Emblem Leaving?

Emblem Leaving?

Emblem GHI Leaving?

Is Emblem Leaving?

Is EmblemHealth (GHI formerly) leaving the small business market?  Yes and no.  The popular traditional EPO is slated to be chopped up for new business May 1 pending State approval. The remaining consumer driven health plans which have deductibles and coinsurance (a %) will stay in tact.  With that Broker compensation commissions will be significantly cut as well.  The family popular 2-tier rating is also phased out and new groups must submit everything clean within 30 days.

Our quote in todays Crains Health Pulse Crains EmblemHealth pulls small business plans Feb 2013 | Crain’s New York Business reflects our deep concerns on market consolidations. “The unintended consequences of legislative changes has created a de facto single-payer system where Oxford is empowered to dictate to the New York market,” said Alex Miller, founder of Millennium Medical Solutions Corp. in Armonk, N.Y.  To be fair Emblem has been steadily streamlining plans with in network only plan offerings and lowest  HSA (Health Savings Account)  family deductible starting out at $11,600.  They are not the first insurer to do this as Empire Blue Cross issued a broader exit back in Nov 2011.

A healthy health insurance marketplace depends on competition as we all agree.  From approximately 12 insurers 15 years ago we are today down to 2 active insurers Aetna and Oxford with Oxford claiming approx 2/3 of the small business marketplace. In NYS the MLR (Minimum Loss Ratios) are higher than any other state with additional state taxes.  See NYS Surcharge on Health Insurance.   The tight State Regulators allowing for razor thin margins while requiring insurers to maintain high reserves makes a burden many insurers are not excited.  This resembles more of a utility company environment except ConEd realizes a 10% operating profit and do not have to have insurance reserves to prove solvency.  Is there any surprise why there is no rush by outside insurers to compete here?

While on topic of ConEd we all know how customer care  was in the aftermath of Hurricane Sandy.  When was the last time an independent veteran consultant (not an ESCO) worked with you on your utility bill, servicing, negotiating, educating, and maximizing savings?  Sure you can use a different supplier or ESCO but its still the local singular utility company that you are using.  In comparison,  same is happening in the health insurance field and the consequential exit of Health Insurance Brokers.  Sadly, this is precisely the time when their training is most in demand and the most in need will be least likely to afford them.


Crains EmblemHealth pulls small business plans Feb 2013 | Crain's New York Business

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HIP/GHI Merger

HIP and GHI merger. GHI and HIP have been working since 2005 on merging under a common parent, EmblemHealth, serving more than four million members across the tri-state area. As sister companies, GHI and HIP has continued to operate separately until they get NY State Approval. Affiliation is the first step as GHI and HIP begin the process of combining and integrating as they move toward an eventual merger. Existing group coverage will not change as a result of the affiliation. Over time, their stated mission is to will develop and make available an expanded range of cost effective products and new services to you and your employee’s. There have been a recent executive fall out of the changes and expect more to come. NY will be losing the last few non-profits left in the state. The state is running public forums to review this, see state insurance site on recent meetings. Will this be NY State politics as usual and allow political leaders to dole out the stock market gains for personal gains or will citizens stand to gain? Unlike our state, California took a long term view for the medical care of its citizens. They set up a non-profit with a mission that the Blue Cross conversion set up a fund of not less than $100 million to be spent on charitable activities in 1994 and not less than 40 percent of WellPoint stock ($1.2 billion) to be contributed to a newly formed foundation. Pataki on the other hand used 90% of the $1.1Billion Empire Blue Cross 2002 conversion for Mr. Rivera’s powerful 1199 Union. I’m sure that this did not harm his 2002 reelection campaign but I wish New Yorkers did as well as California. See article in NY Times for your consideration.