Oxford Updates New York Small Group Underwriting Guidelines

Oxford updates New York small group underwriting guidelines to meet DFS Guidance – We were advised of the following update from UHC Oxford regarding changes to their underwriting guidelines for new and renewing groups for coverage starting on 1/1/18.  These changes are being made to comply with DFS guidance as follows:

To qualify as a group eligible for coverage under Employee Retirement Income Security Act (ERISA), a group must have at least one common law employee who is both eligible for and enrolled in the coverage.  If no “employees” are covered by the plan, an employee benefit plan does not exist.

As a reminder, the following individuals are not eligible employees and if enrolled, do not satisfy this requirement:
a.    a person who does not meet the common law employee definition under Department of Labor and Internal Revenue Code rules.
b.    a former employee who is covered through retiree benefits, COBRA or state continuation;
c.    an employee who does not live, work or reside in the  United States;
d.    individual proprietors/owners and their spouses (“sole proprietors” or “partnerships”).

Sole props must have at least one other eligible employee that also enrolls.

The New York Department of Financial Services (DFS) also provided additional guidance surrounding the small group annual open enrollment period.  Here is the link to the DFS guidance: http://dfs.ny.gov/insurance/health/market-rules-guide.pdf

Please visit our New York Small Group health insurance page for the most up-to-date information and rates.