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Multiple-Employer Welfare Arrangements (MEWA) a Healthcare Alternative

Multiple-Employer Welfare Arrangements (MEWA) a Healthcare Alternative

Multiple-Employer Welfare Arrangements, or MEWAs, are growing in popularity as another alternative to traditional health insurance policies. The Affordable Care Act’s mandate requires a broader range of employers to cover their employees’ healthcare costs. MEWAs are an alternative healthcare option to the federal health insurance exchanges.

MEWAs are a kind of self-funded insurance plan. MEWAs are put together by a group of employers who don’t want to work within the governmental healthcare system. A self-funded MEWA allows a group to get together to pool their health care resources, rather than strike out on their own to fund their health insurance needs individually.

Benefits of MEWAs

MEWAs are beneficial to employers because they allow for risk to be spread to a number of entities, rather than be shouldered by one small business. MEWAs can be used to offer health care incentives to employees or members of a professional association. If a small business doesn’t want to use the existing federal health insurance marketplace in order to provide health insurance for their employees, this can be a viable alternative.

MEWAs are member-owned, meaning the benefits flow around to all the people who are involved in the program. Employers who offer a MEWA health insurance plan are able to keep deductibles and premiums stable while still offering full healthcare coverage to their employees. Profits from the MEWA stay within the group that started the MEWA, so the savings and the risks are spread around.

Many MEWAs are set up like a board of trustees. This means that there is no artificial inflating of health insurance costs and that your payments don’t have to change year to year. If an employer is offering up incentives for their employees in the form of a wellness program, that positive action comes back around in the form of healthier employees and even lower insurance costs. If employees sign on to the MEWA program but don’t use it very often, costs are decreased for everyone.

A board of trustees is usually set up to manage the MEWA, which allows changes and alterations to be made to the program to account for the specific needs of the group that is being insured. This ensures a stability that doesn’t always exist in traditional insurance plans, because people are in control of the costs and not the insurance market.

Although small businesses can benefit from MEWAs, other organizations large and small can create a MEWA, too. Individuals, large groups, and professional associations are also eligible for this kind of insurance program.

What to know about MEWAs

There are some states in the US that allow MEWAs, while others do not. Other states may regulate MEWAs strictly. Although too many restrictions can harm the functioning of a MEWA, a level of regulation isn’t a bad thing. This keeps MEWAs for the people, businesses, and organizations that can benefit from them the most and use them properly.

When determining your eligibility for a MEWA, your state’s laws regarding this kind of insurance plan will need to be checked. If your state does allow MEWAs, this can be an incredibly helpful opportunity for you and your employees.

MEWAs are member-owned, so the rewards and the risk are contained in that particular group of employers or associated organizations. This allows for a dissemination of pressure if there are a lot of claims one year and not the next. A MEWA is set up to be regulated, but also to give employers the ability to control their own health insurance options and not be vulnerable to the changes in the government-run health insurance exchange.


Other brokerages take a cookie cutter approach to insurance and outfit their customers with generic coverage.  Skyline is different.  We believe insurance should be built on innovation and experience. We appreciate the fact that every engagement is unique and understand proper coverage requires a deep understanding of the underlying business and individual.

"The opportunity to safeguard your concerns is a privilege we never take for granted."

Health Insurance Relief for NY Business

Health Insurance Relief for NY Business

Finally some good news for New York business owners actively insured in the small group commercial health insurance market. Effective April 1, 2017, businesses with 1-99 employees will now have 7 health insurance carriers to choose from, which is almost double what the market offered in 2016. In January of 2017, New York welcomed Empire Blue Cross Blue Shield, which was the first of three new carriers to enter New York’s commercial health insurance market. Just recently, both Healthfirst and Oscar health insurance companies also announced that they will be participating in New York’s commercial health insurance market beginning on April 1, 2017. Here is what you’ll need to know about these two new carriers: 


Healthfirst is a not-for-profit managed care organization sponsored by several prestigious and nationally recognized hospitals and medical centers in New York. Currently, Healthfirst is a major player in the New York individual market offering Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term care plans for more than 1.2 million members in downstate New York.
Healthfirst’s history in New York indicates a strong track record and has analysts optimistic regarding the carrier’s decision to join the New York commercial health insurance market.
Fun Fact: Healthfirst plans are the only plans in the NY small group market offering dental insurance as additional insurance for no extra cost. When you buy your health plan it comes with a complimentary dental plan at no cost.


Similar to Healthfirst, Oscar has made their reputation in New York’s individual health insurance market. Know for its cutting edge technology, Oscar appeals mainly to a millennial business demographic, keen on simplicity and innovation. Oscar has made an emphasis on enhancing the member’s experience and has created a mobile application allowing users to:

  • Search for symptoms, providers, and drugs
  • Use Doctors on Call to talk with a doctor over the phone at anytime
  • View you Oscar health history
  • Send questions to Oscar’s customer care team
  • Access your digital ID card

The Oscar mobile application also rewards members:

  • Track your steps and earn rewards for just hitting daily goals and staying active.
  • By connection to Apple’s Health App, you can see all your steps tracked by your phone and compatible step tracking devices, and get rewarded for your hard work.

Customer Reviews: “Tracks my steps to earn Amazon rewards, links to my watch’s app and account for the steps my watch records.”

Both of these carriers will be available effective April 1st, 2017. It is okay to switch carriers during your plan year. If you are currently insured you do not have to wait until your renewal to change carriers. If you have questions and/or would like to see if these rates and plan designs work for your business please contact Skyline Risk Management, Inc. at (718) 267-6600 for consultation.  

If you have questions and/or would like to see if these rates and plan designs work for your business please contact Skyline Risk Management, Inc. at (718) 267-6600 for consultation.  

Diving into the Dynamic Behind Self-Funding and Voluntary Benefits

Diving into the Dynamic Behind Self-Funding and Voluntary Benefits

Employers have changed how they view health care plans. With all the reforms and high costs, companies struggle to cope with the ever-changing landscape. Employers create benefit plans with employee retention and cost control on their minds. However, many forget about a little helper called voluntary benefits.

Nearly every employer looks to achieve these goals with health care. Offer great benefits to employees without breaking the bank. Many companies achieve this noble goal by using a self funding approach that features a high-deductible. Often, these companies are larger. Recently, smaller companies have taken this approach, too.

The Self-Funding and Voluntary Benefits Dynamic

When paired with voluntary benefits, employers reduce costs greatly while still giving their employees the type of insurance they need. Plus, employees can tailor their coverage with a variety of options.

So why have employers started going the self-funded route? That's simple. Health care costs are rising. By using self-funded services, a company can keep medical expenses down.

What Does Self-Funding Offer?

Self-funding may sound nice in theory, but it's important to understand what self-funding allows employers to do. Overall, an employer can:

1. Control Costs: Self-funding allows employers to control costs, with funding amounts that are pre-determined. This ensures the profit margin of the insurance company is cut down.

2. Protect the Plan: Using stop-loss insurance as an employer can ensure no catastrophic claims exceed the pre-determined amount in their self-funded plan.

3. Only Pay Actual Claims: Instead of paying the margin created by an underwriter, a self-funded plan allows the company only to pay medical claims that actually happen.

4. Keep Track: A self-funded plan ensures an employer can keep track of the plan and accounts. By keeping statistics year after year, an employer can plan for the future management of their self-funded program.

5. Further Savings: Certain self-funded plans save even more money by utilizing a predictive analysis to determine health and wellness. A third-party administrator usually administers this.

Lastly, many companies prefer self-funded plans because they may not be subjected to Obamacare regulations. Since they do not have to follow all the regulations of the Affordable Care Act, the company can tailor plans to the needs of specific employees and groups.

Adding Voluntary Benefits to Self-Funding

Once an employer has a self-funded benefits plan, they can begin to allow voluntary benefits. Voluntary benefits complement the plan and allow employees to meet their every need – without adding unnecessary costs to the plan.

By combining these two options, employers allow their employee the ability to customize the benefits to their unique needs. The benefits of this methodology are vast and allow companies and employees to account for expenses in a detailed manner.

Always Be Communicating

No matter how a company offers health insurance, communication is key. The majority of employees are tired of spending so much money on health care. As well, most have concerns about how the changing health insurance market and reform will impact their families and pocketbooks.

Studies have shown that 95% of employees need an individual to talk to them about benefits information. This means your employees need to speak with an administrator. They want to keep communication lines open when they have questions and want access to resources.

Communication is especially needed when a company offers a self-funded plan with voluntary benefits. The variety of options and costs can be confusing – so being able to communicate with an administrator is key.

A Winning Combination

Employees want great benefits and lower costs. Most companies want similar things in regards to health insurance. As such, many have found self-funded plans combined with a myriad of voluntary benefits options to be a dynamic insurance duo.

For more information about self-funding contact Skyline Risk Management, Inc. at (718) 267-6600. 

Replacing Obamacare Will Be Harder Than Any Republicans Thought

Replacing Obamacare Will Be Harder Than Any Republicans Thought

President-elect Donald Trump has made many promises as he campaigned for the Presidential election. While no one knows which promises he'll keep and if he'll be able to accomplish many of them, repealing the Affordable Care Act will be difficult. Here's why:

The Repeal

It took President Obama several years to create and complete Obamacare. The system is vast and complex. Plus, it took years just to approve the legislation before any implementation could be completed. Repealing the system is not going to happen overnight.

Millions of people utilize Obamacare. And many Republicans agree that instantly repealing the system could cause a shock to the industry – and not in a good way. No matter what happens, most predict change is inevitable.

Trump could sign a repeal of Obamacare in his first days in office. Then ensure it doesn't go into effect for some time. This would allow Republicans to draft complex plans and policy for the replacement of the Affordable Care Act. Everyone in Congress is confident that repealing the act will be much easier than replacing it.

For example, certain provisions will be included in the new health care laws and mandates. Many Republicans, including Trump, like the age provisions that allows young adults to stay on their parent's insurance plan. Other Republicans are found of provisions that offer guaranteed coverage to all.

Health Insurers & ACA

Health insurance companies are essentially playing a waiting game at this point. The Affordable Care Act was a complete and utter shock to the industry. Many insurers struggled to cope with the various regulations and costs. However, now that the act is in place, things seem to be running smoothly.

Repealing and replacing Obamacare will be anything but smooth. Many health insurance companies are crossing their fingers in hopes of a minor disruption. Most people in the industry don't want to see the shock and chaos that implementing Obamacare brought just a few years back – again!

Getting Into the Details

Obamacare, repealing, and new replacement legislation is going to get tricky. For instance, most believe that guaranteeing coverage for pre-existing conditions is an important piece of legislation. However, many argue that the mandate requiring all Americans to have health coverage is unjust.

Alternatives to the mandate have been discussed. However, most agree that the financial penalties found in the mandate ensure more Americans get coverage. Without the financial penalties, there would be many people who wouldn't buy coverage

Many Republicans, like Speaker of the House Paul Ryan, have proposed similar legislation to Obamacare. He'd like certain people to receive tax incentives to help people afford the type of coverage they need. He's also interested in protecting people from rising rates for illness – when they maintain continuous health insurance coverage.

Breaking Records

While Obamacare has taken certain hits here and there, the people of the United States have hit a record low of uninsured. More people have coverage in the United States than nearly ever before. In this way, the Affordable Care Act was a success.

Not every aspect of Obamacare has been successful, though. Major insurance companies like Aetna and UnitedHealth Group both withdrew from the program. Premiums have skyrocketed, too. Plus, many Obamacare plans feature high deductible – ensuring many couldn't afford care if they got ill.  

The Reality of Obamacare

The Affordable Care Act will be repealed. With Trump as the President and a Republican House and Senate, the legislation doesn't stand a chance. The reality of the situation is this:

Once the bill is repealed, Republicans and Democrats will have to work together to replace the parts of Obamacare that everyone agrees on. It will take time, a lot of time – as that's just how things work in Washington. Hopefully, the time and change won't have too negative of an effect on the health insurance industry and the American public. 

For more information about health insurance contact Skyline Risk Management, Inc. - (718) 267-600.

What is Long-term Care Insurance?

What is Long-term Care Insurance?

There are roughly 76 million baby boomers in the United States with an approximate average age of 60 years old. It is no secret, as people age, they may require assistance for activities of daily living. Understanding this concept and considering the large population of aging baby boomers, insurance carriers have created a product to help reduce the costs of long-term care. This product is called long-term care insurance (LTCI) and this article well help educate anyone who is considering purchasing this product. 

What is Long-term Care Insurance (LTCI)?

Long-term Care Insurance (LTCI) is an insurance product, which helps to cover the expenses associated with long-term care beyond a predetermined period of time. People who require long-term care are those who have an inability to preform two or more basic activities of daily living.

Activities of Daily Living (ADL):

1. Mobility - ability to "transfer" your body. For example, a persons ability to walk or get out of bed. 

2. Bathing & Showering - the ability to shower yourself

3. Dressing - the ability to dress yourself

4. Feeding - the ability to feed yourself

5. Personal hygiene - the ability to brush your teeth, comb your hair, and other grooming practices. 

6. Bathroom - the ability to use the bathroom independently. This includes being able to get to the toilet and your ability to get up off the toilet. 

If a person is unable to complete two or more of these activities of daily living (ADL) then they are eligible and would certainly benefit from long-term care. 

Who does Long-term care insurance (LTCI) benefit?

Long-term care insurance has many benefits for various people. A common misconception is that long-term care insurance is a benefit only for the person in which the policy is meant to insure.

This is not the case!

Actually, the family members of the insured are the ones who benefit the most. In many cases, long-term care is expensive so when a loved one is no longer able to perform two or more actives of daily living the responsibility of caring for this person often falls to family members. Depending on their financial situation, some families cannot assume this responsibility and cannot afford to hire professional help. 

By purchasing LTCI a person is not only protecting themselves but also the financial well-being of their loved ones.

What does Long-term care insurance (LTCI) cover?

Long-term care insurance covers certain expenses for those who participate in any of the following care facilities:

  • Home Care - this allows a person who requires help with ADL to receive aid right in their own home.
  • Adult Daycare - this is a non-residential facility, which caters to adults who require help with ADL.
  • Hospice care - this services provides care to support people with advanced or terminal illnesses. 
  • Nursing homes - private institutions, which provide aid for elderly people and/or people who require help with ADL.
  • Assisted Living  - provides housing for elderly people and/or people who require help with ADL.
  • Respite Care  - temporary care for a person who requires aid with ADL.

Does my health insurance and/or medicare cover long-term care insurance?

No, traditional health insurance and medicare does not cover you for long-term care. Although under certain financial circumstances medicare may cover a portion of long-term care, an individual will still have to cover the costs of the majority of long-term care expenses themselves.

There is a price associated with everything. The important thing to remember is that if you require long-term care this could really become a financial burden to yourself and your loved ones. Be prepare, be protected and please do not underestimate the impact of long-term care insurance. 

For more information contact Skyline Risk Management, Inc. at (718) 267-6600.

How the Affordable Care Act Increases Will Affect Consumers

How the Affordable Care Act Increases Will Affect Consumers

Unfortunate news broke the health insurance world in the last month in the form of the announcement of the rising costs of insurance premiums under the Affordable Care Act, also known as Obamacare. These new increases will go into effect in 2017 and plans have increased by as much as 116%. This increase is leaving many Americans currently insured under a plan from the Affordable Care Act feeling confused and dismayed at the idea that their premiums would skyrocket.  However, it appears that the majority will not see a massive increase.

Higher Sticker Prices

It is true that the “sticker price” of insurance premiums are going up an average of 22% across the board. The increase varies based on the state. Some states such as Indiana and Massachusetts will see small decreases of up to 3%, some will see no difference at all, and other states such as Arizona and Pennsylvania will see premium increases of up to 116%.

For those in the states with significant increases, especially, the increase is quite shocking It is understandable that consumers might be surprised and even upset by the news considering that one of the highest priorities of the Affordable Care Act is for insurance to be affordable.  While there will be some consumers sorely affected by the increase, thanks to other provisions of Obamacare, most will not.

More Credits and Deductions

The good news in this situation is that, in correlation with the increases seen in the plan sticker costs, there will also be an increase in the credits and deductions available under the Affordable Care Act.  TheFederal Treasury will fund those deductions, and most consumers who currently have Obamacare will be eligible.  With these deductions, low and mid-level income households should not see a major increase and may not see an increase at all.

Those Who Will be Affected

The group who will be hardest hit by the higher sticker prices will be those individuals who earn more than four times the poverty level.  The amount varies based on your household size, but for an individual that amount is $47,520 and increases from there with additional household members.  Those who earn more than the set amount are not eligible for any subsidies. They will have to pay the full sticker price which could now be more painfully than it was previously.

It is important to note, that the majority of those who currently have an insurance plan purchased under the Affordable Care Act do not meet that level of income.  Because most Obamacare consumers are below four times the poverty line, most will be eligible for the reductions. In fact, 77% of those with plans currently would still be able to pay less than $100 a month.


There is no denying that this increase in premiums under the Affordable Care Act is disappointing.  Some Americans are going to be several affected by these hikes and may be in the same situation they were before, where they can no longer afford insurance. However, as frustrating as seeing an increase in rates can be, the reality is that most consumers insured under Obamacare will not see those increases passed along to them.

Whether these increases will continue, or if there ever will be a relief to those who do not currently qualify for the subsidies, it is uncertain. With new leadership taking over the country, there are sure to be many more changes to the Affordable Care Act to come. How the everyday consumer will be affected in the new round of changes

To voice your concerns contact Skyline Risk Management, Inc. at (718) 267-6600

Insurance, Employment, And A Trump Presidency

Insurance, Employment, And A Trump Presidency


What a year. Trump has been elected as the next President of the United States of America, promising many changes and garnering as much criticism as he has support. What he manages to actually do during the course of his presidency, of course, remains up to time itself. However, as the clock ticks towards his inauguration, here are some of the things he has said he will do regarding insurance, taxes, and the business world.

Trump and Healthcare

One of Trump’s main campaign points was a repeal of the Affordable Care Act. The Affordable Care Act was signed in by President Obama and gave health insurance to 22 million people. That is 10% of the American public who received insurance because of the existence of the Affordable Care Act, where many of them were uninsured before the Act being created.

So far, Trump and his allies have not given the American public any real answers regarding his health care plan, only that he wants to repeal the Affordable Care Act as soon as possible. This leaves the 22 million newly insured Americans with no real course of action should their current health insurance plans become defunct. He has thus far not replied to concerns about the healthcare industry and insurance companies that have benefited from the healthcare market set up by the Affordable Care Act. Trump has said he will provide universal health care coverage, but has not detailed what that will look like. He also wishes to make changes to Medicaid.

Insurance and Employers

Trump’s economic policies also include a repeal of the employer insurance mandate, the medical device tax, and the tax on medical insurers. While there has been considerably less backlash on this topic than on his health care policies, a lack of clarity regarding the future remains. However, the removal of these taxes and laws allows employers and the insurance industry the chance to have a say in the new president’s policies. Hopefully, there are a positive and effective series of policies created from the knowledge of employers and the insurance industry.

The Children’s Health Insurance Program

The future of the Children’s Health Insurance Program is also up in the air with the Trump presidency looming. This particular insurance program was created by Hillary Clinton in the 1990s as part of her time as First Lady of the United States. This program is up for review in 2017, and could put a strain on the relationship between Trump and members of Congress in support of the Children’s Health Insurance Program.

Lower Tax and Decrease Regulations

Growing in specificity and detail are Trump’s proposals regarding taxes and business regulations. Trump has proposed putting a hold on new business regulations and has said that he will ask related federal agencies to rank current business regulations in order of importance.

One of his most outspoken policies that gained the most support for him during his campaign was his promise to cut corporate and overall income taxes. He hopes this will jump start the economy and make up for the money being spent on the current military budget. He has not stated how much he will cut taxes by, and Congress may stall his efforts to change the current rates due to ongoing issues with the national budget.

Looking Ahead

We cannot say for certain what a Trump presidency will bring in terms of changes to the health care system, tax breaks, deregulated business and much more. Congress and various federal bodies, in addition to the outspoken American people, will set the tone for the next four years regardless.

For more information contact: Skyline Risk Management, Inc. at (718) 267-6600

2017 ACA Health Insurance Plan Increases

2017 ACA Health Insurance Plan Increases

2017: ACA Average Plan Increase by State

Alabama - 71%

Alaska - 26%

Arizona - 145%

Arkansas - 1%

California - 5%

Colorado - 12%

Connecticut - 27%

Delaware - 19%

D.C Washington - 22%

Florida - 17%

Georgia - 13%

Hawaii - 32%

Idaho - 27%

Illinois - 48%

Indiana - (-4%)

Iowa - 6%

Kansas - 46%

Kentucky - 3%

Louisiana - 13%

Maine - 19%

Maryland - 24%

Massachusetts - N/A

Michigan - 5%

Minnesota - 55%

Mississippi - 25%

Missouri - 8%

Montana - 32%

Nebraska - 18%

Nevada - 8%

New Hampshire  - 2%

New Jersey - 7%

New Mexico - 39%

New York - 24%

North Carolina - 40%

North Dakota - 9%

Ohio - (-2%)

Oklahoma - 67%

Oregon - 20%

Pennsylvania - 51%

Rhode Island - (-1%)

South Carolina - 29%

South Dakota - 45%

Tennessee - 49%

Texas - 13%

Utah - 20%

Vermont - 5%

Virginia - 7%

Washington - NA

West Virginia - 23%

Wisconsin - 16%

Wyoming - 9%


2017 is certainly going to be a year of decisions. If you are concerned about your health insurance rates for 2017 contact Skyline Risk Management, Inc at (718) 267-6600 to discuss the best health insurance options for you. 

Affordable Care Act Marketplace Competition Getting Slim

Affordable Care Act Marketplace Competition Getting Slim

Those who are taking advantage of the Affordable Care Act may find themselves with fewer choices in carriers. Three major insurance companies are pulling out of the marketplace, and this can leave some counties with only one carrier and others with only two.

Why Are Insurance Companies Pulling Out of the Marketplace?

This lack of competition as far as insurance companies goes is largely due to a lawsuit that the Obama administration is part of in trying to prevent two major insurance companies from coming together into a merger. The administration contends that it would harm the competition. One of the companies, Aetna, had previously said that they were going to expand the plans that they were going to offer in the marketplace. However, after the lawsuit was filed, they decided to exit the marketplace in most areas of the United States.

The other company involved in the lawsuit, Anthem, has not said that they are pulling out of the state marketplaces. However, it has hinted that it may leave in the future, simply because of the money lost on its Obamacare claims last year.

Completely separate from the above legal battle, the largest insurance company in the country, United Healthcare, reduced its offerings in the marketplace to just five states. This comes after seeing hundreds of millions of dollars in losses in plans and claims over the last few years.

Some Areas Worse Than Others

Some areas of the country are seeing a lack of competition more than others. This is especially true in the South. In fact, South Carolina and Alabama are finding that none of their counties have more than one carrier option; North Carolina, Georgia, Florida, and Mississippi are seeing this in the majority of their counties as well. The only state not seeing this trend in the South is Arkansas. Every county in this state has at least three different carriers to choose from in the marketplace.

Research Finds Some Good New About ACA

A study released recently by the University of Miami School of Business had some good news about the Affordable Care Act (ACA). Based on over 100 other studies of the ACA, it was found that approximately 20 million Americans had received coverage through the ACA. It broke down to 11.7 million receiving coverage through the marketplace, almost 11 million receiving coverage through Medicaid, and 3 million young adults being able to stay on their parent’s insurance.

On the other side of the coin, this research study found that there were not enough providers that accept ACA plans. Almost 40 percent of Americans still say that they have an issue getting health care access, and this is especially true for those who are impoverished or people of color.

More Work Still to Do

The Affordable Care Act is a mix of good and bad, but it has given many Americans access to health care for the first time ever. Unfortunately, however, it sounds like it is time for some attention to be given to the plan to ensure that it continues to work for Americans now and in the future. 

Are you an employer or employee struggling to adapt to Obamacare? Contact Skyline Risk Management, Inc. at (718) 267-6600 to voice your concerns. 

How To be Healthy and Save Money on Health Insurance

How To be Healthy and Save Money on Health Insurance

Have you ever heard of a Gym Reimbursement?

Many health insurance carriers offer a gym reimbursement option, which is an incentive for a healthy lifestyle.

The trade-off is simple!

Health insurance carriers offer to reduce health insurance premiums if the person who is insured consistently goes to the gym. Requirements vary depending on the insurance carrier.

The requirements for United Health Care Oxford in 2016 are:

“1. Visit the gym – You must complete a minimum of 50 visits per six-month period. Reimbursements will not be issued until six months have passed, even if 50 visits are completed sooner than six months.”

(For more information about Oxford Gym Reimbursements Click Here)

To find out how much you can save you should contact your health insurance broker or plan administrator.


Why Should Employers Care?

Employers should care about gym reimbursements for 3 reasons, which include premiums, claims, and culture.

1. Premiums:

Employers have a significant upside for encouraging gym reimbursement participation. Companies electing to pay for employee benefits, including medical will benefit from a premium reduction for all employees who decide to participate. For an employer who pays for the medical benefits of its employees, encouraging gym reimbursement participation is a great way to offer essential benefits while also cutting costs.

2. Claims:

Encouraging healthy habits can be a great way for employers to save money on claims. This is especially important for companies who elect to offer self-funded medical benefits. Self-funded medical benefits are benefits offered by the employer at a lower premium. In a Self-funded plan the employer assumes responsibly if anyone on the plan submits a claim. To offset this risk employers collect a portion of the premiums, which is allocated specifically in the event that a loss occurs. 

For employers who elect self-funded medical insurance reducing claims is essential. Utilizing a gym reimbursement option is a great way for employers to help their employees stay healthy and hopefully reduce claims.

3. Culture:

Culture is a key factor for a prospective employee when deciding to join an organization. Employers can enhance the attractiveness of their organization by establishing a healthy work culture. A prospective employee understands the commitment of joining a new company. There are a lot of unknown factor and risks involves, however having an upbeat and healthy workplace is a great way to reinforce the positive experience of working at your company.

SKYLINE's Bottom-Line

The bottom line is this… Why not encourage employees to utilize the gym reimbursement program offered by your business’s healthcare carrier? The carrier, employer, and employee all benefit! If you are a leader in your organization with the power to reduce premiums, claims and enhance the well-being of your workforce wouldn’t you promote this?

For more information about your business's gym reimbursement program, or for more ways to add benefits to your organization, contact Skyline Risk Management, Inc. at (718) 267-6600.

Making the Most of Benefits Integration

Making the Most of Benefits Integration

Businesses are always concerned with the bottom line. It's a part of being in business. The goal is to generate as much profit as possible. While increasing revenues are essential to this aim, one's bottom line can see a huge bump by keeping employees healthy, free of injuries, and at work as much as possible.

One way to encourage employees to continually come to work stems from benefits integration. By combining absence management programs and disability benefits, many companies can find a cost savings advantage.

If the employer adds a wellness program into this mix, the company may see added benefits. Wellness programs have been proven to rapidly improve the health of employees after implementation.

Integrating Benefits For Good

Cost savings isn't the only reason to combine benefits. Many companies have seen compliance risks eliminated due to integration. When programs are segregated, and administration is not properly aligned, a company puts itself at risk of making compliance errors. And these errors can be costly.

If a company does not integrate their benefits, then numerous claims could all be made at different times for the same injury, including:

  •  Workers' compensation
  • Family and Medical Leave Act time
  • Short-term disability

For an example, let's look at someone who had surgery. The first eight weeks they are out stemming from the surgery could be on a workers' comp claim. Once they come back from that claim, they could use an additional 12 weeks by filing for FMLA time.

Instead, an employer can run both of these claims concurrently – limiting the time away from work for the employee to 12 weeks, not 20. This is one of the easiest ways for employers to lower their lost time rates. Implementing a few return-to-work programs has also shown benefit to some companies.

It's important to remember that benefits integration will work differently for every company. Each employer has a variety of factors to consider before implementing any integration programs.

A Focus On Wellness

While limiting lost time rates is vital to improving profitability, some employers are taking a different route. Many companies have begun to focus on keeping employees productive by keeping them healthy.

Many wellness programs promoted by employers are focusing on helping employees with illnesses become healthier. Standard concentrations of employee health programs include diabetes, heart disease, and more.

Employees with diabetes, cost employers 2.3 times more on medical coverage. This hurts profitability. So wellness programs aim to limit the impact of such illness by incorporating recreation centers, trainers, desk exercises, health assessments, and more.

Many employers also offer employees with diabetes free testing supplies, monitoring, and more. Some companies even provide a reduction in employee health care premiums – if the employee takes part in the wellness program.  

How Your Business Can Make the Most Of Integration

When increasing profitability is in the cards, companies will pull out all the stops. From wellness programs to benefits integration, employers have many ways to bump the bottom line without increasing revenues.

From an insurance standpoint, wellness programs offer great benefits to employers and employees alike. Combining benefits like workers' comp and short-term disability eliminates employees taking advantage of the system. Employers also benefit from wellness programs as it covers their compliance when integrating.

Oxford Health Plans Exits Commercial Market in New York

Oxford Health Plans Exits Commercial Market in New York

After conducting a review of their entire portfolio, the decision was made that Oxford Health Plans (NY) will exit the commercial market and not renew the OHP license in 2017.

The Changes

Not renewing the license means that Oxford Health Plans (NY) will not offer individual plans, small group OHP New York plans, or OHP New York POS products.

*All changes will begin at the clients' renewal date in 2017.

While Oxford Health Plans (NY) is withdrawing, Oxford Health Insurance (OHI) is not. OHI will still offer a wide selection of insurance offerings in New York. The OHI portfolio will still offer an extensive range of insurance coverage options for any and every employer regardless of size.

What the Changes Mean

You should have the opportunity to select a new OHI group plan before any current coverage runs out.

All groups and individuals who may be affected by this change will receive notice of the changes at least 180 days before the end of their 2017 coverage date. Notices will clarify all action that needs to be taken to ensure future coverage, along with different options.

How You Could Be Impacted

A few large group employers will end up needing to select new OHI plans for any and every affected employee. Most large group employers won't have to worry about the change, as only a small number of these clients will be affected.

Small group employers are more likely to be impacted. Many offer both OHP and OHI plans. These clients will find their plans automatically moved from the OHP HMO plan to an OHI program. Information on this change will be sent to affected customers. There will be no changes to the current OHI plans.

If a small group employer was only offering an OHP plan, then they will need to take action and potentially purchase a new OHI plan, as OHP plans will not be renewing. Groups like these will need to reapply as a new group with OHI to get coverage again.

Groups that qualify for Healthy NY group coverage will be offered a similar plan from OHI. These groups will not need to apply again; they only have to use the Healthy NY Recertification Form. The key requirement for any groups using this coverage is that they meet Healthy NY's requirements.

Individuals who have OHP will need to find new coverage. Working with your individual clients, you'll want to encourage them to seek coverage through "The Marketplace" from the New York State of Health.

How SKYLINE Can Help

Ultimately, this change may be confusing for many groups and individuals. Many will need to work with insurance consultants and/or agents to find the proper coverage options from OHI moving forward. 

If you need help finding comparable coverage for your Oxford health insurance plan please call Skyline Risk Management, Inc. (718) 267-6600, or email us at to voice your concerns.  

Affordable Care Act: A Year-By-Year Overview

Affordable Care Act: A Year-By-Year Overview

The Affordable Care Act, often referred to as Obamacare, although passed by the Congress in 2010, was designed to be phased in each year with 2016 marked as full implementation. Along the way there have been challenges by some of the states and challenges by Congress; but, alas, the full-blown Affordable Care Act (ACA) has arrived. Each year, portions of this massive healthcare reform act were implemented, and the most significant are as follows:


Patient's Bill of Rights - This provision was designed to protect U.S. consumers from alleged abuses of the insurance industry. It also called for free preventative services to begin for U.S. consumers who become insure. There was also an additional twenty changes included with the 2010 implementations.


Medicare members are offered key preventive services at no cost and receive a 50% savings on brand-name drugs while in the "donut hole." There are an additional eight components that were also implemented in 2011.


This year was all about improving healthcare quality and reducing paperwork and administrative costs in the healthcare industry. 2012 was also the year for the implementation of CLASS, a voluntary long-term care insurance solution. There were also four other major implementations in 2012.


This was the year when open enrollment began for the Health Insurance Marketplace and will be remembered for the many failures of the HealthCare.Gov online portal. There were also four other major implementations that went into effect.


2014 is considered by many to be the year of the consumer. Pre-existing conditions, annual limits of coverage, and clinical trial coverage were the highlights for 2014.


Physicians who provide a higher quality of care rather than volume of care will receive higher payments than physicians who provide a lower quality of care.


2016 is scheduled as the year for complete implementation of the employer mandate:

  • Any business that employs at least 50 full-time employees will be required to offer at least 95% of the full-time employees health insurance to avoid penalties.
  • The definition of "affordability" is changed to 9.66% of an employee's total household income.
  • Employers will be penalized for failure to provide minimum essential coverage to employees or offering an inadequate health plan. The new penalty under section 4980H(a) is increased to $2,160per full-time employee in excess of 30 employees.
  • If an employer offers minimum essential coverage the doesn't satisfy the requirements of "Minimum Value and Affordability," a penalty will be levied if a full-time employee receives a premium tax credit to buy insurance on an exchange as a result of the following:

1.      The employer health coverage did not offer "minimum value".

2.      The employer health coverage was considered "unaffordable."

Challenges Over the Years

Although the ACA was passed by the Congress, it was done so on a razor thin margin and therefore there were many who felt that the massive health care overhaul might not pass constitutional muster, and so challenges were certainly to follow:

  • Early on Republicans in 26 states challenged the mandate in the act, saying it was an unconstitutional expansion of federal power. The Supreme Court heard the case and in June of 2012 ruled that it was constitutional.
  • In June of 2014 after a case was filed by Hobby Lobby that complained that the ACA forced closely held businesses to violate religious convictions while being required to pay for contraception, the Supreme Court ruled against the ACA.
  • In another case in 2015, the Supreme Court ruled that health insurance subsidies could be awarded in states that set up their own and exchanges and in states that did not.

Whatever your feelings are regarding the Affordable Care Act, most can agree that it is a massive piece of legislation that is complex and confusing. To make certain that your business is adhering to the rules and regulations, contact an insurance professional at Skyline Risk Management  (718) 267-6600 to learn more about managing your employee benefits.

Health Insurance 101: Lowering Premiums

Health Insurance 101: Lowering Premiums

Obamacare Tax Penalties

Obamacare Tax Penalties

We’ve all been there, "My health insurance premium is too high and I am sick of paying every month for coverage I never use!" I have heard it a million times and when clients tell me that their health insurance it too high I don’t argue with them because THEY ARE RIGHT! Unfortunately since the emergence of Obamacare healthcare premiums increased.

ATTENTION: Did you know that since 2014 all Americans are required by law to have health insurance, and if they don’t have health insurance they have to pay an Obamacare tax penalty? It may not seem fair but the Affordable Care Act was implemented to make healthcare more affordable and accessible by obligating all Americans to purchase health insurance.

In response to these laws this article has been created to help Americans learn more about purchasing health insurance.

First off, what is a premium?

A premium is the cost a person pays to obtain insurance. Dependent on the type of insurance, premiums may be paid in a variety of ways including monthly or annual payments. Typically health insurance in New York is paid on a monthly basis.

Premiums should have an impact on a person’s decision to buy health insurance, however it should not be the primary factor dictating what plan you choose. In order to fully appreciate higher or lower premiums a potential health insurance purchaser needs to understand the premium, deductible and co-pay relationship.

A good health insurance broker will present three options when offering a health insurance plan. These plans include a high, medium, and low option, which are commonly referred to as Platinum and Gold for the high option plans, Silver for the medium option plan, and Bronze for the low option plan. A broker may not offer all plan tiers to a potential purchaser if the broker feels that the purchaser has no desire to purchase a certain plan, in which case they may elect to exclude it from the proposal. Regardless at the time of proposal three plan options are usually presented. 

What is a deductible?

A deductible is the specified amount of money that a person must pay before an insurance company will pay a claim. For example, I have health insurance with a $5000 deductible and I have a procedure, which costs $10,000. I am responsible for paying the $5000 deductible before my insurance kicks in and pays the difference.

A higher deductible means that in the event of medical necessity, a person must pay more money out of pocket than they would if they had a lower deductible.

What is a co-pay?

A co-pay is the cost associated with a health insurance policy, which a person must pay if they visit a doctor or specialist. For example, I have a health insurance plan which has a $20 co-pay for both my general physician and specialist. If I go to my physician or specialist I have to pay $20 because my copay is $20.

How the Premium, Deducible, and Copay Relate:

This diagram represents an example of some of the features presented on a health insurance proposal.

This diagram represents an example of some of the features presented on a health insurance proposal.

High Option:

  1. Deductible - $1,000
  2. Primary Care (Co-pay) - $25
  3. Specialist (Co-pay) - $40
  4. Premium - $750.40

This option has the lowest deductible at $1000 and has co-pays of $25 and $40 dollars. The reason that this option is the high option is because it has the highest premium, which is dictated by the plan's low deductible and low co-pays. This plan is good for someone who plans on visiting their doctor or specialist regularly throughout the year. Examples of medical specialists induce:

  • Addiction psychiatrists
  • Allergists
  • Cardiologists
  • Dermatologists
  • And more...

Medium Option:

  1. Deductible - $1,250
  2. Primary Care (Co-pay) - $30
  3. Specialist (Co-pay) - $60
  4. Premium - $747.27

The medium option has a deductible of $1,250 and co-pays of $30 and $60 dollars. This option is a good choice for someone who doesn’t visit the doctor’s office regularly but wishes to have a lower deductible in the event of a medical emergency.

Low Option:

  1. Deductible - $2,000
  2. Primary Care (Co-pay) - $40
  3. Specialist (Co-pay) - $70
  4. Premium - $654.16

The low option has a deductible of $2000 and co-pays of $40 and $70 dollars. This plan is good for a person who wishes to have health insurance instead of paying the Obamacare tax penalty and who doesn’t feel the need to visit their doctor or specialist regularly. This option has the lowest premium and has a higher deductible and higher co-pays. 

Wrap Up

                People are always complaining about the premiums of their health insurance plans. What they often fail to understand is that the premium reflects the deductibles and co-pays they elected in their coverage. BE SMART and ask your insurance broker about ways to strategically alter your health insurance to customize a plan with deductibles and co-pays that fit your budget.

If you have questions about health insurance and ways to lower your premium for yourself, or your business, contact Skyline Risk Management, Inc. today at (718) 267-6600 to voice your concerns. 

6 Factors Driving Critical Illness Insurance

6 Factors Driving Critical Illness Insurance

In recent years Americans have expressed a growing interest in critical illness insurance policies. Now more than ever, Americans desire coverage for critical illness due to the increase likelihood of critical illness and the devastating affects it has on families and friends. 

So, what's driving the surge in critical illness insurance?

1. Living Longer

The average lifespan for both men and women has been steadily increasing over the years. Currently, the Center for Disease Control lists the average life span of an individual in the United States at nearly 79 years. That's a long time! For men, the average life expectancy is around 76. American women live to be 81 years on average. Compared to 1950, when the average life expectancy was around 71 years, that's a significant improvement.

2. Living With Diseases

While we are living longer as a society, we are not living without disease. Many individuals suffer through their final years battling medical conditions like cancer, heart disease, dementia, and more. Luckily, modern medicine extends these people's lives, but there is still pain and suffering.

3. Cancer Is Rampant

Speaking of suffering, cancer rates have never been higher. While we are living longer, more people are suffering from cancer than ever before. Roughly 41% of men will face cancer at least one time in their lifetime. Around 38% of women will suffer similar bouts with the nasty disease.

4. Medical Expenses Sky-High

The continuous battle that many people suffering from cancer face does not come cheap. In fact, medical treatments when fighting illnesses like cancer, heart disease, or a stroke can wreak havoc on bank accounts and savings. An individual and their family can go bankrupt trying to afford the treatments that come with battling cancer, even if they have great health insurance.

5. Employer Provided

Due to the nature of these critical illnesses, many businesses have been providing their employees with critical illness insurance. The insurance product has gained steam as a protection policy against cancer, and many employees view the plan as an excellent perk in the benefits package. Around 45% of large companies have started to offer the policy – compared to just 34% a few years ago.

6. Financial Security

Ultimately, individuals and families find great value in critical illness insurance due to the financial security it provides them. Many people have been saved from bankruptcy due to their critical policy. The lump-sum payouts make a huge difference when paying for chemotherapy and for when other treatments become a necessity.

Critical Illness Policies for Your Clients

Ultimately, insurers should be offering critical illness policy to all customers of a certain age. The policies have helped many avoid bankruptcy and offer great peace of mind if an illness disaster strikes. If you have questions about critical illness policies contact Skyline Risk Management, Inc., (718) 267-6600 to voice your concerns.