October 1, 2009

New York State Health Care Reform Act Adds Premium Accounts to GME Surcharge Payment Requirement [Group Markets]

On April 1, 2009, statutory changes became effective regarding the New York State Health Care Reform Act (NYHCRA). In February 2009, the New York state governor and legislative leaders passed the Deficit Reduction Plan to close the state’s current year fiscal deficit. The plan requires that insured accounts become subject to the Graduate Medical Education (GME) regional covered lives assessment.

Therefore, effective April 1, 2009, the GME regional covered lives assessment is now applicable to both “insureds” (licensed to do business in the state of New York) and “self-insured funds, and third party administrators of such self-insured funds, whether domiciled in New York State or out-of-state.”

Blue Cross and Blue Shield of Illinois is actively working to ensure that all fully insured accounts that have members in the state of New York are set up to accommodate the NYHCRA requirements.

At this time, BCBSIL anticipates that retroactive payments (from the effective date of the law, April 1, 2009, to the current month) will be assessed and appropriate payment will be made to New York. The payment method will follow the established process currently in place for self-insured accounts.