SPECIAL NOTICE FOR TRI-STATE PRODUCERS New Developments for Oxford Sole Proprietor Plans & Groups of One Business We are excited to announce several new and exciting developments to our product line for New York-based groups of one and sole proprietors (SPs). These changes are designed to make it even easier for qualified businesses to obtain coverage, and also for our valued producers to place business with us. The following updates are for business with an effective date of October 1, 2007 or later. Sole Proprietor Plans Now Available on Idea Management System SM Effective immediately, brokers can submit groups of one and sole proprietor (SP) business to Oxford through our popular Idea Management System (accessible via the broker web site at www.oxfordhealth.com). Submitting cases electronically via IDEA has many advantages for you and your clients. These include: Streamlined application process Faster case installation Immediate receipt of group and Member Oxford ID numbers Simplified renewals Additional time to submit cases o We will accept SP applications via IDEA up until the last day of the month for 1 st of the following month effective dates. o We will continue to accept paper applications for SP business, however, the deadline for those will remain the 15 th of the month. In addition, if you normally work with an appointed General Agent, we will begin paying a GA override on SP cases with this upgrade. Please contact your General Agent for additional details. New Underwriting Guidelines We are also excited to announce several changes to our underwriting guidelines that will make it easier for qualified business owners to obtain coverage. While many of our previous rules are remaining the same, the following items will be changing for business with effective dates of October 1, 2007 and beyond. MS-07-515 September 2007
We are eliminating our $25,000 income requirement. Going forward, if one has positive income on any of the tax documents we accept as proof of sole proprietorship, and meets our other guidelines, he or she will qualify for coverage. We are increasing the proportion of W-2 income compared to SP gross income and will allow to 49.9%. That means that if the simple majority of a SP s gross income comes from the SP business, and he or she meets our other guidelines, the SP will qualify for coverage For your convenience, we have attached an updated listing of our eligibility requirements to this communication. Please call our Inside Sales team at 1-800-216-0778 for more details about these exciting new options. IDEA Continues to Make Doing Business with Us Easier! In addition to Groups of One and Sole Proprietor plans, Healthy New York and Connecticut Blue Ribbon plans are now also available to quote and enroll online via IDEA! To sign up for a username and password, call our web help desk at 1-800- 811-0881. Click on the broker web site at www.oxfordhealth.com to view the online demo and instructional one-sheets. MS-07-515 September 2007
Required Documentation for New York Groups of One and Sole Proprietor Business We will accept applications from sole proprietors and S-Corporations with one eligible employee who is able to submit the following documentation and meet the standards outlined below: Business Organizations in Operation More Than 12 Months Instructions for Sole Proprietors: 1) Provide at least one of the following from most recent tax year: Schedule C Profit & Loss From Business (Sole Proprietorship) Schedule C-EZ Net Profit From Business (Sole Proprietorship) Schedule F Profit & Loss From Farming 2) Provide a current signed copy of first two pages of U.S. Individual Tax Return Form 1040 Any W-2 forms reported on the sole proprietor s 1040 must be submitted. Gross income from Schedule C, C-EZ or F must exceed any W-2 income the applicant may have received. 3) Sign our Sole Proprietor and Group of One Attestation Form Instructions for Corporations that have elected to be taxed as S-Corporations: 1) Provide an IRS Form 1120-S Income Tax Form for S Corporations 2) Provide a Schedule K-1 Schedule K-1 must show 100% ownership (i.e. sole S-Corp shareholder) for prospective insured. 3) Provide a W-2 Received by the shareholder-employee from the S-Corporation under which group coverage with us is sought. In addition, if applicable, S-Corporation shareholder must provide any other W-2s reported on their 1040 from other business organizations. Gross income from IRS Form 1120-S must exceed any W-2 income the applicant may have received from other business organizations. 4) Provide current signed copy of the first two pages of the U.S. Individual Tax Return Form 1040 and Schedule E (if applicable) for the S-Corporation shareholder who seeks coverage. NY-07-517 September 2007
5) Sign the Oxford Sole Proprietor and Group of One Attestation Form Business Organizations in Operation Less Than 12 Months 1) Provide the following: Certificate of Incorporation (for S-Corporations only) NYS Business License (if applicable) Copy of Business Bank Statement (for Sole Proprietors only) 2) Sign the Oxford Sole Proprietor and Group of One Attestation Form Oxford reserves the right to modify the above eligibility requirements and required documentation. NY-07-517 September 2007
Big Company Benefits for Companies of One Sole Proprietors We understand the unique challenges sole proprietors face in running their businesses day to day in the New York metropolitan area. Access to affordable, high-quality health insurance is the last thing you need to worry about. That is why we are proud to introduce a suite of products designed especially for sole proprietors. These plans represent some of our most proven and popular offerings for small businesses, and have built-in cost shares that make them affordable. If you are a New York sole proprietor with a business located in New York, Kings, Queens, Bronx, Richmond, Nassau, or Suffolk County, you are eligible to enroll in one of these exciting plan options: Freedom Plan Oxford Exclusive Oxford HSA Oxford HSA Direct SM Plan SM Metro Direct SM Exclusive SM Network Liberty Liberty Freedom Freedom Office Visit Copayment $30/$50 $25/$50 D&C D&C In-network Deductible $2,000 $2,000 $2,850 $2,000 In-network Coinsurance 80% to $10K 90% to $10K 90% to $10K 100% Out-of-network Deductible $2,000 In-network Only $2,850 In-network Only Out-of-network Coinsurance 60% to $10K In-network Only 70% to $10K In-network Only Hospital Inpatient Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Outpatient Surgery Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Pharmacy $15/50% w/$100 $15/50% w/$100 $15/50% $15/50% Tier 2 deductible Tier 2 deductible Fourth Quarter 2007 Rates Manhattan, Richmond, Bronx and Suffolk CountIES Single rate $334.58 $310.18 $275.64 $302.63 Parent / Child(ren) rate $618.98 $573.83 $509.94 $559.88 Husband / Wife rate $736.08 $682.39 $606.42 $665.79 Family rate $1,037.20 $961.55 $854.50 $938.17 Mental Health Rider Unlimited Biologically Based Mental Health Services Single rate $2.71 $1.76 $2.25 $1.70 Parent / Child(ren) rate $5.03 $3.25 $4.17 $3.15 Husband / Wife rate $5.97 $3.88 $4.96 $3.75 Family rate $8.42 $5.45 $6.99 $5.28 Fourth Quarter 2007 Rates Kings, Queens and Nassau CountIES Single rate $342.54 $317.68 $283.91 $311.71 Parent / Child(ren) rate $633.70 $587.70 $525.24 $576.66 Husband / Wife rate $753.58 $698.88 $624.61 $685.76 Family rate $1,061.86 $984.80 $880.13 $966.30 Mental Health Rider Unlimited Biologically Based Mental Health Services Single rate $2.79 $1.82 $2.32 $1.75 Parent / Child(ren) rate $5.18 $3.36 $4.30 $3.23 Husband / Wife rate $6.15 $4.00 $5.11 $3.84 Family rate $8.66 $5.64 $7.20 $5.42 More information on the back page... For more information, contact your broker or Call us at I-800-449-8880.
Big Company Benefits for Companies of One The Products n Routine preventative care and laboratory services covered in-network at no charge (includes PCP and OB/GYN) n Access to our industry leading network of over 73,000 physicians in the New York tri-state area 1 n In-network access to over 520,000 UnitedHealthcare Choice Plus Network physicians throughout the United States when outside the Oxford service area 2 n No referrals for specialist visits The Advantage n Comprehensive benefits that are affordable n Streamlined plan designs features making plan selection and enrollment easy n Choice of traditional or cutting edge consumer driven options n Access to most of the area s finest hospitals including New York Presbyterian, North Shore/LIJ, Robert Wood Johnson University Hospital and Yale/New Haven The Oxford Difference n Online plan administration with cutting-edge functionality on www.oxfordhealth.com n Preferred relationship with Exante Bank for seamless HSA banking administration n Knowledgeable, responsive customer service that our Members know and trust. n Access to our industry-leading support programs, such as Oxford On-Call, giving Members 24/7 telephone access to healthcare guidance from registered nurses, including referrals when necessary. n Access to our pioneering Complementary & Alternative Medicine (CAM) Program and preventive care programs, designed to help maximize Member health and satisfaction. 1 As of 6/30/07. This data represents all participating providers except ancillary providers (i.e., laboratories, radiology centers, urgent care centers, etc.) and hospitals. Dental and complementary and alternative medicine providers are included. Providers who are board certified in more than one specialty are counted for each specialty. Therefore, providers who are board certified in more than one specialty are counted multiple times. 2 UnitedHealth Networks 2007 Region Summary, April 2007. NY-07-516 9287 Rev 4 For more information, contact your broker or Call us at I-800-449-8880.