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Press Release

July 31, 2015

Contact: Matt Anderson, 212-709-1691

NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES ANNOUNCES 2016 HEALTH INSURANCE PREMIUM RATES, INCLUDING RATES FOR NY STATE OF HEALTH

Individual Rates for 2016 Remain Nearly 50% Lower than Before Establishment of New York’s Health Exchange

DFS Rate Reduction Actions Will Save Consumers More than $430 million

New Essential Plan Will Lower Premiums to $20 or Less and Provide Better Benefits for Lower-income New Yorkers

The New York State Department of Financial Services (DFS) today announced health insurance rates for 2016, including rates for the NY State of Health, the state’s official health plan Marketplace.

Premiums for individuals remain nearly 50 percent lower than prior to the establishment of the State’s health benefit exchange in 2014 – even before adjusting for inflation or federal financial assistance that is available to many consumers purchasing insurance.  Overall, DFS cut insurers’ requested 2016 rates by more than 30 percent in the individual and small group markets, which will save policyholders more than $430 million. Additionally, a new Essential Plan, available only through the NY State of Health, will lower premiums to $20 or less and provide better benefits for hundreds of thousands of lower income New Yorkers.

Anthony J. Albanese, Acting Superintendent of Financial Services, said: “We closely analyzed each insurer’s request and cut rates that were excessive or unreasonable. The influx of new consumers into the health insurance market in recent years means that rates for individuals will continue to be nearly 50 percent lower than before the creation of New York’s health exchange. However, underlying increases in medical costs continue to be the primary factor contributing to the cost of insurance.  We are working closely with the NYS Department of Health on reforms to the health care payment and delivery system, including efforts to shift away from the costly ‘fee-for-service’ model. It is vital that we continue to attack the underlying factors driving up health insurance premiums in order to bring better care to patients at lower costs.”

“NY State of Health provides many options for consumers, and it pays to shop around on that marketplace,” said Donna Frescatore, Executive Director of NY State of Health.  “Consumers will find a wide variety of affordable, high-quality insurance plans on the State’s health marketplace.”

Individual Market

On average, insurers requested a 10.4 percent rate increase in the individual market.  DFS reduced the average increase more than 30 percent, to 7.1 percent, which is below the average increase in health care costs of approximately 8 percent.  Around one-half of the rate increase is due to reductions in a federal reinsurance program.

New Yorkers with incomes up to 400 percent of the federal poverty level ($47,080 for individuals and $97,000 for a family of four) are eligible to receive financial assistance to reduce premiums through the NY State of Health.

Starting on January 1, 2016, New York will add a new Essential Plan to the plans that can be purchased by lower income New Yorkers through NY State of Health. Households at or below 150 percent of the federal poverty level ($17,655 for a household of one; $36,375 for a household of four) will have no monthly premium for the Essential Plan.  Those with slightly higher incomes at 200 percent of the federal poverty level ($23,540 for a household of one; $48,500 for a household of four) will have a low monthly premium of $20 for each adult.

The Essential Plan will provide the same covered services as other plans offered on the Marketplace.  The Essential Plan has no annual deductible and lower copayments, making health care even more affordable for hundreds of thousands of New Yorkers.  For example, a person who earns about $20,000 a year and uses moderate health care services including an inpatient hospital stay, prescription drugs and doctor’s visits, will pay about $730 a year for premiums and out-of-pocket costs under the Essential Plan in 2016 as compared to about $1,830 in 2015 if they were enrolled in a Qualified Health Plan.

Small Group Market

On average, insurers requested a rate increase of 14.4 percent in the small group market.  DFS cut the requested rates by 32 percent, to 9.8 percent.  A number of small businesses will also be eligible for tax credits that would lower those premium costs even further.

The following chart summarizes the requested and approved rates, including the companies selling policies through the NY State of Health.

2016 Individual Market Rate Actions – Overall Summary

 

Company

Requested Approved Reduction

Affinity*

6.63%

6.63%

0.00%

CDPHP HMO*

5.69%

2.52%

-3.17%

Emblem HIP*

13.20%

10.51%

-2.69%

Empire HMO*

14.50%

13.20%

-1.30%

Excellus*

12.80%

5.72%

-7.08%

Fidelis*

4.66%

4.66%

0.00%

Health Republic*

14.36%

14.03%

-0.33%

HealthFirst*

12.89%

9.60%

-3.29%

HealthNow*

6.68%

-1.32%

-8.00%

Independent IHBC*

-10.36%

-10.36%

0.00%

Metro Plus*

-7.00%

-7.00%

0.00%

MVP Health Plan*

13.48%

10.24%

-3.24%

North Shore LIJ*

4.93%

4.43%

-0.50%

Oscar*

4.54%

4.54%

0.00%

Oxford OHP

5.32%

-12.25%

-17.57%

United*

22.00%

1.65%

-20.35%

Wellcare*

4.71%

-3.30%

-8.01%

All Companies Combined

10.40%

7.09%

-3.31%

*Companies that offer policies through the NY State of Health in 2015.

2016 Small Group Rate Actions – Overall Summary

 

Company

Requested Approved Reduction

Aetna Life

23.87%

21.47%

-2.40%

CDPHP HMO*

-19.84%

-19.84%

0.00%

CDPHP UBI*

16.56%

16.56%

0.00%

Emblem HIP*

29.74%

29.74%

0.00%

Empire Assurance

8.70%

3.40%

-5.30%

Empire HMO

9.21%

4.37%

-4.84%

Excellus*

13.90%

10.00%

-3.90%

Health Republic*

20.00%

20.00%

0.00%

HealthNow*

8.06%

0.66%

-7.40%

Independent IHA*

-15.60%

-15.60%

0.00%

Independent IHBC

-6.19%

-6.19%

0.00%

Managed Health

5.60%

3.94%

-1.66%

Metro Plus*

-0.81%

-0.81%

0.00%

MVP Health Plan*

7.28%

6.36%

-0.92%

MVP Services*

16.71%

15.90%

-0.81%

North Shore LIJ*

3.27%

3.27%

0.00%

Oxford OHI

13.61%

6.75%

-6.86%

Oxford OHP

10.58%

3.90%

-6.68%

United UHIC

18.79%

11.61%

-7.18%

All Companies Combined

14.41%

9.80%

-4.61%

*Companies that offer policies through the NY State of Health in 2015.

The next NY State of Health open enrollment period begins on November 1, 2015 for coverage starting on January 1, 2016.  New Yorkers eligible for Medicaid, the Essential Plan and all children can enroll in coverage through NY State of Health at any time during the year. 

The Small Business Marketplace for employers with 50 or fewer employees is open to enrollment throughout the year (beginning January 1, 2016, small group will include 100 or fewer employees).   For more information about the NY State of Health exchange, please visit https://nystateofhealth.ny.gov/.   

To view a summary of the rates by region, please visit the following links: individual market and small group market.

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