An employee benefits consultant in White Plains, James P. Schutzer followed closely the recent announcement in Albany regarding the state”™s health benefit exchange that will open Jan. 1 to individuals and small business owners. Some of what he heard left him disappointed.
With six weeks left before the Oct. 1 opening of enrollment in New York”™s health plan marketplace, state Health Department officials unveiled a new brand name and logo for the exchange. It will be called NY State of Health, an ad agency”™s echo of “New York State of Mind,” the Billy Joel song that has become a staple of New York City benefit concerts in the aftermath of the Sept. 11 terrorist attacks and Hurricane Sandy.
Donna Frescatore, executive director of NY State of Health, in the announcement said state officials wanted a name that would be “meaningful, memorable and capture the essence of what it is to be a New Yorker ”“ that unique ”˜can do”™ attitude and state of mind.” She predicted the name and marketing campaign “will inspire New Yorkers who are uninsured or underinsured to explore the options and choose the plan that fits their needs.”
Of greater concern to Schutzer and other insurance advisers and brokers, state officials also announced 15 health plans and 10 dental plans that will be offered on the exchange to individuals and small business owners with 50 or fewer employees. Not all of those plans will be available statewide.
In Westchester County, Schutzer noted that only two carriers will offer heath plans to small businesses on the four-tier premium rate system ”“ platinum, gold, silver and bronze ”“ the state has created for its exchange.
One carrier, Freelancers Health Service Corp., which does business as Health Republic, will offer its new Consumer Operated and Oriented Plan in the county. A longtime insurer in Westchester, United Healthcare”™s Oxford company also has joined the exchange.
In Rockland and Putnam counties, business owners shopping at NY State of Health can choose from Freelancers Co-Op, MVP Health Plan and United Healthcare Oxford. In Dutchess County, employers can choose from those three insurers and a fourth plan, Capital District Physicians Health Plan. The Capital District plan also will be offered to Orange County businesses along with Freelancers Co-op and MVP Health Plan.
Schutzer said Freelancers is leasing the health care provider network of MagnaCare for its new business.
Insurers that have a share of the group health plan market in Westchester ”“ Aetna Inc., MVP Health Plan and EmblemHealth ”“ have chosen not to participate in the state”™s Small Business Health Options Program exchange.
“It was a little bit of a letdown, not getting a robust menu of plans inside the SHOP exchange,” said Schutzer, vice president at J.D. Moschitto & Associates Inc. “When you only have two carriers in the exchange, it kind of takes away some of the appealing features of what the SHOP exchange could be.”
For individuals shopping for health coverage on the exchange, “There are going to be a lot more options,” Schutzer said.
Individuals living in Westchester can choose from seven health insurance carriers on the exchange. They are Affinity Health Plan; Empire BlueCross BlueShield; Fidelis Care; Freelancers Co-op; EmblemHealth”™s Health Insurance Plan of Greater New York, Oscar Insurance and United Healthcare.
Individual coverage “is a totally untapped market for the carriers,” Schutzer said. Currently there are only 20,000 to 30,000 direct-pay health care policies throughout New York state, he said. “I think the carriers see that more as an opportunity” than the small business marketplace.
Schutzer, though, said he expects more insurers will later choose to participate in the small business exchange. “I think for everybody it”™s a wait-and-see approach,” he said.
At RPO Group Inc., an employee benefits brokerage and advisory firm in White Plains, President Rory O”™Brien said he is advising his business clients to take that approach if possible.
He said his advice is “that they wait a year and see how it works ”¦ and look at it more closely next year.”
“If you can wait, why get involved? It”™s got to be a chaotic mess” when the exchange starts up in 2014.
O”™Brien said the exchange will benefit only a limited population of New Yorkers.
“It is a very good thing for people who do have pre-existing (medical) conditions and do have low income,” he said. “For those who do get (income-based) subsidies, it”™s a fantastic deal ”“ but at everybody else”™s expense.”
“Even if it all works, the funding for it just isn”™t right,” O”™Brien said. “You”™re not going to get the young, healthy population.”
