Small Group and Sole Proprietor Plans:
Changes for 2014
The Affordable Care Act (ACA) and New York State Law require that starting January 1, 2014, all health insurance plans include a core set of health services (known as essential health benefits) and more cost-sharing choices. While EmblemHealth's plans already offer many of these benefits, we will be replacing our current products with new, fully ACA-compliant plans.
As of January 1, 2014, EmblemHealth will offer new small group and individual plans that will meet the ACA requirements. These products will utilize our new Select Care network, which offers a broad-based fully integrated health services network throughout the New York metropolitan region. All Select Care network plans include AdvantageCare Physicians — one of the largest physician group practices in downstate New York. AdvantageCare Physicians offer:
- A full range of health services, from preventive and primary care to specialty care,
often in one location
- Quality specialists affiliated with most of the area's leading hospitals
- Extended evening and weekend hours available at most locations for routine medical care
- Urgent care centers at select locations
- Same-day appointments with primary care physicians, including pediatricians,
at select locations
- Access to more than 400 doctors and 2,300 staff members
For a full list of locations, check out www.advantagecarephysicians.com.
The small group Select Care plans that we will offer are some of the most competitively priced commissionable products in the market. These include our EmblemHealth HMO 40/60 (Gold) plan, our EmblemHealth HMO 35/55 (Silver) plan, and our EmblemHealth HMO HD6300 (Bronze) plan.
We also want to make the enrollment process seamless, so we'll be offering electronic enrollment via the broker portal for effective dates beginning January 1, 2014.
The small group Select Care plans will be available on our Web site shortly.
On December 31, 2013, all of EmblemHealth's current small group, sole proprietor and individual plans will be discontinued, and coverage under these plans will cease. Note, however, that ConsumerDirect high deductible health plans that have a deductible(s) that accrues on a basis other than a calendar year will be discontinued upon renewal in 2014. ConsumerDirect high deductible health plans that run on a calendar year basis or have a January 1 renewal date will be discontinued effective on December 31, 2013 along with our other community rated business.
Small groups, sole proprietors (who, under the ACA, must now purchase individual coverage) and individuals can purchase coverage from our new product portfolio as soon as it becomes available. They can also go to the New York Health Benefit Exchange at http://nystateofhealth.ny.gov.
Over the next week, we will be mailing letters announcing the discontinuance to affected small groups, small group subscribers and sole proprietors. This will provide ample time for your clients to consider their options in the marketplace.
Samples of discontinuance letters to be sent out on September 25 are provided below:
Samples of the discontinuance letters for GHI ConsumerDirect high deductible health plans that have a deductible that accrues on a basis other than a calendar year are provided below. These letters will be sent out on October 1. Recipients of either of these two letters should disregard the earlier discontinuance letter (one of the six above) that may have been sent to them:
We are in the process of finalizing communications about our new product portfolio, and we will send you more information in the coming weeks.
You may also check emblemhealth.com regularly for up-to-date information.
If you have questions about the plan discontinuance, please contact your EmblemHealth representative.
Please DO NOT respond to this message. If you have any questions about this communication, please speak with your Account Representative.