Changes to Special Enrollment Period Coverage Effective Dates:
Beginning January 1, 2025, NY State of Health must make the coverage effective date for special enrollment periods with no other specific effective date the first of the month following plan selection, with an earlier effective date at the option of NY State of Health.
This change removes the 15th of the month rule used to determine the coverage effective date and aligns the NY State of Health and Federal Exchange policies. It applies to the Essential Plan and qualified health plans on and off exchange.
If binder payment confirmations are received after the coverage effective date, we will effectuate coverage retroactive to the effective date.
Gold Select Updates:
The regional placemats and guidebooks have been updated to clarify the Gold Select PCP and Specialist copays.
Blue on Demand Updates:
As a reminder, individual plans, rates, placemats, guidebooks, tip sheet and product brochures for 2025 are available on Blue on Demand. The tip sheets, placemats and guidebooks have been updated to reflect the changes above.
Expanded Cost Saving Reductions:
As a reminder, beginning January 1, NY State of Health consumers with incomes between 250% and 400% of the Federal Poverty Level (FPL) will be eligible for additional assistance to lower their out-of-pocket costs.
The Cost-Sharing Reduction (CSR) benefit lowers consumers’ out-of-pocket costs, copays, deductibles and the out-of-pocket maximum limit when they receive health care services.
For example, consumers with incomes up to 350% of FPL are estimated to save $3,500 a year with a CSR plan.
CSRs are only available to QHP consumers who are enrolled in a Silver CSR plan. If a CSR-eligible consumer chooses a non-Silver plan, they cannot access the CSR benefit.
Although premiums for a Bronze plan may be less than a Silver CSR plan, consumers who use care during the year may end up paying more in out-of-pocket costs, like copays and coinsurance, than with a Silver CSR plan.
Please review the differences in premiums and cost sharing between the different plans with your clients so they can determine what plans are best for them.
Log in to the Broker Portal to access Blue on Demand. Please contact your account consultant with questions. If you do not have access to Blue on Demand, please contact Megan.Brooks@excellus.com.
