The New York Insurance Exchange (Marketplace) is called New York State of Health. The New York Health Benefit Exchange is administered by the State of New York.
General information about the New York Health Benefit Exchange can be found at: http://www.healthbenefitexchange.ny.gov/.
PATIENTS
The New York Health Benefit Exchange is essentially a marketplace for individuals and small businesses with up to 100 employees to shop for health insurance if they do not already have insurance coverage from another source. If they have insurance from another source (such as employment, retirement benefits, or spousal benefits), they do not need to obtain it from the Marketplace.
HIV PROVIDERS
Providers must contract with each of the plans in the marketplace individually in order to fully participate in the Alabama Health Benefit Exchange.
This process is similar to enrolling in insurance or managed care organization provider networks. See below for a list of insurers participating in the state marketplace, and information on contacting them.
As an HIV provider, you may qualify for designation as an “Essential Community Provider (ECP).” The Qualified Health Plans participating in the Insurance Exchange (Marketplace) are required to contract with a minimum number of ECPs and Specialists to ensure network adequacy.
Visit our Provider Resources Section for more specific instructions to assist you in contacting health plans.
REPORTING PROBLEMS
The state office of insurance is primarily responsible for examining and addressing issues with the plans offered within the state Exchange (Marketplace), and the companies that offer them.
If you are experiencing problems as a medical provider with the plans or companies in the state exchange, or if your patients are experiencing problems with the plans or companies in the state exchange, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any otherproblems related to the Affordable Care Act, please report these problems to the state office of insurance:
One State Street
New York, NY 10004-1511
800-342-3736
www.dfs.ny.gov/
Complaints: http://www.dfs.ny.gov/consumer/fileacomplaint.htm
Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.
QUALIFIED HEALH PLANS PARTICIPATING IN THE EXCHANGE
Below is a list of the Qualified Health Plans that have publicly announced that they will offer plans in the Alabama Health Benefit Exchange.
Alabama has established Blue Cross Blue Shield of AL as the “benchmark” plan.
This list is being routinely updated, and may change as insurers join or drop out of the exchange. Please check back for updates
Affinity Health Plan, Inc.
Plan Website: http://www.affinityplan.org/
Provider Enrollment: http://www.affinityplan.org/Affinity/Providers/Credentialing.aspx
Plan types offered: Individual
Capital District Physicians Health Plan, Inc.
Plan Website: http://www.cdphp.com/Providers
Provider Enrollment: http://www.cdphp.com/Providers/Join-Our-Network
Plan types offered: Individual, SHOP
Empire BlueCross BlueShield
Plan Website: http://www.empireblue.com/home-visitors.html
Provider Enrollment: http://www.empireblue.com/home-providers.html
Plan types offered: Individual
Excellus Health Plan, Blue Cross Blue Shield (Central NY and Univera in Western NY)
Plan Website: https://www.excellusbcbs.com/wps/portal/xl
Provider Enrollment: https://www.excellusbcbs.com/wps/wcm/connect/3261c056-bc33-4458-a409-2f4285b2e1b6/Excellus+BCBS+Provider+Relations+Contact+List+7.9.13.pdf?MOD=AJPERES&CACHEID=3261c056-bc33-4458-a409-2f4285b2e1b6
Plan types offered: Individual
Fidelis Care
Plan Website: http://www.fideliscare.org/Products.aspx
Provider Enrollment: http://www.fideliscare.org/apps/providerRequestForm/
Plan types offered: Individual
Health Insurance Plan of Greater New York- Emblem Health
Plan Website: http://www.emblemhealth.com/
Provider Enrollment: http://www.emblemhealth.com/Contact-Us.aspx
Plan types offered: Individual, SHOP
Health Republic Insurance Company
Plan Website: https://healthrepublicny.org/
Provider Enrollment: https://healthrepublicny.org/for-providers/index/
Plan types offered: Individual, SHOP
Healthfirst New York
Plan Website: http://www.healthfirstny.org/
Provider Enrollment: http://www.healthfirstny.org/providerservices
Plan types offered: Individual
HealthNow New York, Inc. (Blue Shield of North East New York, Blue Cross Blue Shield of Western New York)
Plan Website: https://securews.healthnowny.com/web/content/HNNY_brochure/home.html
Provider Enrollment: https://securews.healthnowny.com/web/content/HNNY_provider/home/network-participation/credentialing.html
Plan types offered: Individual, SHOP
Independent Health
Plan Website: https://www.independenthealth.com/portal/site/IndependentHealth/;jsessionid=St2xSPQFrF5QpZqXQ2PwlJYvCnhQwGzJBySZ05JThz91SCDnRpgn!654417611!NONE
Provider Enrollment: https://www.independenthealth.com/portal/site/footer/menuitem.2ba8fb86becf8b6a818e6c1020a08a0c/?vgnextoid=daf67ded4cf2f110VgnVCM100000113110acRCRD
Plan types offered: Individual
MetroPlus Health Plan (Market Plus)
Plan Website: http://www.metroplus.org/
Provider Enrollment: https://intranet.metroplus.org/EmailUs/ProviderContact.aspx
Plan types offered: Individual, SHOP
MVP Health Plan, Inc
Plan Website: https://swp.mvphealthcare.com/wps/portal/mvp/home/!ut/p/b1/04_Sj9CPykssy0xPLMnMz0vMAfGjzOJDTQ2CnZwMHQ0s3N3NDDz9XDy9vTwMjPyNzIEKIoEKDHAARwNC-v088nNT9QtyI8oBGot8Og!!/dl4/d5/L2dBISEvZ0FBIS9nQSEh/
Provider Enrollment: http://www.mvphealthcare.com/provider/credentialing.html
Plan types offered: Individual, SHOP
North Shore LIJ Health System
Plan Website: http://www.northshorelij.com/hospitals/home
Provider Enrollment: http://www.northshorelij.com/hospitals/contact-us
Plan types offered: Individual, SHOP
Oscar Insurance Company
Plan Website: https://www.hioscar.com/
Provider Enrollment: https://www.hioscar.com/provider/?planState=NY&planDate=2014
Plan types offered: Individual
United Healthcare of New York Inc.
Plan Website: http://www.uhccommunityplan.com/health-professionals/NY/provider-information
Provider Enrollment: http://www.uhccommunityplan.com/health-professionals/NY/provider-information
Plan types offered: Individual
Wellcare
Plan Website: https://www.wellcareplans.com/
Provider Enrollment: https://www.wellcareplans.com/provider
Plan types offered: Individual