healthfirst phsp, inc. individual 2020 public comments · 2019. 7. 10. · healthfirst phsp, inc....

Healthfirst PHSP, Inc.Individual2020 Public Comments

Please do not raise these rates. I rarely ever use this and it's already exhorbitant in cost each much. Thank you for your time and consideration.

There is absolutely zero justification for a rate increase to this bare minimum plan. As it is, I am paying over $400 of my own money every single month for mediocre health care. My most important doctor, my , doesn't even accept this plan, so I have to pay for those necessary annual visits on my own. To increase the rate of this plan, yet again, is robbery, plain and simple, and absolutely disgusting.

I do not think HealthFirst should get a 6.7% rate change. The cost is already too high.

Please, please, please do not allow the premium percentage increase of 6.7%. It is way too much. My cost of living raise to my salary each year is less than half of that. I know we’re all just numbers on a screen to these insurance companies but please try to look at us as human beings trying to survive with very basic healthcare. Health insurance is breaking me financially. Please, I beg of you. Do not allow this increase. Sincerely,

I will absolutely be dropping this insurance if it goes up by even a penny. Your CEO, Ms. Wang, makes 3.2 MILLION a year maybe trim some fat over there before you come to strip the finances of a working mother with preexisting conditions. Cost increases for prescription drugs Get your lobbyist to work fixing your relationship with the pharmaceutical industry. These are FIXABLE PROBLEMS there is no reason in the richest country in the world that you need to bleed the consumer, your fellow citizens.

I recently received notice of a requested increase in rates for 2020 and I very much disappointed. Having just joined this plan a few months ago, I am not prepared to factor for a higher premium and do not expect my income to increase a commensurate amount with the rate. This will be very detrimental for me.


I feel it's a terrible idea to raise premium rates because I've found my health insurance to be entirely unaffordable as is. in my experience, between the premium, deductible and co-pays, I simply cannot afford the treatment I need. Recently I experienced some problems - and I was told by my primary care doctor that I needed to see a which I had to pay for out of pocket because of my deductible policy. The told me that I needed to take two tests - a test and a However, I would also have to pay for these tests out of pocket because of my policy, which would cost thousands of dollars, which I simply cannot afford. So as of now, I am not getting the treatment I need and the coverage I'm paying for has failed me. After rent, utility bills and New York City living expenses, there is no way I can afford the cost of these medical bills. I truly feel that we should be focused on providing more affordable coverage and not compounding what is nothing less than a national crisis. I sincerely hope this feedback makes a difference in some way.

Well, I received my proposed rate increase for HealthFirst for 2020 and while it is the lowest increase in a few years it will take my premium from from about $884 a month to $943 a month (remember my premium rose 13% from 2018 to 2019). If approved, my premiums will have increased about 22% from 2018 to 2020. I should note that where I work, myself and my coworkers, have received 1 pay raise in the last 11 years. Please forward my message to the powers that be to let them know that endless price increases are squeezing middle class insurance buyers of Obamacare. You have to be either poor or rich in NYS to get health insurance, Please let it be known that NYS regulators should do their best to minimize health insurance premium price increases for 2020. Thanks.

I am trying to stay ahead of these price increases but it is hard with no pay raises. Property taxes are capped at 2% annual increases but not health insurance increases. Health insurance premiums are now becoming more than property taxes for a decent sized home across Long Island. This cannot go on much longer.

My health insurance premiums have already skyrocketed going from 2018-2019, of which I can barely afford, and I don't make a dime more than I made last year. If my premiums increase again next year, I will be leaving HealthFirst.

It would be CRIMINAL to raise health insurance premiums further. I already cannot really afford my premium. I pay far more out than I get back. It is a major financial stress every month. Universal health care is a human right. Insurance companies should not be profiting by squeezing individuals like this. I would like my tax dollars to go to subsidizing affordable health care for all Americans, not just the poorest. Consumers should not pay more than $400 a month for comprehensive health insurance. Raising rates above $733 a month is unjustifiable. That is half my cost of rent and more than I can afford.


The request for 6.7% increase in monthly premiums starting January 2020 is unacceptable This is a lousy plan with already $580 premium, $1,700 deductible and $7,500 maximum out of pocket - in other words maximum cost of insurance $14,460 a year !!! - Completely unaffordable. This is no go - The state should turn down the request - If the request is approved I am going to drop the plan - In addition there was already a premium increase for year 2019 !

I was very upset to see that there a request for a year 2020 increase in the premium rate for my insurance by 6.7% per month. This is unacceptable and I urge you to deny this request in full. This plan was implemented specifically for freelancers. As a self-employed worker, my monthly income is always unknown, which is why I chose an affordable plan. This increase could very easily prove to be a hardship in the months when work may be scarce. In addition, the insurance companies continue to make a profit. Until a single-payer plan is implemented (as it is in every other civilized country) healthcare costs to individuals such as myself will continue to cause stress on a regular basis -- we will be forced to choose plans that are less expensive but that don't cover our medical needs (and, as you know, medical bills are the primary cause of US bankruptcies). The claim by HealthFirst that the increase in prescription drug prices has forced their hand, is all the more reason to focus on suing the pharmaceutical companies for reimbursement of exorbitant prices rather than passing on high premium rates to elderly and cash-strapped consumers who are already relying on subsidies to pay our medical bills. The premium doesn’t even cover all the medical costs as co-pays continue to drain additional money saved – money that could help pay for rent, food, and retirement. Please DO THE RIGHT THING and do NOT increase the premium rates. Instead, support the self-employed, like myself, who contribute a great deal already to the pockets of the insurance companies. Thank you.

I recently received Healthfirst's notice of proposed premium change and it is hard for me to see why they need to increase their rates. From 2018 to 2019 my rate has increase from 893.58 to 900.48 (which may not seem like a huge increase) BUT my deductible and out of pocket went up from $7,150 to $7,900 and total out of pocket from $14,300 to $15,800; these numbers represent a pretty large jump in out of pocket costs. Although costs of care may have increased, the financial burden that has been placed on the consumer by these high out of pocket costs have also increased, reducing the amount of money that Healthfirst must pay per claim. Of all the doctor appointments my husband and I have attended, we have had to pay for every single one of them, without any payment from Healthfirst. We don't meet the tax credit that is available to others, so every increase that is asked for each year is felt in our pockets. The idea behind the affordable care act was to provide access to insurance coverage at a reasonable price and to curb how much the insurance companies can charge consumers every month. Although Healthfirst may feel that the monthly premium they are requesting is reasonable, does it account for the financial burden that is being placed on consumers which will probably increase along with the premium increase?

CMS, and other sources are projecting a nation-wide 2020 increase in healthcare spending of 5.5%, with a smilar increase in 2019. The increase in NY State should differ by very much. It seems outrageous for Healthfirst to request another increase of 6.7% for 2020 after receiving a 15% for 2019. This represents an accrued increase of nearly 23% within a two year period. There has been no substantiation for such a large increase in plan costs.


I do not believe that HealthFirst should raise its rates. Any rate change should come with more administrative transparency and/or better services, which have not been proposed or promised. As a healthy, self-employed individual buying health insurance in the marketplace, costs are already too high (over $700/mo).

I beg you not to approve this increase. Currently, it's a struggle to pay my premium. Combined with rent (even living with 6 roommates) the premium counts for half my salary. It's almost impossible to build up any savings or safety net. If I were involved in an accident, there is currently no way I could even meet my deductible. If this increase where to go into effect, I might have to go without insurance entirely. The higher premium will hurt working New Yorkers. Please don't prioritize the profits of insurance companies ( and prescription drugs companies) over the citizens of New York. Healthfirst can and will survive without this increase. Their customers will likely experience a decrease in their quality oflife in order to meet rising costs.

Please do not raise premiums. They are devastatingly high as it is.

I do not believe an increase in premiums is warranted. Much of Health First activity is with Beth Israel Mount Sinai and that organization uses segmented billing. That billing methodology, which breaks up the costs into smaller doctor fees, facility fees and hospital fees appears to produce modest costs but does little to add transparency to pricing so the patients/customers have no way to comparison shop. The doctors also do not know the pricing of their services. More cost information needs to be provided to patients, particularly with specialists, so they can effectively manage costs. I do not believe that the current billing arrangement makes it possible for the insurer to effectively audit and challenge bills and demonstrate compliance to their negotiated rates. I have had several instances where the gross amount (adding all the charges together for a single visit) have led to challenge on my part and some reduction. I doubt most patients would be as particular as me (I am a ). Prescriptions - I believe that doctors should be retrained on a wide variety of medical mitigants. Prescriptions are but one solution and are too easy to issue. I would like the insurance companies to run diagnostics against individual doctors and doctors groups and challenge when they see outsized quantities of prescriptions made. This is particularly important for elderly who may not have the capability to fully appreciate the impacts. The insurance companies should also use their clout to pressure pharma companies to charge competitive prices where relevant. Finally, I have noticed a number of doctors groups associated with hospitals and operating on their premises. I have not been able to identify the owners of these groups and wonder if doctors provide services directly to the hospital and also to other hospital groups. This arrangement provides additional income to doctors on a full time or near full time arrangement. I wonder about the potential for conflicts in these arrangements and how a hospital identifies, management and discloses these potential conflicts. Decline the pricing increase until more responsible prescribing methods are implemented, diagnostics and cost controls are more sophisticated and on the hospital and doctor side - there needs to be a concerted effort to disclose a price range on services, particularly with specialists.


I do not believe an increase in premiums is warranted. Much of Health First activity is with Beth Israel Mount Sinai and that organization uses segmented billing. That billing methodology, which breaks up the costs into smaller doctor fees, facility fees and hospital fees appears to produce modest costs but does little to add transparency to pricing so the patients/customers have no way to comparison shop. The doctors also do not know the pricing of their services. More cost information needs to be provided to patients, particularly with specialists, so they can effectively manage costs. I do not believe that the current billing arrangement makes it possible for the insurer to effectively audit and challenge bills and demonstrate compliance to their negotiated rates. I have had several instances where the gross amount (adding all the charges together for a single visit) have led to challenge on my part and some reduction. I doubt most patients would be as particular as me (I am a ). Prescriptions - I believe that doctors should be retrained on a wide variety of medical mitigants. Prescriptions are but one solution and are too easy to issue. I would like the insurance companies to run diagnostics against individual doctors and doctors groups and challenge when they see outsized quantities of prescriptions made. This is particularly important for elderly who may not have the capability to fully appreciate the impacts. The insurance companies should also use their clout to pressure pharma companies to charge competitive prices where relevant. Finally, I have noticed a number of doctors groups associated with hospitals and operating on their premises. I have not been able to identify the owners of these groups and wonder if doctors provide services directly to the hospital and also to other hospital groups. This arrangement provides additional income to doctors on a full time or near full time arrangement. I wonder about the potential for conflicts in these arrangements and how a hospital identifies, management and discloses these potential conflicts. Decline the pricing increase until more responsible prescribing methods are implemented, diagnostics and cost controls are more sophisticated and on the hospital and doctor side - there needs to be a concerted effort to disclose a price range on services, particularly with specialists.

My monthly premium is already way too high at $581 a month. I truly thought that going through NY State of Health to enroll in health insurance that I would be able to purchase a much more affordable plan. I received a letter stating that Healthfirst is requesting an increase to premium rates in 2020. Please do not approve this increase. Please.

Healthfirst's request for a higher rate for the 2020 is a joke. The amount of fraud and price-inflation perpetuated in the healthcare system by these insurance companies is immoral. That these same companies would then request that customer's should have to pay more is despicable. Please do not approve this rate increase, and instead do your part to hold the insurance companies accountable for their inflationary policies, instead of continuing to bail them out and perpetuate this vicious cycle.


I'm receiving assistance through the health insurance marketplace since my employer doesn't provide insurance. It's unclear based on the letter I received about this rate increase whether or not the assistance I'm receiving will increase as well. I understand you may not know, but if you have any information regarding how I can check this/when that will be available to me, that would be great. Honestly can't afford to pay what I already am, and any unsubsidized increase would really hurt. Thanks a bunch.

Premiums are too high - cannot afford

I appreciate this opportunity. I understand my health care plan is not as conducive to the amount of help I needed in this past month. In all honesty - as you can check in my record. I am a very healthy year old man. I've used Health Care exchange since ACA was signed into law. I've never needed medical attention ever till I had this

. It was apparently life threatening. It had to be treated immediately. Otherwise, the only issue I go in to see my primary care Dr. is for a preventive drug called . This drug

It's a smart move and an important pill to take (along with other protections) for my community. All in all, I have paid my dues in the past (and will pay a whole lot more as the years go on and I'm as healthy as I've always been) to have one incident in life that should be looked at as a freak accident rather than hiking up my premium (or any rates for that matter) and treating my case as if I'm now a risk. It's out of proportion. I am not a car who got into an accident. I am a strong healthy young man who lives in a city. And after 15 years of living here I scratched my nose and caught

- which nearly killed me. Please do not raise my rates. You guys need more men like me who pay more into the system than take out. And I assure you, you have made more money off me over the years than the 20k that was asked by Mt. Sinai. $600 of which I paid. Thank you for your service. I truly love this system. I just hope you keep my rates as affordable as they've been so that I may continue to be a customer. Again, this was a one time fluke. Check the records. I do not deserve a rates hike. Thank you for your time.

I am requesting that Healthfirst not be granted a rate increase. As an individual, I have been subject to increased rates over the past few years and the benefits have decreased while costs continue to increase. Currently, my health cost of $1466 per month is more than my mortgage. Other neighbors and family members are also complaining about the increased costs of healthcare. Making ends meet is increasingly difficult. Please consider this statement when evaluating Healthfirst's request. I would ask that this rate increase of 6.7%. (which is almost $100 more per month, $1200 per year is exhorbitant and usurious) or any other amount not be approved by your agency. Thank you.


Healthfirst PHSP, Inc Healthfirst platinum leaf premier Individual coverage with family HIOS ID 91237NY0020058 I am currently working for a small company and had to get health insurance for myself and family from the market place paying full price. Currently I am paying $2,269 per month for coverage which is a total of $27,228 per year. I received notification of a 6.7 % increase for January 2020. I find this is too much for me to pay. This will notbe financially beneficial for me to pay $30,000 per year for health insurance plus co-pays for visits and medications. My take home pay will not be enough for me to take care of my family and pay my bills and live. If this rate continues to increase, it will force me to seek employment with a bigger coorporation where the cost will not be as high and leave your company. Please consider my concerns and refrain from increasing the health insurance premiums for 2020. Thank you. .

I do not agree with the premium increase. Specifically, I'm not on-board with cost increases for prescription drugs. If there are going to be changes, it should be making prescription drugs more affordable. I can't afford the medication I need as it is.

Healthfirst is requesting a rate increase to my Gold Leaf Premier premium at 6.7%. My insurance cost has gone up dramatically over the past few years, far outpacing inflation rates. I would therefore urge DFS to not approve the requested rate change.

I think its absolutely absurd that Health first is proposing a premium increase. I cannot afford an increase, I am a work on an as needed basis which with a fluctuating salary! I believe we pay enough for our

premium along with a deductible, co-pays and other out of pocket expenses! This is just plain greed it sickens me to think I live in a country with so much cooperate greed! You should be ashamed of yourselves! In my opinion you want more money in your pocket not looking after the welfare of you customers! If you are granted an increase I will be shopping for a new insurance carrier!

I oppose this proposed rate increase for many reasons. First, the proposed premium increase is well beyond the rate of inflation. Second, Health First consistently makes using their insurance and getting agreed upon coverage nearly impossible for a customer to achieve. Here is one example: I currently pay $733/month in order to have a low deductible ($900) 2 months ago I noticed a and called them to get referrals to have a doctor look at it for . I used one of the doctor's they said I should use. Their rep on the phone said no PCP referral was needed as these doctor's where in-plan. I went. I received a bill for the doctor's services as I expected. What I did not expect was them insisting on not applying this charge to my deductible per the terms of the insurance agreement. I now have to go through months of adjudication with them to get them to apply $310 against a $900 deductible. THAT IS MY RATE INCREASE. This company doesn't seek to provide usable insurance for people it is stealing money. Any rate increase would be further government santioned private theft.


Please see http://hcfany.org/resources/comments-on-healthfirsts-2020-rate-request/ for our full comments. Healthfirst in New York’s third largest individual market insurer with over 36,000 members in the downstate region. It has been a relative leader in controlling medical trend rates in the past and should be lauded for projecting a decline in the coming year. HCFANY also appreciates that Healthfirst voluntarily has dropped its requested profit ratio to 1.5 percent. Healthfirst is a non-profit, provider-sponsored plan which should experience lower-than-average administrative costs—and yet, remarkably, it is posting the highest expense ratio—15.7 percent—across all the carriers in New York State. Healthfirst has a healthy member population and is a net payer into the federal risk adjustment program. In its 2020 rate application Healthfirst seeks a 6 percent increase of its individual rates. This rate proposed rate increase follows two years of proposed double-digit rate increase—15 percent increase for 2019 and 22 percent for 2018. Fortunately, the Department reduced these proposals somewhat, and Healthfirst secured an approved rate increase of 17.7% in 2018 and 9.5 percent in 2020. But the cumulative impact of such large rate increases caused Healthfirst to fail to make the statutory minimum medical loss ratio by three percent. Because Healthfirst is not paying out enough claims for the premiums it is collecting, HCFANY urges the Department not to approve any rate increase for Healthfirst for 2020 and consider imposing a premium decrease instead. HCFANY identified three issues that the Department should carefully review to ensure that Healthfirst’s members are protected from unnecessarily high rate increases: medical loss ratio, administrative costs, and its request for an individual mandate adjustment. A. Healthfirst’s medical loss ratio is below the statutory minimum Healthfirst had a medical loss ratio (MLR) of just 79.4 percent in 2018 and accordingly, owes its members rebates for that year. It now projects an MLR of just 83.5 percent for 2020—but there is now indication of how it intends to meet the statutory minimum should it get its requested rate increase. It appears that Healthfirst was unable to make its MLR because it filed overly aggressive rate increases for the past two years. These rate increases were predicated, in part, on Healthfirst’s prior MLRs, which were 99 percent in 2016 and 90.7 percent for 2017. The fact that the MLR has plummeted by 10 percent each year for the past three years indicates that the approved rates were too high. B. Healthfirst has the highest administrative costs (or expense ratio) in the state Healthfirst projects the highest expense ratio—15.7 percent—of all New York State carriers for the 2020 plan year. The average projected expense ratio in the individual market is 12.8 percent for 2020. Along with Fidelis and MetroPlus, Healthfirst has traditionally served New York’s public insurance programs which means those plans provide a useful comparios.n Healthfirst’s expense ratio is much higher than either: Fidelis projects 9.1 percent and MetroPlus just 8 percent. Indeed, Healthfirst itself was able to operate with a 12 percent expense ratio in 2016. No explanation for Healthfirst’s ballooning administrative costs is offered in its Actuarial Memorandum. In addition, it appears that Healthfirst has failed to invest its administrative spending wisely. Its faulty premium collection program was the source of many consumer complaints until it was revamped in late 2018, and most recently, it has disclosed serious patient privacy breaches. In public comments on the Department’s website, consumers appear to be particularly concerned about Healthfirst’s administrative costs. As one consumer notes: “ I will absolutely be dropping this insurance if it goes up by even a penny. Your CEO, Ms. Wang, makes 3.2 MILLION a year. Maybe trim some fat over there before you come to strip the finances of a working mother with preexisting conditions.” Another consumer asks the Department to require Healthfirst to transparently disclose why their administrative costs are so high, stating, “I do not believe that HealthFirst should raise its rates. Any rate change should come with more administrative transparency and/or better services, which have not been proposed or promised.” Finally, New York’s consumers would like the Department to address Healthfirst’s administrative expenses. This sentiment was best expressed by this public comment: Healthfirst's request for a higher rate for the 2020 is a joke. The amount of fraud and price-inflation perpetuated in the healthcare system by these insurance companies is immoral. That these same companies would then request that [its] customers should have to pay more is despicable. Please do not approve this rate increase, and instead do your part to hold the insurance companies accountable for their inflationary policies, instead of continuing to bail them out and perpetuate this vicious cycle. C. Healthfirst’s request for an individual mandate adjustment should be rejected Healthfirst is one of just three carriers that seeks an upward rate adjustment for the elimination of the individual market tax penalty. This


adjustment should be disallowed. First, since New York’s individual market in not constricting—even in a booming job economy—there is not support for the notion that there is any impact to the elimination of the tax penalty under the individual mandate. Second, any adjustment for the elimination of the penalty was issued last year, when the penalty was first implemented. Quite simply, this is not the gift that keeps on giving and the Department should reject this increase. Accordingly, HCFANY respectfully requests that Healthfirst’s proposed 6 percent rate increase be rejected and that the Department considering issuing a rate reduction. Thank you for the opportunity to provide our comments.

healthfirst phsp, inc. individual 2020 public comments · 2019. 7. 10. · healthfirst phsp, inc....

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