Finding health insurance for a small firm in New York

I reached out to my network recently to solicit advice on getting health insurance for a small firm in New York. Here are all the responses I received. I'm not making representations or recommendations on any of these, but I hope this may be helpful to someone in the same situation:

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I highly recommend Scott Martin - his firm has given me great service for several years:

Scott L. Martin
President
211 East 43rd Street, 18th Floor
New York, NY 10017
p.212-818-9570 ext.224
f.212-818-9572
c.917-887-6868
scottm@martinbenefits.com
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Check out HealthPass: http://www.healthpass.com/index.html
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Dianne Corsbie is the person who has arranged for my personall and my
wifes life insurances. Very knowledgeable and highly recommend. I cc
her here.
DCC1910@aol.com
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When I went through this a year ago, the cost-effective choice was freelancers. I'm using an extended cobra so am not on them, but my understanding at the time was it's the same blue cross that I had under cobra, and only slightly higher than my cobra payments are. I plan to switch over once the cobra runs out.

we did go with freelancer's for dental and it has been fine so far, about a year now, with claims paid without issue (guardian dental) and not feeling restricted on the choice of practitioners.(i guess the freelancer's bit is actually not so relevant as the providers they contract with as my interactions with freelancers are in the form of auto-payments each month.)

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Liberty is awful. Better to be on Medicaid
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My wife and I were on both Liberty and Freedom - the big difference is the network. In the end, the question is which network the physicians you prefer are in. If you can do everything in the smaller network, Liberty is not a bad way to go. On the other hand, you need to weigh that against the price difference and how important it might be in the "what if" scenario. All hospitals take either plan (not sure about MSK or HSS, but all the others in NYC do).

As for other options, the other major carriers in NY worth looking at are Aetna and Cigna. I had just one employee on Aetna a couple of years ago. She had no complaints, but I don't know much about it. I would avoid GHI because their provider rates are terrible, so no one wants to take them. I also don't know if Blue Cross offers a small business product, but they are a good carrier.
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We use HealthPass. I can't recall the qualifiers, but it's worth looking into if you haven't already.

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I outsource all of my benefits, including Health Insurance, to ADP Total Source. They get prices that no small business could get buying direct. Also, they do all of your benefits admin and provide a host of other services. The only catch is that you have to use ADP for your payroll.

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I suggest you contact Ken Krill of the Varsity Group who is a health insurance broker I've used for many years for my small biz health insurance.
ken@thevarsitygroup.com
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There is a difference between catastrophic coverage and having a very high deductible. I run a small firm and also have had some problems making exactly the same choice. The Freelancers program is really not a health insurance program. It sets a cap, should someone undergo a catastrophe, but I cannot seriously recommend it. Moreover, I am not clear how many physicians are willing to deal with their carrier or what true coverage anyone who makes claims on it can expect.

I currently use the Oxford Freedom, but have now eliminated coverage for out-of-network providers, as the difference between the monthly premium paid and the amount I pay my out-of-network doctor when I pay him a visit made it much better for me to pay a lower premium and then pay such bills directly. That, of course, depends upon the doctors utilized, and their policy toward health insurance payments, as well as the relative health of the insured.

If you like, I can recommend a firm which specializes in helping small businesses to choose a group health insurance policy:

Marc Herold
Benefits Consultant
Michaels & Associates, Inc.
80 Business Park Drive
Suite 306
Armonk, New York 10504
(p) 914-273-4723 ext. 119
(f) 914-273-4728
(w) www.michaels-associates.com
mherold@michaels-associates.com

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We were on Oxford Liberty in 2009 - family of 5 (3 young kids).

A few comments;
• GP for wife and I were in the network, so no problem there. However, my kids' pediatrician was not, so my wife had to hunt around for a new one. It took a while, but she found one she was extremely happy with (in some respects preferred it to our original pediatrician)
• We didn't incur any out-of-the-ordinary treatment/expenses so cannot speak to the coverage or level of service.
• it was very expensive - we paid $2,700/month in 2009. Despite no unusual claims, they wanted to increase it to $3,200/month.
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I just moved my family from Oxford Freedom (paying $2250/mo for a $1,000 deductible and 80/20 for out of network). I thought the ins was outrageously expensive. I switched to Freelancers Ins PPO3 and now pay $890/mo for family of 4 ($16,000 deductible and 70/30 out of network). I dropped dental too as its not worth it in my calculations. Like you, I thought money was better in my pocket than having a lower deductible. So far, its been a month, we are happy enough. We seem to have a larger pool of doctors, surprisingly, than Oxford (meaning I was able to chose from the two top ENTs for my kid in Manhattan vs Oxford who only had 1 of the two on the Oxford plan). We stayed with all our same doctors as they take the Anthem Blue Cross Blue Shield (Freelancer's Ins). Copays are slightly more: $35 vs $25 for GP and $55 vs $40 for specialist. No pre cert required. Again, the $10/$15 more for a visit is meaningless when I save $1,360 per month. Calling Freelancers Union is fine - people are helpful enough. Can pay online which is nice - good web experience.
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Blue Cross Blue Shield of North Carolina was both the best value and the least expensive coverage that I found when looking for health insurance. I would venture to say that checking into Blue Cross Blue Shield of New York, might be worthwhile.
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We moved from Oxford high end plan to Empire high deductible HSA on the advice of:

Joe Cortelli
Managing Partner
HealthInsuranceGeeks.com
Cell - 917-301-7560
Toll Free - 1-866-976-3977
Fax - 1-888-726-8397
www.healthinsurancegeeks.com

They will show a financial model of why this makes sense.

The trick is to stay in network.

I believe that the savings in premiums more than outweigh the out of pocket in network doctor fees as you pay down your deductible.
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Ironically, I am in the same boat with having to look for group health insurance plans. The only difference wrinkle here is that I live in NJ so I know I cannot get the Freelancer's Union health insurance. So, I would appreciate you passing on any comments that you do receive on health insurance. Thanks and much appreciated given the not so little investment you need to make to have coverage these day.
Regards,
Bob
One other thought for you. I would highly recommend the following insurance broker, although I am not sure if in writes in NY but he is excellent, really knows his stuff:
Alan Salowe, CLU, RHH, CLTC, President of Midatlantic Resource Group at 732-922-6300, ext. 114; Alan.Salowe@margfinancial.com www.margfinancial.com

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I know that at my old venture fund we chose to use
TriNet and they handled health insurance and benefits for us. We had
about 12 employees.

Seem to specialize in small businesses.

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At our company we use Liazon as our "high tech insurance broker" that lets each employee choose a different plan. Pretty neat and the company is run by a McK alumnus. liazon.com
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- Bryan Kelly
212 879 0122 tel
212 879 3557 fax
bryan@myhealthplans.com

Visit our website: http://www.myhealthplans.com

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We use Emblem, it's a 20k deductible for a family but the monthly cost is only $650. I believe their network is more limited than Oxford, I have no experience with their customer service.
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We have had the Oxford Liberty (gated/HMO) plan for the past 3 years. Haven't felt any constraints with respect to doctors although haven't had the need for any kinds of deep specialist to test depth of doctor pool. Plan covers employees in NYC and NJ. We have a zero deductible plan. Overall other than the fact that premiums have risen on average 20-40% per year the plan has been satisfactory. Let me know if you are looking for specifics.

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I have attached an overview of our program and benefits package for your review. We are also undergoing annual enrollment so these plans and rates will be good until the end of the year. Aetna has been our provider for the past ten years. I am available to answer any of your questions and look forward to hearing from you.

Best regards,

Kevin Casebier
Advanco, LLC
kevin.casebier@advanco.net
o: (404) 496-4050 Ext 701
c: (678) 558-0058 (Direct)
f: (404) 496-4050
www.advanco.net
http://www.linkedin.com/in/casebier

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As a note of background, last year my wife was on OXHP Freedom and I was on OXHP Liberty. Here are some of my observations:

1. Out-of-network usage
OXHP Freedom, like almost all plans due to ObamaCare (not a political comment, just relaying facts) has moved from the UCR reimbursement method to X% of Medicare. From a 50,000 foot view this basically means if you used to go out of network and were responsible for ~33% now you will be responsible for ~67% (happy to deep dive on this and explain but for our current purpose I assume this is sufficient). Combine this with OXHP maintaining monthly premiums or slightly increasing them means if you like going out of network your costs have skyrocketed as your premiums are still high and your reimbursement got slashed. OXHP Liberty offers no out of network reimbursement.
2. In-network usage
I have found few cases where I was limited in my choice of Drs compared to my wife's choices due to our differing networks. That being said, many of our old Drs, when we were on UHC, were no longer in-network when we switched to OXHP. As a point of reference UHC bought OXHP and rebranded it as UHC everywhere except the NY area as OXHP had a better brand name here. While only companies with 50+ employees are eligible for UHC, OXHP does small companies and competes with UHC on large companies.
3. Travel
OXHP Liberty is limited to the NY area, if you travel everyone is out of network, which means no coverage as Liberty has no out of network coverage. OXHP Freedom has in network Drs around the country. Have never had a need to utilise them so don't know if the out of NY area network is robust, regardless they have out of network benefits so you aren't SOL.

I have no direct experience with the Freelancer's insurance but it sounds like catastrophe insurance which is much cheaper but like home insurance something you don't use often if at all. Only way to bust through their out of pocket limits is to have some major accident and need surgery.

I believe only 3 companies compete in the NY area in the 2+ employees small business space and OXHP is the best of the bunch.

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If its a family plan, check out Golden Rule (United Healthcare). I know - don't like the idea of the 800 pound gorilla. I looked at everything, and Golden Rule won. We are a family of six, kids age 8-16. $10k deductible, (HSA) - $588/ month. Pretty free to see who we want - but check out who's in the network before you sign up. Call if you want to discuss anything. 203-247-3312 - happy to share.
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