Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

I have received the letter from my healthcare provider indicating their request for rate changes for 2019, and I am appalled. I’m already paying $1057 per month for a 3rd tier plan and one of the few plans available in County. It carries a significant deductible and so far has denied tests that my physician feels is necessary for assuring my continued wellbeing. I can’t even seek healthcare outside of NY! How can they possibly want more money from me? The rate increase appears to be 28.40% which may end up costing me out of healthcare for 2019 altogether! I’m years old, have my own business and wondering what New York is doing for individuals to continue living in this State? How can New York allow insurance companies to take such advantage of its individual working middle class citizens? Please help us!

I am already paying $1350 per month and they are proposing a 35.3% increase on top of that? I am not just making idle threats, I will go uninsured if that is the cost for 2019. It is insane and totally unfair to the consumer. I go to the gym 5 days a week and am healthy so what are they thinking? Please do anything to stop it. That is a a $477 increase monthly. Thank you for your time.

As you can tell, I have an EPO plan which allows me to see a specialist without a referral. In addition, selecting a primarycare physician is not required. The 2019 policy would require the selection of a primary care physician who would give referrals if needed. Firstly, eliminating their EPO plans gives very few choice options upon renewal. Secondly, changing this plan to a gatekeeper one is basically naming it an HMO. In addition, the requested rate increase of over 35% is outrageous. The 2019 downgraded plan should result in a lower premium than that of 2018. Thank you in advance for your consideration in this matter.

To whom it may concern, This is the second year in a row that Empire is requesting a premium rate increase that is astronomical! My premium went up from 2017 to 2018 by $600 and now for 2019 they are asking for another 22% increase. Since all the major carriers, Aetna, Oxford and Empire do not carry small business only large businesses the majority of the population in NYS has reverted to individualized plans and count on them to provide their health insurance. It's a bonus if you can receive subsidized premiums if you apply through the NYS of health. The average New York resident can not afford to keep paying these increases. People will continue to move out of state and or go without coverage leaving them uninsured. All the insurance companies are becoming greedy and we as paying tax citizens do not deserve this. ! Please DO NOT APPROVE THIS Increase for Empire Health Choice Assurance, INC Thank you for your time and concern

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

I received a notice today that Empire is applying for yet another premium increase which is shocking. My premiums have been increased every year. I currently pay over $729 a month for the only plan available to me through Empire which has a $5,500 deductible. Other than the one preventive exam a year, I have to pay for all my other medical visits out of my pocket due to the high deductible. This means Empire is receiving my high premium payments every month for close to no costs to them based on the game of offering these high deductible plan to individuals who have no other access to affordable medical plans. I am part of a select population of individuals who have been targeted by Insurance companies. To continue to allow Empire to increase their premiums every year for individual plan especially in

where we pay the highest premiums nationwide creates a population of individuals who out of desperation funnel their savings into a plan that is nothing more than an emergency plan since I cannot afford to visit a doctor when my dollars are going to paying the high premiums. I ask you to consider this often neglected population of individuals who are not covered through an employer yet do not qualify for medicaid especially in . Another increase would leave me without healthcare. I ask that you deny yet another increase to Empire for plans that already have outrageous monthly premiums attached to outrageous deductibles. Thank you for the opportunity to submit my comments.

Empire is proposing a 35.30% increase on my already obscenely overpriced EPO 0, Platinum plan. I now play over $1269 a month. A 35.30% increase would bring raise my monthly insurance by $447.96 to $1716.96!!!!!!! No one should have to pay this much for health insurance! In there are very limited choices for citizens looking for a good quality individual plan. I have no choice - Empire is the only individual plan that my long time doctors and hospitals accept. I have and other issues. How can this increase be justified? Do not allow Empire to raise their already too high rates! Or give residents of who need individual plans some realistic alternatives. The other individual plans available are not something any of our elected officials would choose for themselves or their own families. Please say NO to Empire’s outrageous premium increases! Thank you.

Your current premiums/deductable s are unaffordable already, increasing them is barbaric. Adding a gatekeeper is also adding further hardship on top of that after paying highest premiums out there that empire has already. You are making people pay unaffordable prices all around and causing severe hardship in the process.

From 2017 my Empire Silver plan went from $650 a month to $882 a month, an increase of over 30%. This year Empire is planning a 27% increase which will boost my monthly premiums to over $1000 a month. What justifies this? How am I supposed to afford health insurance if this continues? This is extortion, something encourage by the Trump administration. The New York State DFS must stop them!

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

I am paying $747/month for 2018 health insurance WITH a subsidy. Empire is asking for a 28.40% increase for 2019. This is Affordable Care Act individual insurance. It's not affordable at all. I pay a $40 copay for specialists, and when I get an , I pay a $50 copay for a surgical procedure. So that is $90 out of my pocket, assuming I have paid my annual deductible. The only one benefiting from this insurance is the hospital, which gets stuck with fewer unpaid bills. I can't afford the Affordable Care Act, and I can't afford a 28.4% increase in premium.

Hello, I started my own business in 2015 and received insurance through freelancers union. When the ACA rolled out the freelancers option went away. Those first two years (2015-2016) I had good and relatively affordable insurance. Last year, the premiums went up but I continued to stay with Empire as they have the most robust network. The premium went up again this year, but the more affordable options did not allow me access to my local hospitals or physicians, so I stayed with them again. Now, I received a notice Empire Heath Choice is asking for 13% increase for 2019!! I have no other options as they have the best network, but I am unable to grow my business and afford such high premiums that still have significant deductibles. I feel trapped. I realize I am lucky in that I've been able to afford good insurance while others are not so lucky. It is terrifying that as a small business owner in a good neighborhood in

I find myself looking at closing my business or having to move as I will unable to make ends meet. If this is happening to me, I am very scared for so many who others who will not be able to afford insurance or to afford good insurance that will allow them to maintain a relationship with current doctors or to have access to care in their immediate community. I know the system is broken nationally and especially in NY. Please hold these insurance companies accountable to operating differently - perhaps reducing profit margins. My family worked in healthcare administration in NY for 30+ years. Something must be done. Please do not allow yet another increase for individual plans.

Dear Ladies and Gentlemen, I am self-employed resident who purchases a insurance plan for my family of persons from Empire HealthChoice Assurance, Inc. I received a notice of proposed premium rate change of +35.3% for my plan for 2019, which would be Empire Gatekeeper, Platinum, ST, INN, Pediatric Dental, Dep 25. I currently pay monthly premiums of $3,596.81, and for 2019 this would increase to $4,866.48 per month, or more than $58,000 for the year. I appreciate that I have some choices, albeit limited, as a self employed resident seeking a high quality plan for my family's health insurance. However, I urge the New York State Department of Financial Services to thoroughly investigate the reasons for, and to examine independent evidence concerning, this massive proposed increase. It seems to be extreme and unjustified by the insufficient one-sentence explanation provided in the notice provided by the insurer, which states The requested increase is due to our evaluation of current market trends and issues, including the rising cost of medical care, a changing pool of customers and our experience with provider networks. Thank you for your attention to my comment. Sincerely,

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

Rate hikes by Empire HealthChoice are out of control! When will it end? Every year they cancel the current policy and force buyers to look for a new policy which, inevitably, is far more expensive. This time they are proposing a 35% increase! Outrageous!! Please don't let them keep doing this!! Stand up for the people for once, and not for big corporate interests. Thank you.

A year ago, Empire Blue received a rate increase on my Silver plan of more than 50 percent, an astronomical increase based not on actual but projected increases in expenses. Now they return to the well, unabashed, unhumbled, for a 23.10% increase, the result of which my insurance will have nearly doubled in expense in less than two years, at a time of slowed rise if not actual decreases in medical costs. This is simply outrageous. I ask that you deny such an increase altogether. In fact, to match their audacity, I ask that you reduce their premiums by 10 percent. This is of course arbitrary and may make me seem unreasonable. But consider the following: In 2017, Anthem, Empire's parent company, saw profits rise 44 PERCENT to $1 billion dollars in the FIRST QUARTER ALONE, after which they received this greater than 50 percent increase in premiums for 2018 (See, for example, https://www.forbes.com/sites/brucejapsen/2017/04/26/anthems-profits-soar-but-wont-commit-to-obamacare-beyond-this-year/#11de5c8f3cdb). Was their request for a 50 percent increase reasonable?: By their own admission, their first quarter report indicated their profit rising 33 percent to $1.3 billion dollars based explicitly on medical cost performance (See http://ir.antheminc.com/phoenix.zhtml?c=130104p=irol-news_financial_investnyo=0) In sum, they cried wolf in spite of enormous profits, they cried wolf and received a 50 percent increase and increased profits; now they are crying wolf again after their profits have increased. This is shameful. The premiums should be decreased. I know that the 10 percent decrease I suggest is arbitrary, that I do not have the exact economic data from which to argue this case. Please take the figures in the spirit intended: You alone can protect consumers on the exchange from being gouged, at a time when Americans receive very little protection from health insurers. Businesses such as Empire and Anthem have enormous financial and political influence. I ask that your sympathies lie not with them but with us, and that those sympathies be translated into action. I do not wish these companies to go under; I wish that their requests be viewed with rigorous skepticism given their and where they are found to have inflated their expenses, that the DOFS roll back their requests and restore integrity. Not an increase but a decrease until such a time that they are actually losing money. Thank you for your attention.

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

EMPIRE Healthchoice Assurance is proposing a premium increase of 10~30% in my area for 2019; 23.1% for my specific policy. Although technically not a crime since the price increase is proposed through legal channels, it is criminal to propose such a drastic increase in cost to provide healthcare coverage. It is immoral to require health insurance coverage by law and also make it so expensive that honest, tax-paying people cannot afford decent coverage. My name sounds foreign so my opinion may be ignored by American lawmakers but it is unfortunate that in one of the worlds wealthiest and most powerful countries people are forced to suffer financial extortion by the healthcare industry. Although I earn a modest yet satisfactory living(salary), I am forced to apply for state sponsored financial assistance and also pay higher taxes to cover the financial aid I receive from the taxpayers(including myself) of this state . The tax funded healthcare financial aid system seems to be a loophole made to benefit large healthcare companies since I am paying higher healthcare premiums and higher taxes to provide the same amount of healthcare for myself (that I am required to do by law). Please recognize the hypocrisy of this system and put a stop to increasing healthcare premium rates.

I strongly object to the premium increase!!! I have had to pick and choose and been disqualified from using many doctors that I've been referred to because my plan doesn't cover them EVEN THOUGH I have a gold plan and pay over $1,000/month now. I have no doubt that the coverage will be equal or less for more money. The insurers are not using the premiums to reinvest in the system; rather they are stripping it of any value and taking the cash out. PLEASE DO NOT APPROVE this drastic rate hike!!

Presently, I have Empire EPO, Platimum, ST, INN, Pediatric Dental, Dep 25 for which I am paying $1262.04 per month. Under this plan there was no need for referrals. That is one of the reasons for my going with this plan. At the monthly premium that I am now paying, I thought at the least l was getting something for my money. This year l had to retire; but, l am not yet eligible for Medicare. Empire is requesting a 35.30% increase. That would put up my premium to $1707.54. Besides putting a great strain on me both financially and emotionally, Empire is now also requiring under the new plan (Empire Gatekeeper, Platimum, ST, INN, Pediatric Dental, Dep 25) a gatekeeper. What am I getting for my money? The increase is well ahead of any inflation rate. We are certainly not experiencing 35% inflation. Are Empire lost statistics so great as to require such a steep increase? Empire is making access to health care very difficult. Perhaps, people are best off just going to an emergency room when healthcare is needed? Please do something about this increase and the requirement of a gatekeeper. They are leaving individuals who are near Medicare age with less and less choices. I have no one else to depend upon except the DFS. Please help individuals like me who are not millionaires, but at the same time do not qualify for financial aide. Please! Respectfully submitted.

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

People like me are already in a bind, and now it looks like it's going to get even tougher. As a who needs healthcare coverage my monthly payments take a big chunk out of my bottom line. In 2017 I paid

somewhere in the neighborhood of $550/mo for a personal health plan with Empire. Not ideal but doable. In 2018 the premiums rose so much that I was forced to step down a level in insurance (higher deductible) while paying an additional $200/mo for coverage. My PCP will only accept my specific Empire plan since I'm a , which means I'm stuck paying this exorbitant amount each month. Going with other (less expensive) providers is not even an option with my doctor. Not to mention that I pay him an annual concierge fee. The current monthly amount hurts me enough already. Now I'm learning I might be asked to cough up even more - 13%? As it stands, I find myself paying a lot of money right now stressing and hoping I don't use insurance whatsoever because I won't be able to afford the deductible. Where is the common sense in any of this? I know I'm not an anomaly and I love working as a who adds value to the workforce. But another raise in rates gives people like me no option but to shut down the operation I've worked at for 10+ years at to join bigger businesses like a sucker. Please don't do this to us. Thanks for listening.

I just received a notice from Empire Blue Cross Blue Shield and they are notifying me of a requested medical care premiums increase of 28% for 2019. That is outrageous and simply not affordable. I already am paying nearly $25,000 a year for medical insurance for my wife and I and an increase like that is a disgrace. I can barely afford the premium I am paying now. I should not be required to pay for all of the free medical care being provided to those who choose to not purchase any insurance and receive free medical care.

Dear NFS The proposed increases of health plans premiums in 2019 (in the range of 30%) come as a shock after a similar increase in 2018. This is not even in line with the actual increases of healthcare costs and denotes a broken healthcare system, as we know. Deteriorating public health, with huge impacts on quality of life and on the economy, is a regrettable consequence of inaction. In 2018, international plans, although not ACA-compliant, were roughly at the same costs as US plans for comparable coverage. With such US plans increases and the removal of the ACA individual mandate, US insurers may lose market share to international insurers. All of this is even without speaking of the deteriorating of the quality of care itself in the US, compared to other developed countries. #37 in efficiency http://www.who.int/healthinfo/paper30.pdf or Last in quality of care: https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-u-s-highest-rate-deaths-amenable-health-care-among-comparable-oecd-countries or https://nordic.businessinsider.com/the-16-countries-with-the-worlds-best-healthcare-systems-2017-1/ In any case, we oppose strongly the proposed 2019 premiums increases. Best regards

A 27.20% increase in my premium? This is after my previous insurance plan was cancelled and I was forced to choose a more expensive policy already! This is disgusting! Shame on you!

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

I currently received notice that Empire Blue is asking to raise my premium by 27.2% for 2019 which is outrageous. I highly object to this sort of increase.

My insurance plan is Empire EPO 600,Gold, ST, INN, Pediatric Dental Dep 25. My individual coverage is currently costing me $1,057.86 per month not including my deductible, copays and/or out of network doctors. It has come to my attention from Empire BC/BS that they are proposing a 28.40% rate increase to my insurance. If the rate increase goes through, my insurance will cost me $1,358.29 per month which is $16,299.51 per year. This is hardly affordable! Please DO NOT let Empire BC/BS increase my insurance rate. Sincerely,

If the proposed rate hike of 27.20% on our Empire EPO 2000 Silver policy is approved, it basically means the end of insurance coverage for my husband and myself, especially if our ACA tax subsidy is reduced or eliminated. I urge you to consider the number of people who will be forced to drop from the insurance rolls as a result of these egregious hikes and what that will mean to the overall health, economic, physical and mental, of our country.

Although my current health plan is the most extensive and costly individual plan currently available on the NYS exchange, it is still a daily struggle to ensure I receive quality care. My husband and I own a small business that providesjobs to New Yorkers and tax revenue to the city and state, but rising health case costs (and the hours each week required to navigate health insurance) prevent us from growing our business and increasing hiring, while also decreasing the tax revenue we remit to New York City and State. Increased insurance costs and a more difficult-to-navigate gatekeeper plan model will further reduce our ability to be job creators and contributing taxpayers. It is unconscionable that it is so difficult to get good care even at this highest available tier, and absurd that Empire would request permission to dramatically increase premiums while further restricting ease and quality of accessing care by moving to a gatekeeper model. For this reason, I strongly urge you to decline Empire's proposed changes to plans and rates.

WE ARE SMALL BUSINESS OWNERS AND PAY FOR OUR OWN HEALTH INSURANCE. EVERY YEAR OUR PREMIUMS INCREASE HUNDREDS OF DOLLARS PER MONTH. FOR WHAT? IF WE PAY MORE WE EXPECT TO GET MORE SERVICE/PRODUCT FOR THE INCREASE. ENOUGH ALREADY! WE ARE NOT GETTING MORE OF ANYTHING FOR THE INCREASE. BETWEEN OUR MONTHLY PREMIUMS, MEETING DEDUCTIBLE, PAYING CO-PAYS FOR DOCTOR VISITS AND PRESCRIPTIONS WE ARE PAYING MORE EACH MONTH THAN JUST THE PREMIUM AND IT'S OUTRAGEOUS. IF THE PROPOSED 19.70% INCREASE IS APPROVED FOR OUR PLAN FOR 2019, WE WILL BE FORCED TO SWITCH INSURANCE COMPANIES, OR WORSE MOVE OUT OF NY! OUR PREMIUM OF $2,000/MONTH IS TOO MUCH ALREADY. WITH THE INCREASE OUR PREMIUM WILL GO UP AN ADDITIONAL $400/MONTH! WE CAN'T PAY THAT.

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

The premium rate increase request by Empire of $32.7% is utterly excessive and unreasonable on top of already a very high premium. The current premium rate is already exceedingly high and is the highest from all of the options on the NY exchange marketplace. I was forced to choose it as other choices are rarely accepted by many NYC doctors. I believe Empire uses its unique network monopolization position to dictate the excessive high premiums. The current coverage is already limited and any increase will force me to stop the coverage to be without a health insurance as it's completely cost prohibitive.

To Whom it may concern. I am inquiring about the up and coming rate increase for my Health insurance. As of 2018 my old plan of 2017 was eliminated, the present comparable plan, which with very few exceptions is identical, came with 28% higher premiums. With all do respect, I now see the new rate increase for my situation has a possible rate increase is 22%, this is beyond reasonable.

I received the notice of premium rate change for my plan from my insurer. I have the plan Empire EPO 5500 for HSA. I currently pay $729.59 per month (and have a $5,500 in network deductible) myself as I'm self employed and they want to raise the rate by 13.9% which equals an increase of $101.41 per month or an additional $1,216.92 for the year. They write in the letter that coverage changes for 2019 will effect deductibles, copays, coinsurance, benefit limits, and/or annual out of pocket maximum amounts. Before submitting comments I wanted to learn the details of these changes. Upon speaking with a health plan advisor from the insurer I was informed that they had no details to share as more information regarding these coverage changes would be released in November. As a result, it's hard to write comments on coverage changes about which I know nothing as the comment period is 30 days. However, I suspect based on past experience with this insurer that they will increase deductibles and decrease my flexibility and how much value they provide, which is already limited while they obviously increase my premium. In addition, it will require members to choose a gatekeeper aka a primary care physician who will amongst other responsibilities provide referrals to specialists. As my current plan stands, I do not need to get my primary physician to give me a referral for a specialist so that's a definite negative even though they want more money. One of the few if only added benefit this year. Last year I had the same insurer with the plan Empire HMO 2250 Silver where I paid $577.60 monthly premium with a $2,250 in network deductible. They eliminated that plan for this year so I had to choose a new plan. I believe I'm paying more but getting less and I fear this same scenario will repeat itself in 2019. I don't understand why I should pay more but get less. I believe in value and if they provided me with value then I'd be willing to pay. You might be asking why do I stay with this insurer? Previous to 2017 I had United as my insurer but then they left the NY marketplace so I was forced to choose another insurer. Over the years there are less and less options in NY. I'm definitely an individual on whom the insurance companies make a substantial profit. I'm just asking for the insurance companies to be fair. Thank you for your consideration.

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

I am , considered healthy, but the thought of my monthly insurance bill going any higher makes me sick! I just heard my insurance company declared a $3.4 BILLION PROFIT....off of who's back I might ask? They are suggesting a 27.20% increase on my Empire Silver plan.... This is completely unjust and an outrage. I do not support the request for an increase by Empire BCBS a part of the Anthem company and Empire Health Choice Assurance, Inc. Please do not give it to them.

My plan is changing from an EPO to Gatekeeper..so it is not as good. I have to have a primary care physician make referrals to specialists next year. Also, since it is a new plan, I have no idea if my doctors are part of it. I have had tochange plans almost every year for 6 years because the insurance companies keep discontinuing the plan I am on. I am very tired of the rollercoaster of changing doctors over and over. So this plan is worse, and my rate is supposed to go up 13.9%, and I have no idea if I have to get new doctors or not. I am sick of this. NEW YORK STATE: DO SOMETHING since our federal government can't do anything.

A 32.90% increase is ABSOLUTELY absurd!!! This is NOT affordable healthcare - individual premiums are already very expensive at $1057.86 a month. I will have no choice to change my insurance in 2019 if the premium gets raised to over $1500 monthly. I understand the issues with inflation, but please help make this more affordable!

Empire Blue Cross is requesting a 27.2% rate increase for 2019. While I understand that there should be small increases each year, my health insurance premium increased by almost 50% in 2018. Please do not allow such a large rate increase.

I just received notice that my premium rate will go up at least 23%. I already pay $882. Last year the rate went up by 15 %... How much more are we expected to pay if it goes up each year? Unacceptable.

I make a little over a year and my insurance will be about $38,000 (family plan) with a $4,000 deductible- how can anyone justify that, considering no one wants to take my insurance because they say it's the Marketplace. I'm tired of basically paying for those who cannot afford insurance but still get the same garbage insurance I have. Thank you to the people who made Obamacare work for the poor and unemployed population- it's screwing up my life. Not only that, I'm not able to purchase my own insurance on the private sector. These increases do not make any sense, let alone the $30,000 that I'm paying now. The Marketplace has the worst doctors on their network- in fact most of them, when called say that they no longer take these plans!

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

Hello, I am appalled at the proposed increase in premium. I am retired and have to purchase my own health insurance at a cost of $882, with a deductible of $2,000 plus co-pays. To have BCBS increase by 27.20%, that would be $1,120 per month!!! This is out landish. In addition, for that amount they want to change the plan to a referral program where I would have to ask my PCP to visit doctors to specialists and other providers. The reason I have this plan is to NOT have an HMO type of plan, where referrals are a pain in the neck and that is why I picked this already EXPENSIVE plan in the first place. For this reason, I ask that you to please DENY, DENY, DENY this proposed increased. Thank you very much!

Unknown Insurer2019 Public Comments

-----Original Message----- From: Insurance Inquiry Sent: Friday, June 08, 2018 9:42 AM To: Subject: NYS Department of Financial Services Consumer Assistance Unit Inquiry : Your inquiry submitted to the NYS Department of Financial Services Consumer Assistance Unit has been received and will be reviewed promptly. The information you entered is as follows: Your Name: Email:

Your Company/Organization: Daytime Telephone#: You are a(n): CONSUMER Type of Insurance question/comment: HEALTH Your Questions and/or Comments have been recorded as follows: * * * * * * * * * * * * * * * * * * * * * * * * * Why do health insurance costs go up every year without fail? And why do you use obfuscating language in your increase notice. "Modify"! "Change"! oh please! This is a shameful racket and anyone- anyone who plays a part in it should be ashamed of themselves. Wake up and be human! * * * * * * * * * * * * * * * * * * * * * * * * * Sincerely, New York State Department of Financial Services Consumer Assistance Unit. email at: consumers@dfs.ny.gov

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

These proposed rate changes (13.9% increase on our Silver Plan) are untenable for us as a family. We have looked through Empire BlueCross BlueShield's justification for them and have found very little justification for such a significant and damaging increase on a plan that already offers very few benefits.

The proposed rate increase for the plan I had last year(Silver EPO) in my area is 27.20%. That is very high especially considering that the plan will go from an EPO to an HMO.

I am a self-employed : I work freelance for a . I have had to pay for my own insurance for the past 23 years, and have often had to change my insurance -- yearly sometimes -- because companies don't want to cover individuals. It is enormously stressful. And now Empire/Anthem BCBS, which I've been using for a year and a half, wants to raise my premiums 27%. That is going to be another $238 a month on top of the $882 I'm already paying. That's $13,440 a year, not to mention copays and meds, etc., and it will amount to almost 25% of my income. It is unconscionable that these insurance companies should be allowed to raise rates at such steep percentages. 27% is just greedy. Please do not sanction such a huge jump in my premium.

My provider is Empire Blue Cross Blue Shield. They have requested an increase of 28.4% for our plan. That would put our premiums close to $3000/month for two people. This is unsustainable and borders on inhumane. People will not be able to afford insurance, and the results of that will be illness and death. I understand there are huge pressures and work here but I am begging you to reduce - or eliminate - this increase. People's lives are literally at stake.

A sizable rate increase has already been applied this year in January. As a result, had to choose a less comprehensive plan by paying 25% more than paid last year for a better plan. This new increase is not justified by quality of service/coverage. Both premium and deductible are currently high and a further 27% rate increase on a yearly basis is not sustainable, especially since the plan would downgrade again, from a EPO to a Gatekeeper.

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

I am self-employed with We have no group plan option. My empire BCBS family plan premium is $3596 per month. That's $43,152 per year... more than half of our household income, and far more than we can afford. This proposed rate increase of 35.3% is astronomical and will result in a yearly premium of $58,384, or $4,865 per month. Note that $58,384 is approximately the same as the medium household income in the US in 2017. We will surely have to drop this plan and seek out a lower quality plan. Or, if we qualify for the exchange (we did not last year), we'll have to find a plan that provides the coverage we need and that our doctors accept (we chose this plan because it was the only plan that all our doctors accepted and that offered the services we require.) I've had to deal with insurance this year a ton ( ) and I can list a dozen major inefficiencies off the top of my head, which lead to so much financial waste; rather than raising premiums, i think it would be smarter for the insurance companies to seek inefficiencies and streamline themselves. 3 quick examples: (1) for claims and HIPPA-related correspondence, they still only accept faxes, rather than a secure portal. That means adjusters have to manually enter in all these faxed sheets. yikes. (2) I am frequently spending hours on the phone with customer service reps, in order to rectify a claim or issue that is far below the cost of the reps salaries. For example, I spent 3 hours aggregate speaking with reps last week, in order to explain a claim which resulted in a $50 payment. Surely the 3 hours in salary cost more than $50; it would be smarter for the company to simply pay the $50 rather than spend hours doing mailings and calls to fight the claim. (3) Blue Cross has 5 major departments that all do basically the same thing, that is, approve or deny coverage: Claims, Grievances and Appeals, Utilization Management, Pre-Authorization, and one other i can't remember (out of network exceptions?). I've had to hop between literally all 5 departments for a single claim, of which Blue Cross had to spend dozens of hours sorting out the paperwork, calls, etc. Why not put it all under one roof/office? I could go on and on, but the point is: cut costs, don't raise premiums! They have tons of areas where they could save.

The proposed increase to my insurance is 35.5% which is a significant amount for me. As a I pay out of pocket for individual insurance and my rate is already about half of my monthly income. If this

increase goes through I may be forced to forego health insurance which is dangerous given I am

Dear D.F.S. Health Insurance division, I recently lost my small business owner health insurance with Oxford because I downsized my business and no longer employed anyone besides myself. After much searching I found one of the only individual plans available to me in , a plan through Empire BCBS (EPO 0X, Platinum) for 1240$ per month. Although extremely expensive, I was willing to pay it for the peace of mind and because i have ongoing health maintenance issues to consider. The plan started retroactively in June. The same day that I received my membership card I received a letter from Empire's Oversight division informing me that the company is filing a request to increase my monthly cost by an additional 30%! This would take my insurance (which doesn't cover dental and with which i still have out of pocket costs for every script and doctor's visit) to almost 1800$ a month! Is this legal? They state that the price increase will begin onJanuary 1st, giving me just 6 months at the price advertised to me through the New York State of health marketplace website. Please could you advise me if I have any options to fight this increase, and thank for your service. with best wishes

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

I'm writing to express my dismay over a proposed premium rate change to my health insurance plan. A 30% increase is simply outrageous. Who can possibly afford that? I won't be making 30% more next year. The lack of good, barely affordable health plans is causing me to reevaluate my entire life plan, after having left my full-time job in 2016 to begin my own consulting business. A 30% increase will place my existing insurance plan in a tier that is entirely out of my league. The lack of decent affordable options is a national disgrace.

I'm writing to express my dismay over a proposed premium rate change to my health insurance plan. A 30% increase is simply outrageous. Who can possibly afford that? I won't be making 30% more next year. The lack of good, barely affordable health plans is causing me to reevaluate my entire life plan, after having left my full-time job in 2016 to begin my own consulting business. A 30% increase will place my existing insurance plan in a tier that is entirely out of my league. The lack of decent affordable options is a national disgrace.

I am shocked that they are planning another rate increase. They increased my plan in 2017. Then they cancelled the plan type and created a new plan, raising the premium. Now they are changing the plan type again, and increasing it again. That is a rate raise three years in a row. My salary is not increasing each year. I would like to know if there are any safeguards to watch that insurance companies are not able to justify raises by changing policy types and then making them more expensive each year...that seems like a bait and switch.

RE: Letter Notice of Proposed Premium Rate Change for Empire EPO 600 Gold (June 1, 2018) Dear DFS: For Anthem/Empire to be raising their rates by any means is absurd and outrageous. Their plans barely cover anything as it is and have a lot of loopholes and caveats that drain the public of every single last penny and their very health along the way. If this rate increases, I will not receive the care I need and the public system will carry the weight. My suggestion isthat if they need the extra capital, they can reduce the CEO's unworldly unfair wages and compensation. These proposed rate changes are inhumane. It is not fair to the insured to abandon their healthcare because of these rates. The city/state social services will end up overburdened and already is. Please. Please. Please. Do not allow these rate increases. Thank you.

Empire HealthChoice Assurance, Inc.Individual2019 Public Comments

As the who works for small businesses, I am responsible for providing my own health insurance. The roller coaster of payments to providers and for premiums has been in play since December 2009. While I did not participate directly in government-supplied plans post ACA, I, like everyone in the United States, benefited from them. Empire BlueCross BlueShield's application for rate changes based on holders' counties is horrific. The variance is assumptive and, frankly, stupid. To believe that those who live in New York City have significantly more money than those living in any of the other counties is discriminatory and ignorant. Does Empire, do those of you at DFS who will decide this, actually, accurately believe that those who have individual insurance WANT to do that? That writing a check for more than $1000 every month helps people to live well as residents of New York State? Know this: the health insurance lobby, second only in power to the NRA, has finagled its way into the corporatization of hospital systems and contributed enormously to what the practice of medicine was always on its way to becoming and has only accelerated since 2017 - profit over patient. As sure as my eyes are green I will not be rendered impoverished by my right to health insurance. That DFS would approve this tells me far more about department behavior than anything else, DFS guidelines and actuarial standards be damned. Please, operate from a place of humanity when reviewing this ridiculous proposal. Enquire how Empire is making money with the elimination of private HMOs and the upcharge in co-pays and constant billing for something as simple (and required) as one's annual checkup. If Empire is unwilling or lags to provide your sought information, take that as it is: letting you know that they are hiding something. Better yet, ask people who have personal insurance what THEIR experience is like. That will, hopefully, affect your decision. I appreciate and respect you and the work that you do. Please do not take my direct nature to be anything buy honest and concerned. I cannot help but take this seriously. The cost of my health insurance did, for more than two years, cost nearly twice as much every month as my apartment. That's not the world in which I want to live, and it's surely not the state in which I will live. I was born here. It will be tragic if what moves me to another state is costs like this, which you have a say in managing. Thank you,

I'm shocked at the proposed rate increase for my health plan which is Empire EPO 600, Gold, ST INN Pediatric Dental, Dep 25. A rate increase of 32.80% for the area is astronomical and way above what many people can afford.

I myself will have difficulty paying this amount and will need to switch to other, less comprehensive insurance. This means that as a healthcare provider, I am limited in the options to care for my own health. This gouging of consumers by the health insurance industry has to stop. It means that many people will not be able to afford preventative care, with consequent increased costs later on when diseases are caught at a later stage. This has to stop. Please do not allow this rate increase. If rates must increase, please limit them to a more reasonable amount of about 10% or less so that the nation can take care of its health.

Actors Fund African Services Committee Children’s Defense Fund-New York

Community Service Society of New York Consumers Union Empire Justice Center Make the Road New York Medicare Rights Center Metro New York Health Care for All Campaign New Yorkers for Accessible Health Coverage New York Immigration Coalition Project CHARGE

Public Policy and Education Fund of New York/Citizen Action of New York Raising Women’s Voices-New York Schuyler Center for Analysis and Advocacy Small Business Majority

Young Invincibles

Health Care For All New York c/o Amanda Dunker, Community Service Society of New York

633 Third Ave., 10th Floor, New York, New York 10017 (212) 614-5312

June 28, 2018 Maria T. Vullo, Superintendent Troy Oechsner, Deputy Superintendent for Health John Powell, Assistant Deputy Superintendent for Health NYS Department of Financial Services One Commerce Plaza Albany, NY 12257 RE: Requested Rate Changes – Empire– Individual – 131472838 Dear Superintendent Vullo, Deputy Superintendent Oechsner, and Assistant Deputy Superintendent Powell:

Health Care for All New York (HCFANY) is a statewide coalition of over 170 organizations dedicated to achieving quality, affordable health coverage for all New Yorkers. HCFANY believes that the public rate review process is a vital consumer protection and is grateful for the opportunity to submit comments on the rate requests submitted for 2019’s individual plans. The comments below address concerns about the market as a whole before offering specific comments on Empire’s application.

I. Market-Wide Comments

A. Action is needed beyond the rate review process to stabilize New York’s individual market.

HCFANY is concerned that New York’s insurance companies have not successfully

controlled costs in the individual market. This year, the carriers seek an average 24 percent rate increase for the 2019 individual market plans.1 This is the fifth year in a row that the requests have been in the double-digits for the individual market (the previous four years of requests and approved rate changes can be seen in the chart below).

1 New York State Department of Financial Services, “Proposed 2019 Health Insurance Premium Rates for Individual and Small Group Markets,” June 1, 2018, https://www.dfs.ny.gov/about/press/pr1806011.htm.

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Average Requested and Approved Premium Increases New York’s Individual Market 2015-20182

Request (Percent) Approved (Percent) Percent Change 2018 17.7 14.5 -18.1 2017 19.3 16.6 -13.9 2016 10.4 7.09 -31.8 2015 12.5 5.7 -54.4

Such large increases cause immense hardships for those New Yorkers who receive little

or no financial assistance through the NY State of Health Marketplace. Fortunately, most people (59 percent) in the Marketplace do receive help through tax credits that are based on income and grow as prices increase.3 As a result, many are insulated from rate increases. However, 41 percent of people who enrolled in qualified health plans last year received no assistance.4 That means they bear the full brunt of any approved premium increases. HCFANY is concerned that approving rate increases so far above the rate of medical inflation will eventually result in enrollment declines and ultimately, an insurance “death spiral” that would catapult premiums beyond the reach of anyone ineligible for assistance.

HCFANY commends the Department for its past efforts to safeguard consumers by reducing the carriers’ average rate increases substantially and urges it to do so again this year. HCFANY’s recommendations for doing so, based on a close reading of the applications, are below. HCFANY additionally asks that the Department and other state leaders take more forceful action outside of the rate review process to stabilize the individual market. High premiums force New Yorkers to choose between health care and necessities like housing and food.5 Those choices continue even after someone gains coverage as they make their monthly payments and face increasing cost-sharing.6 High premiums also contribute to disparities in well-being between white Americans and others. Adults who are black are much more likely to report an inability to afford basic necessities and health care than adults who are white.7 Adults who are black or Hispanic are more likely to have had medical bills turned over to debt collectors than those who are white.8

2 For 2018, see https://www.dfs.ny.gov/about/press/pr1708151.htm. For 2017, see https://www.dfs.ny.gov/about/press/pr1608051.htm. For 2016, see https://www.dfs.ny.gov/about/press/pr1507311.htm. For 2015, see https://www.dfs.ny.gov/about/press/pr1409041.htm. 3 New York State of Health, 2018 Open Enrollment Report, May 2018, page 5, https://info.nystateofhealth.ny.gov/sites/default/files/NYSOH%202018%20Open%20Enrollment%20Report_0.pdf. 4 Ibid. 5 NORC and the West Health Institute, “Americans’ Views of Healthcare Costs, Coverage, and Policy,” March 2018, page 2, http://s8637.pcdn.co/wp-content/uploads/2018/03/WHI-Healthcare-Costs-Coverage-and-Policy-Issue-Brief.pdf. 6 NORC and the West Health Institute, page 8. 7 Ibid. 8 NORC and the West Health Institute, page 6.

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The role of private insurance companies is to pool risk for large numbers of enrollees and negotiate and control prices on their behalves. This year, as in the past, the carriers’ applications state that providers are so powerful that this process cannot take place. If this is true, New York should take steps to control prices in the individual market and ensure that people who purchase their own plans have affordable coverage options. Other states have been more successful in keeping prices down in the individual market. For example, Minnesota has implemented a reinsurance program that has resulted in substantial declines in its individual market rates (between 3 and 12 percent).9 To control prices in the individual market, New York should consider the following strategies:

1. Provide premium assistance to people who make above 200 percent of the federal

poverty level. Increased premium assistance would stabilize prices by increasing the size of the risk pool. The more enrollees insurers have, the more they can spread the costs of care across individuals. Ideally, premium assistance would be available to everyone based on income. Encouraging greater participation by some groups could particularly help stabilize the individual market without great cost. Young people, for example, have lower incomes and lower health risks than older people. This means they are more likely to gamble against buying health insurance when dealing with tight budgets. Providing assistance to them would attract more people into our individual market who are lower risk. Insurers would be able to lower costs benefitting many in the market, and young people would have financial security in the event of a health emergency.

2. Create a drug utilization review board for commercial plans in the individual market

similar to the review board that exists for Medicaid. All of the carriers cite increasing pharmacy prices as a reason for premium increases. For example, HealthNow estimated that medical prices would only increase by 3 percent while pharmacy prices would increase by 9.5 percent. Since so many insurance companies report being outmatched by the pharmaceutical industry, the state should consider intervening. New York’s Medicaid program has a Drug Utilization Review Board charged with reviewing clinical information and making recommendations to the Commissioner of Health on drug coverage.10 The Board’s meetings are public, it includes consumers, and the process for nominating members is transparent. Such a Board could ensure that consumers benefit from any rebates and could negotiate for lower pharmacy costs across the market.

3. Consider a public option such as an Essential Plan Buy-In Program. The state should

allow more people to participate in the Essential Plan as an affordable alternative to the individual market. The Essential Plan provides comprehensive coverage to people who earn between 138 and 200 percent of the federal poverty level.11 Participants at the highest

9 Minnesota Commerce Department, “Health insurers propose decreased average rates for Minnesota’s 2019 individual market,” June 15, 2018, https://mn.gov/commerce/media/news/?id=342571 . 10 New York Department of Health, Office of Health Insurance Programs, “Medicaid Drug Utilization Review Board General Operating Procedures,” https://www.health.ny.gov/health_care/medicaid/program/dur/docs/operating_procedures.pdf. 11 Empire Center, “A surprising surplus in Albany,” February 14, 2018, https://www.empirecenter.org/publications/a-surprising-surplus-in-albany/.

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income level pay only $20 a month; the cost of their care to the state is minimal because most funding comes from the federal government.12 New York could allow people with higher incomes to participate in the Essential Plan and offer state subsidies on a sliding scale. At a minimum the state could allow people to pay full-price to participate in the Essential Plan.

Other states have adopted additional measures that may be worth considering, such as the

state-based individual coverage mandates recently adopted by New Jersey and Vermont.13 Massachusetts has also had an individual mandate in place since 2006.14 Alternately, New York could seek a 1332 Waiver to establish a reinsurance program along the lines of Minnesota or Alaska.15 Finally, New York should seriously consider stepping in for the plans and controlling costs more directly through a Maryland-style global payment model.16 All of these ideas—and more—bear scrutiny in the face of the carriers’ substantial and persistent rate requests and HCFANY urges the Department to establish an Advisory Commission to explore them.

B. Within the rate review process, there are several areas in which we respectfully ask

DFS to question insurers’ arguments and impose greater standardization in their requests.

It is evident that federal activity has had a modest impact on New York’s individual

market. However, New York State has taken important steps to protect companies from those actions. Those steps included increasing the budget for enrollment assistors in the 2019 budget and opting to maintain the three-month open enrollment period. Additionally, under New York’s strict laws, the carriers face little threat from the federal liberalization of rules governing association health plans.

As a result of the state’s actions and an improved economy, New York’s individual

market appears to be stable—not contracting as some carriers claim. The New York State of Heath boasted an overall increase of 4 percent in 2018 enrollment.17 Although New York’s individual off-exchange marketplace lost enrollment, that appears mostly to be a self-inflicted wound imposed by the actions of one carrier (Empire) which terminated its entire line of

12 Ibid. 13 Katie Jennings, “New Jersey will become second state to enact individual health insurance mandate,” Politico New Jersey, May 30, 2018, https://www.politico.com/states/new-jersey/story/2018/05/30/new-jersey-becomes-second-state-to-adopt-individual-health-insurance-mandate-442183. 14 Ibid. 15 Cheryl Fish-Parcham, “Alaska’s Reinsurance 1332 Waiver: An Approach that Can Work, Families USA, August 2017, http://familiesusa.org/product/alaska-reinsurance-1332-waiver-approach-can-work and 2017 Minnesota Session Laws, Chapter 13—H.F.No.5, https://www.revisor.mn.gov/laws/?year=2017&type=0&doctype=Chapter&id=13. 16 Shah et al., “Maryland’s Global Budget Program: Still an Option for Containing Costs,” The Commonwealth Fund, April 3, 2018, https://www.commonwealthfund.org/blog/2018/marylands-global-budget-program-still-option-containing-costs. 17 Burton et al., “What Explains 2018’s Marketplace Enrollment Rates?,” Robert Wood Johnson Foundation, June 2018, https://www.urban.org/research/publication/what-explains-2018s-marketplace-enrollment-rates.

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individual market products, causing disruption and panic amongst its 50,000 members.18 In addition, more New Yorkers may be securing job-based coverage as the economy has improved. Despite these two trends, with a few minor exceptions, nearly all the other plans gained members between 2017 and 2018.

These conditions may not be adequately reflected in the 2019 rate requests. Thus,

HCFANY urges the Department to carefully review the carriers’ filings in a manner that ensures consistency of rate actions in the following areas: (1) the individual mandate; (2) trend; and (3) administration costs.

1. Increases due to the loss of the mandate should be reasonable and companies with

similar risk profiles should receive similar increases. In 2019, the federal tax penalty for failure to purchase health insurance will be

eliminated. The carriers’ applications contained varied estimates of the impact of this change with adjustments ranging from 0 to 23 percent. It is plausible that the variation of estimates is due to a carrier’s claims experience and premium levels (which make the plan more or less likely to be attractive to someone on the fence about buying a plan). However, this explanation for the diversity of estimates is belied by the fact that carriers with apparently similar risk profiles are asking for vastly different increases. For example, Oscar and Fidelis have similar average claims costs, yet Fidelis asks for a 23 percent increase to make up for losing the mandate while Oscar asks for just 7 percent.

To ensure that all New Yorkers in the individual market are treated fairly and equitably,

the Department should consider imposing a cap on the individual adjustment mandate—such as 6 percent, which is the average across all carriers. Those carriers that filed adjustments below 6 percent should be granted the adjustments that they seek (e.g. 0 to 6 percent) and everything above would be reduced to 6 percent.

2. Medical trend estimates vary too much. The state should require a standardized

trend, either for the entire state or for regions. The carriers estimate medical trend between 5.1 and 11.5 percent. While most of the

trend requests are within the ranges seen in national estimates (between 4.5 and 8 percent), there are reasons to think that New York’s insurers could do a better job of managing these costs.19 For example, many of New York’s plans only offer in-network coverage and those networks are

18 Empire’s 2017 Rate Filing indicates that it had 54,000 members, while its 2019 filings now indicate that it has just 24,000 enrollees. In the interim, Empire retired its individual market offerings and re-filed a new product that was 47 percent more expensive than its predecessor. 19 American Academy of Actuaries, “Drivers of 2019 Health Insurance Premium Changes,” June 2018, http://www.actuary.org/files/publications/Premium_Drivers_2019_061318.pdf; Girod et al., “2018 Milliman Medical Index, May 2018, http://www.milliman.com/uploadedFiles/insight/Periodicals/mmi/2018-milliman-medical-index.pdf; and PwC Health Research Institute, “Medical Cost Trend: Behind the numbers 2019,” June 2018, https://www.pwc.com/us/en/health-industries/health-research-institute/assets/pdf/hri-behind-the-numbers-2019.pdf

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increasingly small.20 Most estimates of annual medical trend changes are based on information from the employer market, where networks and benefits are often more expansive. That could be a reason to believe that medical trend should be lower for New York’s narrow network plans.

Additionally, it is unclear why carriers in the same state and even in the same regions of

the state should report such variation in medical trend. Each year, HCFANY notes in our rate review comments that the carriers do not provide enough information about how they arrive at their trend estimates. While the applications have improved in some ways over the years (for example, fewer redactions), not enough applications include a breakdown of trend into pharmacy versus medical costs. When they do, the carriers rarely provide a narrative explanation of how they manage costs, other than to argue that provider consolidation means they cannot reduce medical spend.

As an intermediate step, the Department should consider requiring carriers to provide

better information about their trend estimates. The most helpful way for carriers to provide this information is through a trend breakdown showing the following: inpatient facility care, outpatient facility care, professional services, pharmacy, and other. This is helpful because it is the way that the Milliman Medical Index is reported, which provides a comparison point.21 Some carriers did provide that information, including Excellus, Healthfirst, and Independent Health. Additionally, if all carriers provided this information the public would be able to compare their own insurer’s performance to a statewide or regional average. HCFANY recommends that either Exhibit 18 or 13a be modified to require this information, or that the Department creates a new exhibit that shows a detailed trend breakdown.

More importantly, the Department should consider adopting a standardized medical and

pharmacy trend cap for individual market carriers and requiring them to stay under the state limit. This measure could be implemented on a statewide or regional basis.

3. Administrative costs should be decreasing over time. The Department should

consider imposing a cap to guard against extraordinary administrative costs. Overall plans are asking for slightly lower administrative costs this year (12.1 percent

versus 13.9 percent in their requests for 2018). But plans have had six years of experience operating in this market. New York State invests significant resources into marketing qualified health plans and making it easy for people to enroll and renew. The Department should investigate why administrative costs have not decreased more, and closely question plans whose administrative costs are increasing.

The range of administrative costs in the 2019 requests is also very wide, from 8.2 percent

to 17 percent. Companies that spend much more of their premium dollars on administrative costs than peers should explain their performance in a detailed manner. Above-average rate increases from companies that also have above-average administrative costs deserve special scrutiny. The 20 University of Pennsylvania/Robert Wood Johnson Foundation, “State Variation in Narrow Networks on the ACA Marketplaces,” August 2015, http://ldi.upenn.edu/sites/default/files/rte/state-narrow-networks.pdf 21 Girod et al.

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Department should also consider imposing a cap on administrative costs that are far above average.

II. Issues Specific to Empire

Empire is one of the largest carriers in the New York individual market, covering 25,985 consumers in New York State in 2018. Empire’s 24 percent requested increase is one of the largest and is above average for New York’s individual rate requests (which was 17.8 percent).22 There are areas where Empire appears to be successfully controlling costs, including: (1) having the second lowest administrative costs in the market (8.6 percent, much lower than the average 12.1 percent); and (2) seeking a profit margin of 1.5 percent. However, the size of Empire’s requested increase requires a close examination of its application. HCFANY identified two areas of concern: Empire’s arguments about market contractions and its high medical trend expectations.

A. Empire attributes its declining membership (and subsequent need to raise rates) to market conditions—rather than the reality that this is a self-inflicted wound brought about its precipitous product change with its corresponding elevated premiums.

In 2018, Empire offered a new EPO product, discontinuing previously offered HMO products. The Department received an application for this new line of business and reviewed it outside of the prior approval process in 2017. This application is not publicly available, and as a result these comments rely on an application submitted through Empire HealthChoice HMO in 2016 to assist with comparisons.

The last publicly-available application was filed by Empire HealthChoice HMO, Inc, for

plans that were effective January 1, 2017. This application indicated that 54,058 individuals were covered by Empire’s on- and off-marketplace individual products. In its 2019 rate application, Empire projects that this decline will continue, projecting the number of covered consumers on its on- and off-marketplace plans to be 23,900.23 This means that Empire lost 52 percent of its members by substituting its HMO product with the new substantially more expensive EPO product.

Empire argues that New York’s individual market is shrinking overall. The implications

that might be drawn from this are not clear, as the overall change may be associated with increased employer provided coverage in a booming economy rather than an incipient individual market death spiral. As far as Empire’s own shrinkage is concerned, the culprit seems clear. As discussed in the general comments, HCFANY found that all but three plans experienced growth

22 These are CDPHP, Empire Health Choice, Excellus, Healthfirst PHSP, HIP/Emblem Health, NYQHC/Fidelis, HealthNow, IHBC, MetroPlus, MVP Health Plan, Oscar, and Unitedhealthcare of New York. The applications cover both on- and off-exchange plans for all but MetroPlus and Oscar, which are only offering on-exchange plans. An additional four plans were offering plans off-exchange only, all with under 150 members. Those four plans were not included in the analysis for HCFANY’s individual rate comments. 23Empire HCA Narrative, p4

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in individual enrollments. It seems likely that much of New York State off-Marketplace—and certainly all of Empire’s—decline in enrollment could be attributed to Empire’s own actions. When Empire changed its product, it caused mass confusion amongst its members and in the larger individual marketplace.

Empire’s EPO plans are on average 47 percent more expensive than the old HMO plan.24

This likely incentivized previous Empire enrollees to seek premium relief by switching plans. If Empire’s full request is granted for 2019, any member who chooses to stay with it through the change will have experienced an 82 percent increase in his or her premiums since 2016—a rate increase few can afford.

HCFANY urges the Department to reject Empire’s request for a substantial rate increase

when its own actions may have contributed to a loss of enrolled members.

B. Empire’s medical trend projection of 11.5 percent is too high and is unsupported by its application.

Empire seeks a medical trend of 11.5 percent. This request is far higher than the average

request of 7.3 percent for the New York carriers and is the highest request among plans with more than 200 enrollees. It is also outside of the range suggested by national experts.

Empire’s Narrative Summary and Actuarial Memorandum provide little support for its

requested trend. The Narrative Summary itself acknowledges the PWC estimate of 6 percent, vaguely describing national trends, but offering no support for its request. There is no clear, specific explanation for why Empire is requesting a high trend compared to the national trends. The language includes broad overgeneralizations like “The aging population is driving some of the increase – as people age, they typically utilize more health services.”25 Other carriers provided much more detail about trend including breakdowns showing the differences for pharmacy, medical services, inpatient care, and outpatient facility services. That type of information greatly adds to the public’s understanding and New York’s ability to consider solutions to high premiums.

Accordingly, HCFANY urges the Department to require Empire to provide a more

detailed explanation of its strategy for managing medical trend. As recommended in the general comments, the Department should also consider capping trend.

24 Using Exhibit 13a from Empire’s 2016 and 2018 applications, its average per-member per-month rate increase from $533.33 in 2016 to $781.60 in 2018 when it introduced its new plan. 25 Empire HCA Application, p49.

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In light of these points, HCFANY urges DFS to carefully review Empire’s application.

Thank you for your attention to these comments. Please contact us with any questions at adunker@cssny.org or 212-614-5312.

Sincerely,

Amanda Dunker, MPH Mark Scherzer, Esq Health Policy Associate Legislative Counsel Community Service Society of NY New Yorkers for Accessible Health Coverage