 2 or more ‘owners’ who are not married enroll).

In essence, if your company does not qualify for an employee benefit plan, you will LOSE YOUR GROUP HEALTH COVERAGE upon renewal and be forced into the individual market where there are very limited carriers, higher premiums, and more volatility.

How does this affect you? – this new guidance is different than how insurance companies currently handle ‘owner only’ enrolled groups. Before, as long as there was a common law employee eligible, they did not have to enroll as long as the group met the participation guidelines (usually 60% after valid waivers). Now, a common law employee must enroll, and the group as a whole must meet participation, if the only enrolling person on the plan is the business owner.

How can you become compliant when only an owner(s) are enrolling on a group health plan? It depends on how your company is incorporated, how employees and owners are paid, and which insurance company you are enrolled with.

K1 only groups with 2 or more Owners on K1: This is a group with only owners paid on K1s, and no W2 employees.  These are NO LONGER ELIGIBLE for coverage under SOME carrier scenarios going forward. Notable exceptions are HealthFirst and Emblem (this could change soon)…or with Oxford as long as there are 2 or more K1 owners, or with Oscar as long as 2 or more owners are ENROLLED.

K1 owner(100%) and W2 employee(s): These are NOT allowed going forward unless W2 employee ENROLLS under most scenarios, with HealthFirst and Emblem the noted exceptions. Must have at least one common law employee enrolled.

Partnerships/Sole Proprietors: No longer eligible unless a common law employee is enrolled. Partnerships file a Form K1 1065, and are treated as sole proprietors unless there is a common law employee ENROLLED.

S-Corp or C-Corp W-2 only groups: This is tricky, especially if only one member enrolling. These groups have owners listed on the NYS45. Rule is that group must have at least one common law employee enrolled, but there are some exceptions and workarounds. HealthFirst and Emblem are notable exceptions.

There might be some workarounds if you don’t otherwise qualify under the guidelines above so call us to start the process of protecting your ability to stay in the small group market.

Please provide us with the following information if you want to call and discuss your specific company eligibility:
– Type of Business (S-Corp, C-Corp, LLC, LLP, Sole Proprietor)
– type of proof of employment available (NYS45, Sch C and NYS45, K1, etc)
– if you file K1s, how many owners are there in the business (needs to add up to 100% of outstanding shares)?
– Are owners listed on the NYS45, or only on the K1s?
– How many employees (including owners) are ENROLLED on the health plan?
– How many employees (including owners) have signed WAIVERS declining the health insurance?

 

The post NY Small Group Health Insurance Owner Only Guidelines appeared first on Peak Advisors, Inc..

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These are the Oscar best transition options for CareConnect small groups. This new piece lists all metal tiers and options to move your current CareConnect small group plan in NY to a comparable plan with Oscar.

CareConnect is currently winding down their small group plans upon renewal in 2018, and these groups are looking for comparable coverage with the remaining carriers. We represent all small group carriers in downstate NY and would be happy to assist your group in finding alternative coverage to CareConnect. Please check out the following links for more detailed information:
– here is link to download Oscar transition plans for all metal tiers for existing CareConnect groups
– here is link to our small group page which shows all available carriers in downstate NY including participation requirements, sample rate comparisons, and provider search options

Please feel free to or call (631) 207-1800 to discuss your small group health insurance options.

The post Oscar best transition options for CareConnect small groups appeared first on Peak Advisors, Inc..

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