July 31, 2013
State OKs North Shore-LIJ to start selling health insurance
by RIDGELY OCHS / [email protected]
The North Shore-Long Island Jewish Health System will soon be selling health insurance.
The health system was notified Tuesday that it had been approved by the state to operate a health insurance company, two months before New York is to open up its health benefit exchange. The state's Department of Financial Services posted the license Tuesday afternoon on its website.
On Oct. 1, New York plans to open up its health insurance marketplace for lower-cost insurance as part of the federal Affordable Care Act. On Long Island, 13 companies will offer plans for individuals. The health insurance plans will take effect Jan. 1, 2014.
The health system said it will offer its insurance both on the exchange and outside it, from storefront locations.
Insurance plans for individuals and families will be sold in Long Island, Queens, Staten Island and Manhattan under the brand name North Shore-LIJ CareConnect, the health system said.
North Shore-LIJ chief executive Michael Dowling said the health system got into the insurance business to take advantage of the shift in focus from treating illness to promoting wellness, a key part of the Affordable Care Act.
"If I do all these great things and keep people out of the hospital, I don't get any of the savings; the insurers get the savings," he said.
Offering "a full-service line" also means North Shore-LIJ will have "more control over the financing side of the business," he said.
Dowling said the health system would still deal with other insurers and envisioned offering joint products with some.
Members will have access to inpatient care at the system's 15 hospitals; outpatient and specialty care at nearly 400 physician and ambulatory practices; and aftercare services such as home care and rehabilitation.
Superintendent of financial services Benjamin Lawsky commented on the North Shore-LIJ move into insurance at a Crain's Business Breakfast Forum in Manhattan Tuesday, saying that "we've seen in other states providers starting to also become health insurers, and this has the potential to really bring rates down."
Earlier this month, the state revealed how much health insurers planned to charge for different "tiers," or levels of coverage. North Shore-LIJ's charges ranged from $183.53 a month for catastrophic coverage to $568.13 for the so-called platinum tier. The benchmark "silver tier" charge is $419.62, among the least expensive offered by the 13 companies.
Crain’s Health Pulse
North Shore-LIJ License OK'd
August 1, 2013
The state Department of Financial Services approved the North Shore-LIJ Insurance Co.'s application for an insurance license on Tuesday, officially launching North-Shore LIJ into the role of commercial health insurer. Products will be sold under the name North Shore-LIJ CareConnect. The license lets the new company begin marketing plans on and off the New York Health Benefit Exchange to customers in Long Island, Queens, Staten Island and Manhattan. "As the first provider-owned health plan in New York," said system President and Chief Executive Mike Dowling in a statement, the new insurer can "deliver a simple, total solution for individuals, families and businesses looking to access both high-quality medical care as well as more affordable insurance coverage."
Becker’s Hospital Review
New York Approves North Shore-LIJ Insurance License
July 31, 2013
North Shore-LIJ to Launch Health Plan
August 1, 2013
Long Island Business News
NY Grants North Shore-LIJ Insurer Status
by Claude Solnik
July 31st, 2013
Long Island’s largest health care provider, the North Shore-Long Island Jewish Health System, is now its newest insurer.
The system found out late Tuesday that the state’s Department of Financial Services granted it a long-awaited license to offer health and accident insurance.
The system, through its North Shore-LIJ Insurance Co. subsidiary, will begin marketing “a wide range of commercial insurance plans” under the brand “North Shore-LIJ CareConnect.”
North Shore-LIJ will offer insurance starting in October, effective at the start of 2014, through the New York Health Benefit Exchange across Long Island, Queens, Staten Island and Manhattan.
CEO Michael Dowling said the system is “simplifying the process and transforming the way we connect with and serve our customers.”
“Taking risk for a population in this manner will significantly add to our capabilities to work productively and creatively with other third-party insurance company partners,” he said.
In order to offer insurance, North Shore-LIJ is partnering with a third party administrator. The system declined to disclose the name of the firm.
Nevertheless, North Shore-LIJ’s decision puts it in direct competition with many insurers that have long been its biggest customers – and toughest negotiators.
“They’re cutting out the middle man,” Alcott HR CEO Lou Basso said. “They’re cutting out the carrier.”
The system is only selling Exclusive Provider Organization or EPO plans on its commercial license, which means policies offer no out-of-network benefits, except for emergencies.
Preferred Provider Organization or PPO plans offer benefits in and out of network, with higher benefits in network.
North Shore-LIJ said members can get benefits at its 15 hospitals and outpatient and specialty care at nearly 400 physician and ambulatory practices.
The system also offers in-network access to home care and rehabilitation as well as access to thousands of physicians, physician assistants, nurse practitioners and other caregivers throughout the New York metropolitan area.
“You need a truly integrated delivery system. You have to be able to say to a customer, ‘I can cover the family. I have all the specialties,’” said Peter Armstrong Egan, an attorney specializing in health care at Nixon Peabody in Jericho. “North Shore-LIJ’s the first one around here.”
Others said the success of the plan could depend on cost and whether people believe the system’s network is big enough.
“Of course, it’s of interest,” said Andy Lubash, a principal at Melville-based Prestige Employee Administrators. “If this fits needs and price points.”
Although this is new territory for North Shore-LIJ, the system has already partnered with UnitedHealthcare to offer a policy based on its network.
“You would think if they do it well, they can offer a product that will be more reasonable [than others],” Basso said.
North Shore-LIJ’s rates on exchanges can be nearly half those of some other policies for individuals, but seem in the range of some HMOs.
Its platinum policy for individuals on the exchange for Long Island would cost $586 a month, slightly better than the Empire HMO at $598 and the HIP HMO at $631.
But that’s nearly half the $965 for the Oxford HMO and the $913 for United’s platinum policy.
North Shore-LIJ’s platinum plan for small groups on Long Island will cost $746 per month for one person, while Oxford’s HMO costs $773 and United’s plan will cost $752.
“Time will tell,” Basso said. “North Shore LIJ understands the market. But being a carrier is different than being a provider.
“They have a lot of money,” he said. “I’m sure they’ll figure it out.”