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Emblem, Empire, Healthfirst, Oxford, Oscar Group Health Rate for NYC & Long Island (Q4 2020)

NY State (Down State) Region 4 & 8 Group Health Insurance Rate. 

NY Down State means NYC Metro & Long Island. 

For some insurance carrier, the rate in Long Island is higher. 

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Unlike many other states, in New York, group health insurance premium rates are community rated.

This means that the rates companies offer don’t differ based on the coverage you need.

While it may seem like this would make your decision simpler, the contrary is true.

Just going with the cheapest rate you can find might land you with the coverage you don’t need or not cover what you do need.

That’s why it’s useful to have an experienced broker on your side.

We can find a plan that will provide you with exactly what you need. Not only will you get suitable coverage, but you’ll save the time it would have taken you to search through all the insurance plans yourself.

NY State 2021 Group Health Insurance Rate Increase%

The NYS 2021 Rate Increase%were released today.  

Rate Increase for Small Groups Held to 4.2%, Second Lowest Ever Approved.

Overall Requested Rate Increase for Small Group Coverage Reduced by 63%, Saving Small Businesses Over $565 Million

If you are currently with Aetna, Emblem, or OSCAR, and is looking for an alternative, you can call us at  212-484-9888.

How to use our instant rate quote table?

 

See the table below for current quarter rates– click the company name to view full rate sheets, or click the logo to see a review of the company.

* Based on Downstate Metro NYC and Long Island

2020 4th Quarter Group Health Insurance (w/o Doctor Deductibles)

Click Each Company Logo to Learn More About Click below to see if your doctor is inWhat we recommend for Click Any Price to See Full Rate Sheets
BronzeSilverGoldPlatinum
Hello How are you?Emblem Doctor NetworkHMO Select (NYC)$535.30$629.43$734.94$924.84
Hello How are you?Emblem Doctor NetworkHMO Select (L.I.)$608.90$715.97$835.97$1,051.98
Hello How are you?Emblem Doctor NetworkHMO Prime (NYC)$626.62$735.96$858.54$1,079.15
Hello How are you?Emblem Doctor NetworkHMO Prime (L.I.)$712.77$837.14$976.56$1,227.52
oxford-group-health-insuranceOxford Doctor NetworkEPO$579.35$686.22$825.15$981.69
Healthfirst-insuranceHealthfirst Doctor NetworkEPO$518.71$637.44$731.95$896.00
Healthfirst-insuranceHealthfirst Doctor NetworkPro Plus(Dental) EPO$536.86$659.76$757.55$927.35
oscar-group-health-insuranceOscar Doctor NetworkEPO$577.69$773.66$878.74$991.44
empire-bcbs-insuranceEmpire Doctor NetworkEPO$772.90$920.43$1,127.34$1,302.77
empire-bcbs-insuranceEmpire Doctor NetworkPPON/A$1,104.87$1,274.77$1,646.23
empire-bcbs-insuranceOxford Doctor NetworkPPO$743.98$949.44$1,158.68$1,383.59
empire-bcbs-insuranceAetna Doctor NetworkEPO$690.10$758.32$931.49N/A

2020 3rd Quarter Group Health Insurance (w/o Doctor Deductibles)

Click Each Company Logo to Learn More About Click below to see if your doctor is inWhat we recommend for Click Any Price to See Full Rate Sheets
BronzeSilverGoldPlatinum
Hello How are you?Emblem Doctor NetworkHMO Millennium (NYC)$526.35$618.91$722.65$909.38
Hello How are you?Emblem Doctor NetworkHMO Millennium (L.I.)$598.72$704.00$822.00$1,034.40
Hello How are you?Emblem Doctor NetworkHMO Prime (NYC)$616.15$723.66$844.19$1,061.11
Hello How are you?Emblem Doctor NetworkHMO Prime (L.I.)$700.86$823.15$960.24$1,207.00
oxford-group-health-insuranceOxford Doctor NetworkEPO$565.43$669.75$805.35$958.14
Healthfirst-insuranceHealthfirst Doctor NetworkEPO$510.54$627.40$720.42$881.89
Healthfirst-insuranceHealthfirst Doctor NetworkPro Plus(Dental) EPO$528.41$649.37$745.62$912.75
oscar-group-health-insuranceOscar Doctor NetworkEPO$570.45$763.95$867.71$979.00
empire-bcbs-insuranceEmpire Doctor NetworkEPO$757.75$902.39$1,105.24$1,277.24
empire-bcbs-insuranceEmpire Doctor NetworkPPON/A$1,083.22$1,249.79$1,613.96
empire-bcbs-insuranceOxford Doctor Network PPO$726.13$926.65$1,130.88$1,350.38
empire-bcbs-insuranceAetna Doctor NetworkEPO$670.22$736.48$904.66N/A

 

*Emblem HMO(NYC/L.I.) Silver Plan: You get your first 3 PCP (Primary Care Physician) visits at no charge. Thereafter, there is a $35 co-pay per visit.

Aetna Group Health? Is not the same as Aetna Medicare.

2020 New York Group Health Insurance Group Participation Requirements:

Aetna – Aetna was founded back on May 28, 1853 (as Aetna Life Insurance Company). That explains why when you received your bill, it always says Aetna Life Insurance. 

It has a large doctor’s national (across the USA) network. (700K PCP; 1.2 million doctors; 5800 hospitals).

Its premium rate is above average, but the service level is still very challenging.

What sets Aetna apart is the medication. Aetna, (might have something to do with how bad it’s service was, got taken over by CVS in around 2019.)

Aetna EPO plan does not require a referral for a specialist visit.

It has a 60% enrolled after valid other coverage waivers. Minimum enrollment of 2 employees. Not a strong player in the small group market yet, but has been doing great with their Medicare plan.

60% enrollment after valid waivers includes (spousal, parental, individual, Medicare, and Medicaid).

Aetna also allows business owners to offer multiple Aetna health plans in an organization. I.e. A executive’s high plan can coexist with ranked-file employees’ basic low plan.

No other carrier can be written alongside Aetna.

Aetna does not offer any Platinum plans in New York. Only Gold, Silver, and Bronze.

Aetna’s group health plans include PPO (Preferred Provider Organization) plans, EPO Exclusive Provider Organization) plans, HSA (Health Savings Accounts), and now their new Aetna Saving Plus plans.

Savings Plus plans will have reduced rates and are designed to compete directly with the Oxford Metro plan. All Aetna plans are available everywhere in New York State.

AETNA OPEN CHOICE PPO PLAN:
Employees can visit any provider, in-network or out-of-network, without a referral. But when they stay in-network, claims are handled at the lower, contracted rates.

AETNA OPEN CHOICE POS 2 PLAN:
This plan allows employees to visit any doctor, hospital, or facility, in or out of network, with no referrals. But depending on their plan, if they choose a primary care physician (PCP) and stay in-network health care costs will be less.

AETNA MANAGED CHOICE PLAN:
These plans are a type of health insurance that has contracts with health care providers and medical facilities to provide care for members at reduced costs. Members can select a network PCP to guide their care. Or they can go out of network for a higher cost.

AETNA OPEN ACCESS MANAGED CHOICE PLAN:
This plan takes some of the “managed” out of managed care while keeping the savings. Members can visit any provider. And while employees are not required to choose a PCP, savings are offered by staying in-network.

Emblem – has 3 networks in 2021: (POS, Premier & Value). All of them are limited to Tri-State or NY state. 

I don’t want to talk much about them EXCEPT – Emblem is the only carrier that does not have a participation requirement. So you are a small company… 

Empire BC/BS – Most expensive carrier out there. (Mostly, only my doctor client will choose them. If you are doctor, we know. 

Has excellent PPO/EPO no referral NY and National network. Also has a lower-priced, much smaller Blue Access Network.  All plans require 60% participation after valid other coverage waivers. PPO/EPO no referrals, Blue Access plans are plan specific with some requiring referrals and some not.

PPO/EPO – for all EPO and PPO plans
Blue Access – EMPIRE {metal tier} Blue Access (EPO, GEPO, HMO)

HealthFirst – Our go-to recommendation, especially if you are an immigrant like us. NYC centric network covering 5 boroughs and Nassau counties only. Requires 60% enrollment after any other coverage waivers.  Allows management carved out.

The company entered the small business arena in 2017 but has been providing quality health care plans to individuals and families for more than 23 years.

This insurance company is affiliated with some of the most recognized hospitals and medical centers in New York. Hospitals such as Montefiore, Mount Sinai, and Long Island Jewish Medical Center.

Healthfirst’s network is focused primarily in the downstate New York region so if your business is located in New York City or Long Island, you will find a strong network of doctors and hospitals to provide coverage for your employees.

Healthfirst offers EPO (Exclusive Provider Organization) plans only through their “Pro Plus Small Business Program.”

Their health plans are in-network coverage and do not require referrals from your PCP (Primary Care Physician).

Along with providing quality health care plans to small businesses, they also offer:

  • Vision and dental benefits
  • $0 copay for access to 24/7 telemedicine
  • $600 (max) annual exercise rewards
  • Coverage for acupuncture visits. (My go-to plan for Acupuncture specialist.)

Healthfirst’s health plans are compliant with The Affordable Care Act (ACA) covering all metal tiers: Platinum, Gold, Silver, and Bronze.

Their small business plans are competitively priced and slightly less expensive than Oxford or Aetna but nowhere near the vast provider networks offered by these 2 insurance companies.  You can learn more by reading our HealthFirst Insurance Company review.

Health Pass – private exchange comprised of multiple carriers and plan options at all Metal Tiers under one roof.

Requires 75% loose participation that includes any other coverage waivers. Great for groups with diverse employee needs as the only way to offer multiple carriers under one program and one bill. It also has optional Dental, Vision, Identity Theft, and Life/LTD options along with Free Cobra administration. 

Oscar 2 networks as of January 1, 2019. (I didn’t even want to waste time to write anything else, unless, you like their requested 29% rate increase for 2021)

The quality mid-size provider network called Circle that covers the full downstate area. Technology-driven carrier with Qualcare network access for NJ residents.  No referrals required.

Circle Plus adds Northwell, WestMed, Memorial SK, and out of area coverage via MultiPlan PHCS. It competes well with most other large network carriers.

Currently, Oscar has a 51% participation rate and allows management carved out.

United Healthcare/Oxford – (Freedom, METRO, and Liberty Networks) – Largest network option available of all carriers. Prices on the mid to high side. Options for plans with and without referrals. All plans require 60% enrolled after valid other coverage waivers. No other carrier can be written alongside Oxford.  MGMT carve-outs allowed.

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2020 New York Small Group Underwriting Guideline

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