Empire Strikes Back 2017 Plans. Empire recently announced their re-entry back into the New York small group market for 2017. A legendary broad networked PPO is welcome news especially in the NY small group market of 1-100 employees. Recently, the broad national networks have diminished to only 2 national health insurers, Aetna and Oxford. As a result of Empire Blue Cross participation in the BlueCard PPO program members enjoy unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of 28 plans below.
PPO/EPO Network – traditional non-gatekeeper large network of approximately 85,384 physicians, 160 facilities and the BlueCard PPO
Blue Priority Network – hybrid of broad PPO/EPO 160 facilities and similar Pathway’s 65,796 physicians network.
Pathway Network – HMO value based narrower gatekeeper referral network of 109 facilities and 60,535 physicians. Limited to 28 NYS Counties.
Additional Features:
Telemedicine will be available on all products
Vision – Limited adult vision will be available on all products at no additional cost.
Pharmacy – All plans use their large BCBS formulary Except the HMOs, and the Silver and Bronze Blue Priority Plans. They will be utilizing what they call the Select Formulary.
Clinical Programs – health coaching/advocacy, disease management, behavioral health, maternity and Gaps in Care
Online Resources – wellness coaching, discounts, health assessments and The Weight Center.
Healthy Support – Wellness program offers easy ways to earn up to $900 per member, per year. Gym Reimbursement $400 single/$600 couple, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150 and $50 Tobacco-free certification online.
Ask us about Empire’s flexible low participation voluntary group dental, vision, disability and life insurance plans. Stay proactive and contact us today for a customized consult on how your organization can prepare ahead for ACA, Benefits, Payroll and HR @ (855) 667-4621 or info@medicalsolutionscorp.com.
Empire recently announced their re-entry back into the New York small group market for 2017. A legendary broad networked PPO is welcome news especially in the NY small group market of 1-100 employees. Recently, the broad national networks have diminished to only 2 national health insurers, Aetna and Oxford. As a result of Empire Blue Cross participation in the BlueCard PPO program members enjoy unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of 28 plans below.
PPO/EPO Network – traditional non-gatekeeper large network of approximately 85,384 physicians, 160 facilities and the BlueCard PPO
Blue Priority Network – hybrid of broad PPO/EPO 160 facilities and similar Pathway’s 65,796 physicians network.
Pathway Network – HMO value based narrower gatekeeper referral network of 109 facilities and 60,535 physicians. Limited to 28 NYS Counties.
Additional Features:
Telemedicine will be available on all products
Vision – Limited adult vision will be available on all products at no additional cost.
Pharmacy – All plans use their large BCBS formulary Except the HMOs, and the Silver and Bronze Blue Priority Plans. They will be utilizing what they call the Select Formulary.
Clinical Programs – health coaching/advocacy, disease management, behavioral health, maternity and Gaps in Care
Online Resources – wellness coaching, discounts, health assessments and The Weight Center.
Healthy Support – Wellness program offers easy ways to earn up to $900 per member, per year. Gym Reimbursement $400 single/$600 couple, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150 and $50 Tobacco-free certification online.
Ask us about Empire’s flexible low participation voluntary group dental, vision, disability and life insurance plans. Stay proactive and contact us today for a customized consult on how your organization can prepare ahead for ACA, Benefits, Payroll and HR @ (855) 667-4621 or info@medicalsolutionscorp.com.
The Serum Strains are out and the Scheduling is On!
2016/17 Virus Strains: Trivalent Vaccine:
an A/California/7/2009 (H1N1)pdm09-like virus;
an A/Hong Kong/4801/2014 (H3N2)-like virus;
a B/Brisbane/60/2008-like virus.
Quadrivalent Vaccine (special order only), includes viruses above and
B/Phuket/3073/2013-like virus.
Prime time to get your flu shot is late August through early November (shots can be given into Jan., Feb. and later for particularly virulent flu seasons).
Shot cost will be paid through claims for the following Plans:
No Cost to eligible members in good standing. 10-shot minimum for 1st hour of service, minimums vary for larger events. Company responsible to meet minimums and pay for non-covered employees or employees can be asked pay cash at time of shot ($30.00).
To schedule a wellness day contact us directly 855.667-4621 or visit www.TryHFC.com for more information.
Break Your Sugar Addiction in 10 Days (Infographic)
From our wellness partner, Cleveland Clinic
Do you have a sweet tooth? Most of us will overindulge at times. But the more sugar we consume, the more we want, says Mark Hyman, MD. However, the good news is that people can break the sugar addiction in 10 days. Here’s how.
Break Your Sugar Addiction Infographic
For more information on setting up a Wellness Program for your group please call us (855) 667-4621
The Oxford Metro NetworkSM is a new network option available to businesses based in New York. The Oxford Metro
Network was developed specifically for the needs of New York employers and is made up of physicians and other health
care professionals in New York and New Jersey.
1. What kind of access does the Oxford Metro Network provide?
The Oxford Metro Network consists of over 30,000 physicians and 84 hospitals1 throughout the Oxford New York
service area.2 Members enrolled in an Oxford Metro Network plan will also have access to over 18,000 physicians
and 62 hospitals1 in New Jersey.
2. Is the Oxford Metro Network available to small (1-100) and large (101+) group employers in New York?
Yes, the Oxford Metro Network plan designs are available to both small and large group employers.
3. What types of plan designs are available with the Oxford Metro Network?
There are eight gated, in-network only plan designs. The same plan designs are available for large and small groups.
4. What license are Oxford Metro Network plans on?
Oxford Metro Network plans are written on the Oxford Health Insurance, Inc. (OHI) license.
5. Can we offer this product alongside other Oxford products?
Yes, you can offer Liberty and Freedom Network plan designs, which include plan designs that offer out-of-network
benefits, alongside Oxford Metro Network plan designs. To make it easier to offer these plans, we have updated our
Idea Management SystemSM (IDEA) tool. You can use it to enroll in up to three OHI plans.
If you wish to enroll in more than three plan designs, you must submit a completed paper application with the
required documents. Please refer to our New York Small Group Underwriting Guidelines for required documentation.
A complete copy of our New York Small Group Underwriting Guidelines may be found by logging in to the Employer
portal of oxfordhealth.com. From there, click on “Tools & Resources” and then “Forms” in the drop-down menu of
“Your Benefit Coverage” under the “Practical Resources” menu.
Enrollment is required in each plan design that is offered.
6. Do my employees have to live in New York to enroll in a product offered with the Oxford Metro Network?
No, employees do not have to live in New York to enroll in a product offered with the Oxford Metro Network as long
as they work for a New York-based company and live in New York or New Jersey.
7. Is there coverage outside of the service area?
No, these plan designs offer access to Oxford Metro Network providers in the service area only. Members will not
have access to the UnitedHealthcare Choice Plus Network or to the Freedom and Liberty Networks in New York,
New Jersey or Connecticut. Emergency care is always covered, in or out of the Oxford Metro Network service area.
8. How does the non-embedded family deductible benefit work?
All Oxford Metro Network plan designs will include a non-embedded family deductible. When a member enrolls
in family, couple or parent/child coverage, the entire family has one deductible that must be met before the full
insurance benefits begin. The deductible can be met by one family member or by a combination of family members.
Once the family deductible is met, all family members will be considered as having satisfied their deductible for the
remainder of the benefit year.
9. Do Oxford Metro Network plan designs require referrals?
Yes, all plan designs offered with the Oxford Metro Network require referrals. Upon enrolling in an Oxford Metro Network
plan design, members will need to select a participating primary care physician (PCP) to coordinate their care.
10. Are specialty products like dental and vision available with the Oxford Metro Network?
Yes, pre-packaged specialty benefit options through Oxford Benefit Management (OBM) or stand-alone dental, vision
and disability products may be purchased with Oxford Metro Network plan designs. For ease of administration,
when a group has Oxford medical benefits, we do not require tax documentation or a binder check when they
add specialty lines of coverage. Only two enrolled subscribers are needed for voluntary dental, and one enrolled
subscriber for voluntary vision.
11. How can my employees find a participating Oxford Metro Network provider?
There are several ways that employees can search for a participating Oxford Metro Network physician.
If they already have a username and password for oxfordhealth.com:
1. Log in to the Member portal of oxfordhealth.com.
2. Click on “Find a Physician or Facility” on the home page.
3. On the next page, click the “Network” drop-down menu and choose “Metro.”
4. Enter additional criteria and click “Search.”
If they do not have a username and password, or want to search without logging in:
1. Go to oxfordhealth.com and click on “Members.”
2. Click on the “New Metro Plan – Important information for members” link.
3. On the next page, click the “Provider Search” link.
4. On the “Find a Physician” page, click the “Network” drop-down menu and choose “Metro.”
5. Enter additional criteria and click “Search.”
OR:
1. Go to oxfordhealth.com and click the “Browse our Provider/Facility Resources: Search for an Oxford doctor,
hospital or lab” link at the bottom of the home page.
2. Under “It’s in the details” on the right-hand side, click on “Doctor Search.”
3. On the next page (“Find a Physician”), click the “Network” drop-down menu and choose “Metro.”
4. Enter additional criteria and click “Search.”
Employees may also call the toll-free phone number on the back of their health plan ID card (if they are currently
enrolled in an Oxford plan) or 1-800-444-6222 to have a paper copy of the directory mailed to them. TTY users can
dial 711. Si usted necesita ayuda en español llame al número de teléfono en su tarjeta de identificación, 若需中文協
助， 請致電1-800-303-6719, 한국어로 도움이 필요하시면1-888-201-4746, or the phone number on their ID card
for help in English and other languages.
12. What pharmacies are available with the Oxford Metro Network?
The Oxford Metro Network provides access to retail pharmacies including major chains, mass merchants and
supermarkets. Among others, members can fill prescriptions at Duane Reade, Walgreens and Walmart.
13. How can my employees find a participating pharmacy?
Employees can search for a participating pharmacy from the Member portal on oxfordhealth.com by following the
steps below:
1. Go to oxfordhealth.com and click on “Members.”
2. Click on the “New Metro Plan – Important information for members” link.
3. On the next page, click the “Pharmacy Search” link.
4. Enter search criteria on the following “Find a Pharmacy” page and click “Search.”
Employees may also call the toll-free phone number on the back of their health plan ID card (if they are currently
enrolled in an Oxford plan) or 1-800-444-6222 to find out if a pharmacy is participating. TTY users can dial 711. Si
usted necesita ayuda en español llame al número de teléfono en su tarjeta de identificación, 若需中文協助， 請致
電1-800-303-6719, 한국어로 도움이 필요하시면1-888-201-4746, or the phone number on their ID card for help in
English and other languages.
14. What other resources and tools are available to members enrolled in an Oxford Metro Network plan?
• Oxfordhealth.com offers a convenient, secure way for members to search for doctors, check referrals, get a new
ID card, and access benefits.
• Online health and wellness tools such as Rally™, which is an interactive health and wellness enhancement to
oxfordhealth.com. With Rally, members receive personal lifestyle plans that focus on goals, competition, tracking
progress and healthy living. Rally offers a personalized interactive experience with step-based Challenges,
discussion Communities, individual action plans called Missions, health information and more.
• Oxford On-Call® nurses are available 24 hours a day, seven days a week by phone to give members helpful
information about illness or injury.
• Access to a fully-credentialed network dedicated to complementary and alternative medicine that includes more
than 5,900 providers.3
Oxford Benefit Management, Inc. acts as the distribution company for products. Oxford Benefit Management packages are not available in all states and state-specific
requirements may cause limitations or variations to the plans. Packaged Savings is not available for this product. Benefit options may vary by group size. Components
subject to change. Oxford Benefit Management products are provided by: UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located
in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. The New York Select Managed Care Plan is
underwritten by UnitedHealthcare Insurance Company of New York, located in Islandia, New York. UnitedHealthcare vision coverage provided by or through UnitedHealthcare
Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Life and Disability
products are provided by Unimerica Life Insurance Company of New York. Life and Disability products are provided on policy forms LASD-POL-LIFE NY (05/03) and LASD-
POL-ADD/DIS NY (05/03). Unimerica Life Insurance Company of New York is located in New York, NY. These policies may include exclusions, limitations, reductions of
benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or
the company.
Oxford insurance products are underwritten by Oxford Health Insurance, Inc.
For more information on the Oxford Metro Network, please contact Millennium Medical Solutions Corp. at (855)667-4621.
PEO FAQ Q | What is a PEO, ASO, HRO and why should I care about them? A PEO is a Professional Employer Organization a single source provider of integrated services which enable business owners to cost-effectively outsource the management of human resources, employee...
Millennium Medical Solutions Corp. is proud to have formed a partnership with HR360. This partnership will help us deliver state-of-the-art online Human Resources and Benefits Library to our clients.This partnership with HR360 will help The MillenniumMedical Solutions Corp. clients access HR360’s premier online HR library which features a single point for access to the most current and updated federal and state laws. The HR360 website will help Millennium Medical Solutions Corp.’s clients by providing easy, step-by-step guidance on how to comply with a broad range of topics such as how to properly interview, hire and terminate employees to how to comply with laws from Health Care Reform, FMLA and COBRA.This online library of HR and benefits information provides extensive resources in the areas of:
Compliance steps that clearly explain how to comply with the law to help avoid potential employee lawsuit
Categorized HR & Benefits documents
OSHA compliance
How to do performance reviews, interview, hire and terminate
Step-by-step approach to implementing COBRA and FMLA
Fast, efficient online HR tools for developing job descriptions and HR practices
Federal and State employment law information
Safety resources
Salary benchmarking
How to implement wellness plans including:
Needs assessment
Interest surveys
Plan design
Implementation
Evaluation
If you have already been registered to access HR360, please login below.
HR360 is managed by a professional team of attorneys, HR specialists, editors and advisors who have years of experience in developing and maintaining award-winning online HR and benefits content.If you would like to be provided with access to the HR360 portal, please contact your account rep or fill out our contact form on the contact page of our website.
•Change in tax treatment for over-age dependent coverage •Accounting impact of change in Medicare retiree drug subsidy tax treatment •Early retiree medical reinsurance •Medicare prescription drug “donut hole” beneficiary rebate •Break time/private room for nursing moms
•No lifetime dollar limits on essential health benefits
•Restricted annual dollar limits on essentail health benefits, phased amounts until 2014
•No pre-existing condition limitations for enrollees up to age 19 and no rescissions
•No health FSA/HRA/HSA reimbursement for non-prescribed drugs
•Increased penalties for non-qualified HSA distributions
•Additional standards for new or “non-grandfathered” health plans, including preventive care in network with no cost-sharing appeal and external review, provider choice and non-discrimination provisions for insured plans
•Income-based Medicare Part D premiums Pharmaceutical importers and manufacturers’ fees start
•Medicare, Medicare Advantage benefit and payment reforms
•Insurers subject to medical loss ratio rules
•Employers to distribute uniform summary of benefits and coverage (SBC) to participants (deadlines vary with group of recipients)
•60-day advance notice of mid-year material modifications to SBC content
•Form W-2 reporting for health coverage (track in 2012 for W-2 form provided in early 2013)
•Coverage for additional women’s preventive care services
•$2,500 per plan year health FSA contribution cap (plan years on or after January 1, 2013)
•Comparative effectiveness group health plan fees first due
•Annual dollar limits on essential health benefits cannot be lower than $2 million
•Employers notify employees about exchanges •Medical device manufacturers’ fees start •Higher Medicare payroll tax on wages exceeding $200,000/individual; $250,000/couples
•Change in Medicare retiree drug subsidy tax treatment takes effect •Health Insurance exchanges initial open enrollment period
•Health insurance exchanges
•Individual coverage mandate
•Financial assistance for exchange coverage of lower-income individuals
•States Medicaid expansion (possibly only some states)
•Employer shared responsibility
•Dependent coverage to age 26 for any covered employee’s child
•No annual dollar limits on essential health benefits
•No pre-existing condition limits
•No waiting period over 90 days
•Wellness limit increase allowed
•Health insurance industry fees
•Additional standards for non-grandfathered health plans, including limits on out-of-pocket maximums, provider nondiscrimination, and coverage of routine medical costs of clinical trial participants
•Small market, non-grandfathered insured plans must cover essential health benefits with limited deductibles (initially $2,000/individual, $4,000/family), using a form of community rating
•Insurers must apply guaranteed issue and renewability to non-grandfathered plans of all sizes
•Auto enrollment sometime after 2014
•Temporary reinsurance fees first due in late 2014/early 2015
•Additional employee-specific reporting and disclosure of 2014 coverage
•40% excise tax on “high cost” or Cadillac coverage
Welcome Individuals Choose a tabs below to access valuable resources designed to benefit our client’s employees. Shop Individual Medical Insurance Log Into Enrollment Portal Earn Rewards with Retail Benefits Get Healthy with Wellness Individual Medical Plans ...
Protect Your Employees from the Grips of the Flu
