Health Care Committee Update
February 27, 2014

Staff Contact: Lev Ginsburg

New York State of Health Webinar Update

Yesterday, the New York State of Health held a Regional Advisory Committee webinar to discuss their 2015 Health Plan Invitation.  Topics discussed included insurer participation requirements, applicant qualifications, QHP offerings, provider network requirements, out-of-network coverage, stand-alone dental coverage and the SHOP.

Many of the plan participation requirements remain the same as those for 2014 with some changes being proposed for the purposes of “continuity of care” and flexibility for plans to include wellness products.  Of the most concern to the business community, was the declaration that Exchange would mandate some form of an out-of-network benefit, beyond the 2014 requirements.  New York State of Health is seeking stakeholder input to determine its parameters on out-of-network coverage.  Options discussed include mandated products at different metal tiers as well as inclusion of out-of-network benefit as a rider to policies.

The Business Council has advocated strongly for the need for robust health-care networks as the cornerstone to controlling healthcare costs and promoting health and wellness. Mandates on all health insurers to offer coverage for all services performed by out-of-network providers remove leverage from health plans in negotiating with providers to participate as part of cost-saving networks. There is little doubt that an out-of-network mandate would significantly increase the cost of health-care and premiums on the Exchange.

A replay of the webinar is available at http://info.nystateofhealth.ny.gov/news/regional-advisory-committee-webinar-2015-health-plan-invitation  Public comments will be accepted through March 4, 2014 at 5pm at ExchangeRAC@health.state.ny.us.  The Business Council will be offering comments on the plan.  We encourage you to reach out to us with any questions and comment both collectively through TBC and individually.