URL Insurance Group

This email is intended for producers with business in New York.

Important Update: New York State Managed Care Organization (MCO) Tax

The Centers for Medicare & Medicaid Services (CMS) approved a Managed Care Organization (MCO) tax that was requested by the New York Department of Health (DOH). We communicated about this tax in previous emails found on the Producer Pulse and posted below.

May 30, 2025 – Managed Care Organization (MCO) Tax for New York State
January 15, 2025 – New York State MCO Tax: What You Need to Know

What do I need to know?

Fully insured clients were impacted by the MCO tax beginning January 1, 2025. The discontinuation of this tax on fully insured large group clients is at the end of New York state’s fiscal year, March 31, 2026.

Fully Insured Small Group
As a reminder, the MCO tax will be incorporated in 2026 premium for community rated plans, like small group ACA plans.

Fully Insured Large Group
Effective January 2026, fully insured large group clients will see the MCO tax reflected on their invoices for January, February, and March coverage months, as follows:

Existing clients will be charged $1.57 PMPM (per member, per month). This rate is lower than the 2025 charge that was prorated to cover the entire calendar year.
New business clients will continue to incur a fee of $1.57 PMPM.

What do I need to do?

Continue to keep your clients informed of the MCO tax and what they can expect.

Questions?

Please reach out to your Sales Executive or Client Manager.

Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association:
Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company.
Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company.
PA: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418.
Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.
West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit https://www.highmarkbcbswv.com/networkaccessplan to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card.
Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield.
Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.
Highmark Blue Cross Blue Shield and Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal.
All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.

This email was sent by: Highmark, Inc.-
Fifth Avenue Place 120 5th Ave., HARRISBURG, PA, 17089 US

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