With the surprise announcement recently that NYSDFS ordered Health Republic Insurance of NY to cease writing new business and wind down their book of business in the state, we have been inundated with calls as to what alternatives there are for NYC, Nassau, and Suffolk County businesses and individuals.
Based on what has been reported so far, the only definitive date we have on terminations for Health Republic are for those on Individual plans only and not via a small business. These individuals will be losing their coverage as of 12/31/15. Small business groups for now will remain with full coverage until the carrier and NY State come up with a withdrawal plan. We are hoping that will be at the normal renewal date for the group to allow for an orderly change of plans.
So, what alternatives do you have? Below are the plans we recommend for the Individual Market and the Small Group Market. Please call us to discuss your individual needs and to get a quote. You can also visit our respective market websites for carrier provider search links as well.
Individual Carriers: Use this link to search the individual carriers we recommend and their respective provider networks:
Individual Carrier Search Link
Oscar – Comparable premiums and network to Health Republic. No referrals to see network specialists.
NSLIJ Care Connect – (aka Care Connect) – similar if not lower premiums vs Health Republic. Extremely robust Nassau, Queens, and Western Suffolk County network with new inroads in eastern Suffolk and Westchester counties. NO referrals to see network specialists.
Empire Blue Cross Blue Shield – Pathways Network. Slightly higher pricing vs HR. Has a good network in Nassau County, limited in Suffolk County and NYC. Requires a referral to see a network specialist.
United Healthcare (Compass Network) – available thru NY State of Health only. Higher premiums than other choices available. Large network with many choices of hospitals and doctors on Long Island and NYC. Requires a referral to see a network specialist. Utilizes United Healthcare COMPASS Network.
Oxford -(Liberty Network) – available Off Exchange only. Higher premiums than other choices available. Largest network available on Long Island and NYC. Requires a referral to see a network specialist. Utilizes the Oxford Healthcare LIBERTY Network.
Small Group Carriers: Use this link to search the small group carriers we recommend and their respective provider networks: Small Group Carrier Search link
United Healthcare/Oxford – (Freedom and Liberty Networks) – Largest network option available of all carriers. Higher priced than Health Republic. Options for plans with and without referrals. HMO plans have no participation requirements, all other plans require 60% enrolled after valid other coverage waivers. No other carrier can be written alongside Oxford, except when only the HMO is offered.
When selecting plan, choose Liberty or Freedom network.
Aetna – Very large network carrier. Higher priced than Health Republic…similar or slightly less than comparable Oxford plan rates. No referrals required. Require 60% enrolled after valid other coverage waivers. No other carrier can be written alongside Aetna.
When you are choosing a plan to find the doctor : 1) Aetna Open Access Plans… then 2) Elect Choice EPO (Open Access).
NSLIJ Care Connect (aka Care Connect)- similar if not lower premiums vs Health Republic. Extremely robust Nassau, Queens, and Western Suffolk County network with new inroads in eastern Suffolk and Westchester counties. NO referrals to see network specialists. NO participation requirements.
HealthPass – private exchange comprised of multiple plan options at all Metal Tiers for carriers Oxford and NSLIJ Care Connect under one roof. Requires 75% participation including other coverage waivers. Great for groups with diverse employee needs as only way to offer these carriers under one program and one bill. Also has optional Dental, Vision, and Life/LTD options and Free Cobra administration. For provider search use the Oxford Liberty or NSLIJ Care Connect search links under the respective carrier.
Empire BCBS –Pathways Network – Slightly higher pricing vs HR. Has a good network in Nassau County, limited in Suffolk County and NYC. Requires a referral to see a network specialist. In 2015 only had a Silver level plan option…not sure about Jan 2016 options yet.
When selecting a plan, choose NY, and then under Medical-Employer Sponsored choose Empire Essential Guided Access Plus (Pathway/Small Group).