Small Group Health Insurance Options 2017 Long Island NY and New York City

October 20, 2016


Small group health insurance options operating in Long Island, the 5 boroughs of NYC, and Westchester counties of NY State for 2017

Often the most important part of a group’s decision to go with one insurance carrier over another is making sure the member’s doctors and hospitals are in the insurance company’s network. It is equally important to help control the costs of the benefits provided and to make sure the group meets the enrollment participation of each of the carriers. This easy to read summary helps you figure out if your doctors are participation in the listed plans, the size of the network, the participation requirements for the plan, and basic pricing structure compared to the competition.
Please review the information below and call us to discuss your individual situation. We would be glad to help you choose a new health plan for your business, or help service an existing plan for you.

United Healthcare/Oxford – (Freedom, METRO, and Liberty Networks) – Largest network option available of all carriers. Prices on the mid to high side. Options for plans with and without referrals. All plans require 60% enrolled after valid other coverage waivers. No other carrier can be written alongside Oxford.

When selecting plan, choose Freedom(largest), Liberty(medium), or Metro(smallest) network depending on plan you are choosing.

Aetna – Very large network carrier. Similar to 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)– Lowest priced group health option available.  Extremely robust Nassau, Queens, Brooklyn 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% loose participation that includes any 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 Freedom, Liberty, or METRO networks, or NSLIJ Care Connect search links under the respective carrier links above.

Emblem – Select Care network. Mid sized NYC centric network but does include Stony Brook hospital. Plans require a referral to see network specialist. Mid to high prices. Use VISITOR SEARCH by zip, the select PLAN OFFERED THRU MY EMPLOYER, then select 1-100 full time employees. This will default you into  SELECT CARE when choosing a network

Empire BCBS –3 Networks to choose from – Mid to high range pricing depending on plan. Has excellent and large PPO/EPO no referral NY and National network as well as lower priced but much smaller Pathway Network that requires referrals. Plans start in 2017 and after but might not recommend until they have been up and running and working out their problems for the first 6 months of 2017. Plans require 60% participation after valid other insurance waivers.

Empire BC BS Provider Directory Look-Up

Click ‘search by selecting a plan or network’ which is below the ‘search as guest’ and ‘continue’ buttons Choose ‘MEDICAL’ care and ‘New York’ and under the dropdowns by ‘Select a plan/network’ under MEDICAL (employer-sponsored)  use the following network depending on your plan:

PPO/EPO – for all EPO and PPO plans not listed as Priority Blue or Pathways

Priority Blue – for plans listed as ‘Priority Blue EPO’ using your selected metal tier

Pathways – for HMO plans listed as ‘Pathways’ using your selected metal tier