Oxford, Emblem & etc Quarterly Group Health Rate for NYC & Long Island

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.

Give us a call or send us an e-mail, and we'll help you get a plan today!

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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.

 

2018 4th Quarter Health Insurance Monthly Individual Premium (w/o Doctor Deductibles)

* Based on Downstate Metro NYC and Long Island
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
SilverGoldPlatinum
emblem-group-health-insuranceEmblem Doctor NetworkHMO (NYC)$601.05$797.60$924.71
oscar-group-health-insuranceOscar Doctor NetworkEPO (Simple)$606.08$700.42$170.57**
oxford-group-health-insurance Oxford Doctor NetworkHMO (Metro)$629.11$733.62$909.27
Healthfirst-insuranceHealthfirst Doctor NetworkEPO (Pro)$667.03$776.28$912.27
emblem-group-health-insuranceEmblem Doctor NetworkHMO (LI)$683.73*$907.31$1,051.90
empire-bcbs-insuranceEmpire Doctor NetworkEPO$842.36$998.89$1,132.28
oxford-group-health-insuranceOxford Doctor NetworkPPO$855.79$1,019.43$1,192.18
empire-bcbs-insuranceEmpire Doctor NetworkPPO$881.88$1,059.51$1,324.27

2019 1st Quarter Group Health Insurance Monthly Individual Premium (w/o Doctor Deductibles)

* Based on Downstate Metro NYC and Long Island
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
SilverGoldPlatinum
Hello How are you?Emblem Doctor NetworkHMO Select (NYC)$576.71$709.23$902.72
Hello How are you?Emblem Doctor NetworkHMO Select (L.I.)$656.03$806.79$1026.90
Hello How are you?Emblem Doctor NetworkHMO Prime (NYC)$690.82$787.45$1025.17
Hello How are you?Emblem Doctor NetworkHMO Prime (L.I.)$785.84$895.77$1166.19
oxford-group-health-insuranceOxford Doctor NetworkEPO (Metro)$585.60$689.87$822.03
Healthfirst-insuranceHealthfirst Doctor NetworkEPO$637.88$732.43$896.61
oscar-group-health-insuranceOscar Doctor NetworkEPO$624.45$723.18$810.66
empire-bcbs-insuranceEmpire Doctor NetworkEPO$815.58$948.41$1082.71
empire-bcbs-insuranceEmpire Doctor NetworkEPO$896.09$1093.01$1378.32
empire-bcbs-insuranceOxford Freedom PPO EPO$828.10$970.40$1,177.38

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*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.

Why don't we recommend Aetna Group Health?

However, Aetna Medicare is a completely different story.

 

 

New York Small Group Underwriting Guideline

New York Small Group Tax Form Submissions

New York Insurance Company - Ratings of Cost and Quality

2019 New York Group Health Insurance Group Participation Requirements:

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.

Empire BC/BS - 2 Networks to choose from starting January 2019  - Mid to high range pricing depending on the plan.

Has excellent PPO/EPO no referral NY and National network. Also has 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)

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. Also has optional Dental, Vision, Identity Theft, and Life/LTD options along with Free Cobra administration. 

 

Oscar - 2 networks as of January 1, 2019. 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.

Emblem - has 2 networks in 2019: 

PRIME TriState Network is the larger of the 2 networks. The much smaller network is Select Care Network.

They also offer gated (i.e. referral need to see an in-network specialist & non-gated plan (i.e. no referral needed to see a specialist).

Most importantly, Emblem is the only carrier that does not have a participation requirement. So there will be the only option for an employer that is getting the plan for themselves only. 

HealthFirst - NYC centric network covering 5 boroughs and Nassau counties only. Requires 60% enrollment after any other coverage waivers.  Allows management carved out.

Major news this year is the initiation of coverage on Long Island Suffolk County.

Aetna - Large network carrier. Similar to Oxford plan rates but no Platinum level options. No referrals required. Require 60% enrolled after valid other coverage waivers. No other carrier can be written alongside Aetna. Minimum enrollment of 2 employees. Not a strong player in the small group market.

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