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  3. Insurance & Compliance 101

New York Public Goods Pool

Beginning in 2023, Sana is requiring all clients to opt in to the New York Public Goods Pool (NYPGP), which is part of the New York Healthcare Reform Act (NYHCRA). 

What is the New York Healthcare Reform Act (NYHCRA)?

The NYHCRA governs hospital reimbursement methodologies and targets funding for a multitude of health care initiatives.

What is the New York Public Goods Pool (NYPGP)?

The NYPGP was created to prevent health plans from paying higher charges under the NYHCRA. 

Why am I required to opt in to the NYPGP?

We require you to opt in to ensure we can maintain the lowest rates possible for your group. Opting in protects you from excessive fines for member claims filed in the state of New York – ranging from 32% of claims for in-state residents to 66% of claims for out-of-state residents who are traveling and encounter claims in New York. When you elect, these amounts are reduced to a small 10% surcharge, all of which are paid for by the plan through your claims fund and stop-loss coverage.

Even if you do not have employees in New York, Sana still requires that you opt into the NYPGP. Being a part of the NYPGP will protect the employees from the surcharge fees mentioned above in the event that an employee travels to New York and needs emergency care there.

Sana includes the cost of opting in as part of your group’s rates, so there’s no extra charge to opt-in.

What forms do I need to complete?

Sana will send the appropriate form via Dropbox to the signatory of your group. If your group has already opted into the pool, we’ll send you Form 4403 to change your Third-Party Administrator (TPA) to Sana. If your group hasn’t already opted into the pool, we’ll send you Forms 4399 and 4264 to elect to the pool and allow Sana to electronically report on your behalf.

When do I need to complete the form(s)?

You will need to complete your form via Dropbox as soon as you receive it to avoid unnecessary fines.

Have questions? We've got you covered.
 

 

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