NEW 2016 Oxford Metro Network NY

NEW 2016 Oxford Metro Network NY

NEW 2016 Oxford Metro Network NY Image1

NEW 2016 Oxford Metro Network NY

Oxford has released an affordable new plan for 2016 and not a moment too soon.  With the recent exit of popular Health Republic of NY, Health Republic NY is Shutting Down, the market is starving for an affordable option.

Today’s largest networks with  in-network only GOLD  are  priced at  $9,000/single annually. They typically are accompanied with $50 copays and  non-office exposures of $1,000 deductibles and coinsurance percent in network. The new Metro network is approximately 25% smaller than NY Liberty network with up to 15% IN SAVINGS.  For example, an Oxford Liberty HMO Gold  is $745 vs  Oxford Metro Gold $650.

In 2015  Oxford’s Garden State Network  originated the same game plan of offering a third network in addition to FREEDOM and LIBERTY.  After all what good is a large network when one cannot afford to visit Providers? The third network answers the call for access to Providers with half the copays priced at approximately $1,500 less.

All Metal Levels will be included for all size groups including 1-99 & 100+. The new Oxford Metro plan will be limited to NY and NJ Garden State Network Providers. Referrals will be needed to see Specialists.  Importantly, most NY Hospitals will be participating with the EXCEPTION of NYU Health System, North Shore LIJ Health System (NorthWell Health) and Maimonides Medical Center. In addition, certain key medical IPA Groups such as Mt Kisko Medical Group are NOT in the network.

The Healthy NY and off-exchange Individuals will use exclusively this new Oxford Metro Network.



BENEFITS SUMMARY: OXFORD Platinum, Gold, Silver AND Bronze

Individual Sample Rates: Oxford 2016 NY Individual Rate Sheet

Individual Enrollment Forms: Oxford 2016-NY-MMS-Individual-application-Kit

Individual ON-Exchange UHC Network

Oxford Drug Formulary: Click Here

Oxford Metro FAQ. Click Here

Group Sample Rates:

Oxford sample Metro 2016 Rates

Platinum & GOLD

Oxford sample Metro 2016 Rates Bronze Silver

Silver & Bronze






ENROLL TODAY – Individual

3 steps:

1.  Initial Check Deposit: “Oxford Health Plans”.

2.  Proof of address:

  •  Valid New York State driver’s license
  • Voter Registration Card
  • Current income tax return, current lease or current utility bill
  • If mailing address is different than street address, please provide mailing address under separate cover

3.  Enrollment form below and mail back to:

Oxford  Individual Product Department

 14 Central Park Drive

 Hooksett, NH 03106

NOTE: Jan 15th deadline to submit  Feb 1, 2016  effective date.  Jan 31st is the deadline for a  March 1, 2016 effective date.

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Oxford’s Garden State

Oxford’s Garden State

Oxford’s Garden Stategarden_state_movie

OK so this may not be the catatonic movie of our favorite State starring Zach Braff and Natalie Portman but  just the same Oxford couldn’t resist using the same logical name for  the new network.  Starting Sept 1, 2014 Oxford will be offering the Oxford Garden State Network on all size NJ group business.  The 18,000 Doctor and 65 hospitals network will answer the call for a flexible lower cost plan option.

Judging by the #1 selling plan – Oxford Liberty HMO the market supports a smaller lower cost quality network.  Taking the same playbook Oxford  unveiled their plan last Friday. The plan will cover members outside NJ only on emergencies.  Unlike the Liberty HMO some plans options are non-gated plans not needing referrals to for access to a Specialist Doctor.

The Garden State Network provides access to the 21 New Jersey counties only.The Garden State Network does not provide national access to the UnitedHealthcare Choice Plus network. For NJ 1-50, up to 4 plan options can be selected and the Garden State products can be paired with Liberty and Freedom network options. With this network, employers can select which of the 13, in-network only plan designs available will work best for their needs and for the needs of their employees.

Oxford/United has been purchasing Provider groups since 2011 , see our post UnitedHealthcare Buying Medical Groups? This strategy of late is by no means exclusive to this Insurer but it is worth pointing them out as they are a national leading health Provider and worth paying attention to.

Some highlights of the plan designs available with the Oxford Garden State Network are below:

∙ Routine, in-network preventive care covered at 100 percent

∙ In-network only coverage

∙ Choice between 11 non-gated and two gated plan designs (gated plan designs will require a referral)

∙ Plan designs with copayments, deductible and coinsurance, and Health Savings Accounts (HSA) are available.

Oxford Garden State FAQ


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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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Oxford Terminates Westchester Medical Center

Oxford Terminates Westchester Medical Center

Oxford /United Healthcare has announced last week their contract termination with the Valhalla teaching hospital, Westchester Medical Center effective May 1, 2012.  The  NYS “cooling off period”  imposes both parties to renegotiate a contract until July 1st.  The hospital will be considered in-network until that time.

This marks the second time a  large health insurer has terminated their contracts with Westchester medical Center.  Empire had terminated their contract  on Nov 10, 2010  after a similar dispute and is still not under contract.  While contractual posturing is all too common in the health industry with eleventh hour agreements, we are seeing this disturbing trend playing out in other instances now.

We will monitor the situation and keep members posted.  Oxford member letters explaing this are going out. Please contact us with any questions.

Health Reform: Grandfathering Your Current Insurance Plan (06/14/2010 Press Conference)

Health Reform: Grandfathering Your Current Insurance Plan (06/14/2010 Press Conference)

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“A promise to keep your health plan?  …..Plans that existed on March 23 can make routine changes while remaining exempt form some of the new provisions. Americans who like their plan are extended security.” Really?

While there are a few small advantages  the main advantage is for  businesses  with class-out situations where they have a Management vs. Non-Management plans.  Industries commonly likely to get affected are medical offices, construction and restaurants.  By using this clause they are afforded reprieve form non-discrimination.  This affects groups renewing post Sept 23, 2010.

But how likely is allowing the Grandfathering Clause a benefit in real life situations. As per the attached June video press conference , if an insurance company decides to increase their costs sharing significantly they automatically lose this status.  As an example,  if an Oxford raises the deductible from $1000 to $1200 or by  “15% + medical inflation rate”.   Think this is unusual? Just check your benefits form 3 years ago and see if a $10 copay is still available.

How about if a Healthnet decides to exit the Northeast market and sells to United Healthcare? Yes folks you’re out of luck.

So what are the odds that small group will have this imposed on them?  According to Gov Estimates the projections are 58%-80% in 2011 and dropping to 20%-51% in 2014 still remaining grandfathered.    When calculating small employees the number is less than 100 employees.  I suspect for groups under 50 employees the numbers are further skewed.

Which is why in summation this is a red herring issue and wont pose as a viable advantage for most groups.  An excerpt below form our Crains interview earlier this summer discusses the Grandfathering Clause  further.

“The prohibition on changing carriers, in particular, takes an important cost-control tool away from small businesses, which already lack the flexibility and leverage of larger companies. Many change carriers every couple of years in search of better rates or new offerings as insurers offer deals to drum up new business. Westchester broker Alex Miller says that for most of his small business clients, trying to keep their grandfathered status is probably not worth it, especially if rates continue to climb 15% to 20% a year as they have in New York. With limits on cost-sharing, employers could get further behind every year.

“I think a small handful of my clients will stay put because they have a unique health care plan, such as an indemnity plan that is no longer sold,” says Mr. Miller, president of Millennium Medical Solutions Corp. in Armonk. “But for the great majority of my clients, how are they going to take a 20% [premium] increase and not make any changes?””