Excellus BCBS Broker News Vol. 20 No. 2

Managed Care Organization Tax

The Centers for Medicare and Medicaid Services (CMS) recently approved New York's Managed Care Organization tax (MCO), effective 1/1/2025. This tax, authorized by the 2024-2025 State Budget, will apply different tax rates to Medicaid and non-Medicaid plans. The tax rates are based on per member per month enrollment and will apply on a calendar year basis.

The impacted lines of business include Commercial Fully Insured Group Health Plans, Commercial Individual Health Plans, D-SNP/Duals and Government Programs.

Experience Rated: The MCO tax will be converted to a PCPM of $2.70 and be included in the premium as part of retention on all renewals and new business quotes with effective dates of 7/1/2025 and forward. Tax details will be added to the Taxes and Fees Exhibit of the renewal packet.

Minimum Premium: An addendum to your current contract will be necessary to reflect the MCO tax. Minimum premium groups will be contacted by their account manager with additional information on the addendum.

Small Group, Individual, and Large Group HMO: Rates will not be impacted by the MCO tax for 2025 as rates were locked in during the fall of 2024 and approved by the state. The MCO tax will be included in 2026 premium rates.

Medicaid / Essential Plan: No impact to member level premium payments.

If you have any questions, please contact your account manager.

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Enrollment Portal Reminder – Accuracy Is Important

There has been an increase in keying errors submitted from the web and requests submitted through the enrollment portal. This has resulted in ID cards being mailed to incorrect recipients, members being enrolled in incorrect groups and information being sent to groups that are not affiliated with the member. As a reminder, please check your requests thoroughly to ensure the information you are submitting is accurate and complete.

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Voted #1 In NY For Customer Service – Again!

For the second consecutive year, J.D. Power has ranked Excellus BlueCross BlueShield #1 in New York for Medicare Advantage Plan Customer Satisfaction and Most Trusted.

This wouldn’t be possible without the local employees who are committed to providing excellent service, and members, who recognized them for coverage and ease of doing business. See the press release and J.D. Power 2024 award site for more information.

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Tax Form 1095-B

Health insurers—including Excellus BlueCross BlueShield—are no longer mailing tax form 1095-B to members. Because taxpayers are not required to include the form when filing their taxes, the IRS no longer requires the form to be mailed. Members can still download the form or request it by mail if there are circumstances where they require it (i.e., audit). The 1095-B forms are available here.

Please share this information with your groups and reach out to your account manager if you have questions about the tax form.

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