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First and foremost, we apologize for this being the first newsletter since the third quarter of 2013. The reason for our delay is because health coverage has been a moving target and we wanted to be certain of the facts before passing along any information. We have learned from experience that things are not always as you assume them to be. This is especially true whenever the government is involved.
Needless to say things have been more than hectic as a large portion of our membership are sole proprietors. They have been treated, in our opinion, most unfairly by PPACA (Obamacare).
Please be advised that numbers 1, 2 and 5 apply to sole proprietors and numbers 3 and 4 apply to all size groups.
As a result of the private exchange we have established with CDPHP, members that qualified as small groups prior to Obamacare will be able to continue their CDPHP coverage.
Many of our members are seeing double and even triple rate increases. Why is that you ask? It's really very
simple- there are five significant factors:
- Sole Proprietors are no longer eligible for group coverage which is what our members enjoyed prior to Obamacare.
- Husband and Wife businesses prior to Obamacare were considered as employer groups. Obamacare made these groups ineligible for consideration regardless of how their taxes are filed.
- Prior to Obamacare you could take our plans without prescription coverage. This rewarded those who took care of themselves. If you did not need prescriptions you saved 20-30% on your premiums.
NESBG was pleased to be one of the only associations
offering their members this option. We had more than
35% of our members not taking prescription coverage.
Obamacare now requires that all health plans contain
prescription drug coverage regardless of whether you
need that coverage or not. Those of our members who
did not and still do not need that coverage are being
hurt the most.
4. Family plans are penalized. The reason why is that
prior to the implementation of Obamacare, most
plans upstate offered a two, three and four tier rating
structure, which we of course offered to our members.
At the risk of making this complicated, the multiplication
on a two tier rate from the individual rate for a family
was 2.6 and for a three tier rate it is 2.65 and for a four
tier rate it is 2.85. Only four tier rates are now available
under Obamacare which means if you had the same
plan and had a family contract with a 2 tier rate - your
premium just increased by 25%. This is the difference
between 2.6 and 2.85.
5. Our primary carrier CDPHP, decided to cancel all NESBG
sole proprietor businesses upon renewal since Obamacare
dictated they were no longer eligible for group coverage.
We do have alternative plans available through MVP and Health
Republic provided through Apollo Partners NY. Membership in
NESBG is not required, but is appreciated. We have several
other services for members to take advantage of, such as the
Member-to-Member Program, Toll Free Numbers, Website
Programs, Payroll Service, Dental Programs, Legislative
Advocacy and of course Newsletters like this one. Please
also note that we are updating the Apollo website and
this will be done in approximately one week so you can
check back at that time for updates.
We will do our best to keep you updated as the year progresses.
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