2018 MIDTERM ELECTION

Time: D H M S

NEW YORK: Excellent development in the Health Republic saga! (seriously)

Things have been changing rapidly in the ongoing Health Republic of New York saga, and as recently as last night each development seemed to make the situation worse...but a few hours ago, Politco New York reporter Dan Goldberg posted a new story which indicates that the powers that be finally have some positive news:

In an effort to head off a potential health insurance disaster, state officials on Sunday announced a series of steps to protect roughly 200,000 customers who are set to lose their health coverage, and promised to investigate the company behind the crisis.

...And those were just the customers who were aware of the change. No one could say for certain how many were unaware they were about to lose their coverage, and other insurers operating on the exchange expressed concern that the customers most likely to pick a new plan were the ones most likely to be sick, a scenario of adverse selection that few companies were prepared to handle.

...With just one week until the Nov. 15 deadline, the state announced in a press release it will extend the enrollment deadline until Nov. 30, providing Health Republic customers an additional two weeks to shop for a new plan.

Those who do not choose a plan by the end of this month will be automatically enrolled into a new insurance carrier, though the state did not provide details as to how that will work, which plan customers would be enrolled in, or whether their physicians would be covered under these new plans.

The details are still pretty fuzzy about how the process will work, but both of these policy changes are huge improvements over the previous situation. Bumping the official deadline out by another 15 days (as opposed the quasi-extension option which I described last night) buys tens of thousands of people an extra couple of weeks to sort things out. Meanwhile, the automatic enrollment into a "similar" policy for those who miss the cut-off, while not ideal (many will still have to deal with "in network" headaches and the like) is still a hell of a lot better than getting cut off completely. Some people will still be in dire straits, but this should help tremendously for the vast majority of those impacted.

In addition, there was a third announcement which may also help reduce the damage if they're able to work something out:

State officials also announced they are in discussion with Memorial Sloan-Kettering, which is treating hundreds of Health Republic customers, as well as other hospitals, to ensure access for up to one year, though how exactly that will be paid for has not yet been resolved.

Health Republic was the only plan on the exchange that had contracted with Memorial Sloan-Kettering, and now that Oscar Health Insurance has dropped New York-Presbyterian, there are no plans on the exchange that offer that health system either.

Kudos to Mr. Goldberg for staying on top of this, as well as the various regulators/officials who are making this happen (obviously it remains to be seen how smoothly the process goes, but for the moment, this is a very welcome development).

UPDATE: Here's the actual press release from the NY DFS:

NYDFS AND NYSOH ANNOUNCE ADDITIONAL ACTIONS TO PROTECT HEALTH REPUBLIC CONSUMERS

  • NYSOH Extending Individual Enrollment Deadline and Creating Auto-enrollment Option
  • NYDFS Investigating Health Republic’s Inaccurate Representations to the State on Company’s Financial Condition

The New York State Department of Financial Services (NYDFS) and New York State of Health (NYSOH) marketplace today announced a series of additional actions to protect Health Republic consumers and help ensure continuity of care and coverage, including extending the NYSOH enrollment deadline for individual Health Republic customers to choose new coverage for the remainder of 2015 and creating an auto-enrollment option.

Individual Health Republic members can select a new health insurance plan for 2015 through the NYSOH marketplace by November 30, 2015. After that date, however, in order to ensure continuous coverage, the State will auto-enroll individual Health Republic consumers who purchased insurance in the NYSOH marketplace in new health insurance plans. Additional details regarding this auto-enrollment option will be announced in the coming days.

NYDFS is also investigating Health Republic’s representations to the State about the company’s financial condition. On October 30, 2015, NYDFS found that Health Republic’s finances were substantially worse than the company previously reported to the state, making it necessary to end the company’s policies as of November 30, 2015.

Anthony J. Albanese, Acting Superintendent of Financial Services, said: “We will continue to take aggressive action to protect consumers in the wake of Health Republic’s failure. The extended deadline and auto-enrollment option are important steps in helping ensure the company’s customers do not go without insurance. Additionally, while our first and primary focus is protecting consumers, we are also investigating the inaccurate representations Health Republic made to the State about its financial condition.” Donna Frescatore, NYSOH Executive Director, said: “Health Republic customers should act as soon as possible to choose a new health plan. However, to help ensure that consumers do not face unexpected gaps in coverage, we will create an auto-enrollment option for individual Health Republic consumers who purchased insurance on the state marketplace. We will outline additional details surrounding this auto-enrollment option in the coming days.”

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FACT SHEET: NYDFS and NYSOH Actions Regarding Health Republic

  • 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.)
  • Auto-enrollment Option. To help ensure that consumers do not experience an unexpected gap in coverage, NYSOH and NYDFS are working with other NYSOH Marketplace health plans to provide for automatic enrollment of Health Republic members who purchased coverage on the individual NYSOH marketplace and do not select a new plan by November 30, subject to an opt out provision for members who want to decline this new coverage. Consumers who automatically enroll in this way will be eligible to continue to receive premium subsidies through the Marketplace. Because of the “opt out provision,” enrollment in these new plans would be voluntary. These new policies would be effective on December 1, 2015. Additional details about this auto-enrollment process will be outlined in the coming days.
  • 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 Balance Billing and Surprise Billing of Consumers. NYDFS is taking actions that will apply a New York State law that prohibits providers from collecting or attempting to collect from Health Republic consumers amounts that are owed by Health Republic. Additionally, 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 7, the hotline has answered nearly 11,000 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 & Marsell 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.