Excellus BCBS Broker News Vol. 19 No. 5 Special Issue

Individual & Small Group – NYS Prior Approval Of Rate Changes

On May 15, 2024, an application was submitted requesting 2025 premium rate changes in accordance with New York state prior approval law. This rate application applies to Community Rated Individual and Small Group products.

The following products are included in this 2025 rate filing:

• Direct Pay Metal Plans and Base (catastrophic)
• Bassett Preferred
• CNY Preferred
• Healthy NY EPO
• SimplyBlue Plus
• Excellus BCBS HMO
• Blue Simplicity

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Employer Group Communication

Initial notification letters will be mailed to community-rated employer groups and direct pay members enrolled in the products listed above. The letter will include the requested rate percentage changes.

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Broker Communication

Beginning on May 31, (or shortly after that date) agents will receive an encrypted e-mail notification with copies of the initial notification letters being sent to your groups. The encrypted emails* will expire if not read within the specified timeframe as indicated in your email notification.

Groups will receive an annual rate notification with the actual, approved rates 60 days prior to their renewal date. The annual rate notices will be available to Brokers on Information Connection..

It’s important that the groups receive the notification and distribute the individual letters to their employees with any additional information explaining the rate changes which may be different from the rates in the initial notification letters (e.g., shared expense).

^{*Encrypted files expire after a specified time from the send date. You will not be able to access the information in the file if the email isn't opened and read within that time. You will also be prompted to create a password associated with your email address to access the encrypted file.}

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2025 Community Rated Broker Commission Changes

As an Excellus BCBS Broker, you are a valued partner in their mission to provide access to affordable high-quality health care to the communities we serve. That’s why they want to provide you with advance notice of some important information as you prepare for the 2025 plan year.

Each year Excellus looks at their broker compensation plans and review several factors that impact commissions. Projected premium rate changes, market challenges, and overall affordability, all play a role in how they calculate commissions.

Although Excellus BCBS continues to maintain a strong financial position, they are facing issues concerning the rising costs and demand for medical care. As a result, they continue to take a closer look at all the ways they could impact the affordability of plans, including broker commissions for next year.

Beginning with the 2025 plan year, Community Rated products will be compensated at $46 Per Contract Per Month (PCPM). Excellus recognizes this payment structure is a considerable change from the current year, and will evaluate each year for potential inflationary increases.

There are a few considerations that led to make this change. For the past five years the market has seen a decline in community-rated membership. Despite premium rate increases, the health plans absorbed nearly a billion dollars over the last several years in underwriting losses, mainly due to significant increases in the cost of health care. This current trend is unsustainable.

This is the first major commission adjustment since the program’s inception. Excellus continues to value your partnership and feedback, and hopes you understand that this change is important for the long-term affordability of their products.

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