NYSOH AND NYDFS ANNOUNCE AGREEMENTS WITH FIDELIS CARE, EXCELLUS BCBS, MVP HEALTH CARE TO HELP ENSURE HEALTH REPUBLIC CONSUMERS RECEIVE UNINTERRUPTED HEALTH INSURANCE COVERAGE
The New York State of Health (NYSOH) marketplace and New York State Department of Financial Services (NYDFS) today announced agreements with Fidelis Care (Fidelis), Excellus BlueCross BlueShield (Excellus), and MVP Health Care (MVP) to have those companies auto-enroll individual NYSOH Health Republic customers whose plans are ending on November 30, 2015 in order to help ensure continuity of care and coverage.
Donna Frescatore, NYSOH Executive Director, said: “While we encourage Heath Republic customers to act as soon as possible to pick new insurance plans, this auto-enrollment option is critical to helping ensure a smooth transition to new coverage. We thank Fidelis, Excellus, and MVP for stepping up to the plate and working with us to help deliver coverage to Health Republic consumers.”
Anthony J. Albanese, Acting Superintendent of Financial Services, said: “Today’s agreements with Fidelis, Excellus, and MVP are the most recent in a series of actions we have taken to help ensure continuity of care and coverage for Health Republic customers. Going forward, we will continue to do everything we can to protect these consumers.”
"Fidelis Care is pleased to work closely with the State on the auto enrollment process for Health Republic members," said Rev. Patrick J. Frawley, Fidelis Care President and CEO. "For those who do not choose a new health plan before the November 30 deadline, auto enrollment will help ensure that Health Republic members keep their coverage without interruption. In partnership with the State, we're here to help make Health Republic members' transition to their new coverage as seamless as possible."
"Excellus is pleased to assist the state in ensuring that all former Health Republic members are given the opportunity to have continuous and affordable coverage," said Christopher Booth, Excellus BlueCross BlueShield President and Chief Executive Officer.
"MVP Health Care welcomes the opportunity to assist all former Health Republic members living in our service area in obtaining quality health care coverage that meets their needs,” Denise Gonick, President and CEO of MVP Health Care. “We're more than prepared to provide them with the same level of high quality service that customers have come to expect from MVP throughout New York State. We're especially pleased that the New York State Department of Health has chosen us as a partner in its decision to automatically enroll those Health Republic members who live in Ulster County in new coverage provided by MVP."
Under today’s agreements, Fidelis Care, Excellus, and MVP have agreed to accept auto enrollment of Health Republic members who have not selected a health plan for December 1, 2015 and to credit any deductible and out-of-pocket amounts that consumers have already paid through their Health Republic coverage during 2015 – helping ensure that individuals who make the transition will not be required to restart these payments in 2015.
During the third week of November, individuals enrolled in Health Republic through NYSOH and who have not yet selected a new health plan for December 1, 2015, will receive an auto-enrollment notice from NYSOH telling them — based on their county of residence – whether they will be auto-enrolled in either Fidelis Care, Excellus, or MVP. Individuals who reside in the Rochester area (including Livingston, Monroe, Ontario, Seneca, Wayne and Yates counties) will receive an offer to enroll from Excellus. Individuals who reside in Ulster county will receive an offer to enroll in MVP. Individuals who reside in all other counties of the state will receive an offer to enroll from Fidelis Care. In order for coverage to become effective, individuals will need to make their premium payment for the month of December 2015. Consumers will be auto enrolled into the same metal tier or option that is most similar to the coverage the individual selected through Health Republic.
The auto-enrollment plan is subject to an opt out provision for members who want to pick a different plan or decline this new coverage. Consumers who receive an auto-enrollment notice in the third week of November will still have until November 30 to call the NYSOH and pick an alternative plan. Additionally, individuals may decline the coverage by not paying their December premium.
Fidelis Care, Excellus, and MVP were chosen for this auto-enrollment option because they offer consumers access to a broad network of providers and have competitive premium rates compared to Health Republic. They also participate in all programs available for enrollment through NYSOH including Qualified Health Plans, Medicaid Managed Care, Child Health Plus and the new Essential Plan starting on January 1, 2016, making it easier for individuals who have a change in eligibility to stay enrolled in the same plan if they desire in 2016.
Fidelis Care, Excellus, and MVP have been popular choices for Marketplace consumers. As of the end of the last open enrollment period, February 2015, Fidelis covered 20 percent of the individuals enrolled through the Marketplace, the largest percentage of any of the 16 insurers participating on the Marketplace. Excellus provided coverage to 29 percent of the enrolled individuals in their geographic service area. MVP covered 20 percent of the members in its service area.
NY State of Health has established a special webpage for Health Republic members. Information including Frequently Asked Questions and Answers can be found here http://info.nystateofhealth.ny.gov/HealthRepublic
Today’s agreements on NYSOH and NYDFS’ auto-enrollment plan are the most recent in a series of actions those agencies have taken to help protect Health Republic consumers and help ensure continuity of care and coverage. Those actions are outlined below:
• Extension of Enrollment Deadline. For consumers who do not select a new 2015 health insurance plan online by November 15 and who prefer to select a new health insurance outside of the auto-enrollment process, the NYSOH marketplace will create a special Customer Service center consumers can call to enroll individuals in the new health insurance plan of their choice up until November 30, 2015. (Note: Due to information technology constraints, online enrollment for new 2015 health insurance is only available until November 15, 2015 – necessitating that consumers call the customer service center to enroll after that date.)
• Consumer Outreach. In addition to sending electronic and mail notices immediately following the decision to terminate policies on November 30, 2015, the State is conducting an outreach campaign to help ensure that consumers are reached multiple times to make them aware of the need to enroll in a new health insurance plan. NYSOH and Health Republic have also been following up with targeted reminder notices and outbound calls to consumers. Additional outreach communications will continue in the days ahead. NYSOH is also working with in-person assistors to reach out directly to consumers they previously helped enroll in coverage through the Marketplace to help them with a new plan selection.
• Deductibles. For those enrolled in a Health Republic plan that has an annual deductible, NYDFS and NYSOH are working to ensure that consumers whose Health Republic plans have an annual deductible will not be charged by their new plans for the amount of deductible already met in 2015. Consumers may need to provide their new plan with evidence that they have met all or part of the 2015 deductible, and should keep their deductible records.
• Prohibition Against Billing Consumers for Unpaid Claims. NYDFS has taken actions to apply a New York State law that strictly prohibits providers from collecting or attempting to collect from Health Republic consumers amounts that are owed by Health Republic.
• Out-of-Network Provider Services. New York Law requires insurers to permit an insured to obtain the services of an out-of-network provider if the insurer does not have an in-network provider with the appropriate training and experience to meet the particular health care needs of an insured.
• Helping Ensure Continuity of Care. Under New York law, Health Republic members who are: a) in an ongoing course of treatment with a provider for a life-threatening or a degenerative and disabling condition or disease, or b) in the second or third trimester of a pregnancy when their new coverage becomes effective, may be able to continue to receive care from their provider for up to 60 days (or through pregnancy) under their new health insurance policy, even if their provider does not participate in their new health insurer’s network. The State is also in discussions with Memorial Sloan Kettering and other health plans to ensure access to care for Health Republic consumers for up to a year – subject to agreement to reasonable terms with health plans. NYSOH will be discussing similar arrangements with other health care systems.
• Special, Dedicated NYSOH Health Republic Hotline Consumers. In addition to creating a Special Enrollment Period (SEP) for Health Republic consumers, NYSOH has established a special, dedicated Health Republic Customer Service hotline at 1-855-329-8899. Customer Service hours are from 8 am to 8 pm on Monday through Friday and 9 am to 1 pm on Saturday. The helpline will also have extended hours next weekend from 9:00 a.m. – 4:00 p.m. next Saturday and Sunday. As of November 11, the hotline has answered more than 24,000 calls.
• NYDFS Customer Service Line. For questions not related to enrollment through the NYSOH Marketplace Customer Service helpline, consumers can contact the New York State Department of Financial Services Consumer Hot Line with questions regarding Health Republic by calling 1-800-342-3736. The Hot Line hours are weekdays (Monday through Friday) from 8:00 a.m. to 8:00 p.m., and Saturday from 9:00 a.m. to 1:00 p.m.
• Installing Chief Restructuring Officer. NYDFS has required Health Republic's board of directors to consent to the appointment of an independent monitor to oversee the affairs of the company. The leading national restructuring firm Alvarez & Marsal is taking over the management of Health Public as its Chief Restructuring Officer.
• NYDFS Investigation. Last week, NYDFS opened an official investigation specifically focused on Health Republic's inaccurate financial reporting. NYDFS investigators are collecting and reviewing evidence relating to Health Republic's substantial underreporting to NYDFS of its financial obligations. Among other issues, the investigation will examine the causes of the inaccurate representations to NYDFS regarding the company’s financial condition.