Under the HCRA, New York State imposes two additional costs related to health care services received in the state:

• a tax on health care services received in the state ("the surcharge"), regardless of whether a claimant lives there or is just visiting

• a monthly Covered Lives Assessment (CLA) assessed on all covered members of your group health plan that reside in the state of New York

The surcharge on health care services can be upwards of 60% of the claim cost, and is assessed when a covered member receives an applicable service in the state of New York (mostly hospital-related services). New York hospitals are required to collect the HCRA surcharge and to pay it to the New York State Department of Health. If the proper election forms are completed however, the surcharge is much lower.

Fully insured carrier plans should automatically be making the election and covering these assessments in their contracts, but there may be additional steps required for a self-funded plan. Your self-funded medical carrier or TPA will pay the surcharges to New York State directly on your behalf if you elect into the NYHCRA Public Goods Pool by completing the required paperwork, and they will also remit the CLA for any covered members residing in the state of New York.

It’s very important that all self-funded groups check this task off their list, because the process becomes much harder, and the surcharge much higher, if you don’t. As a self-funded group, you should check with your medical carrier or TPA  to confirm that your paperwork has been completed or is already included in your general contract with them.

It’s also important for anyone traveling to New York State to be aware of these additional fees. Finally, anyone without health insurance coverage will be assessed the surcharge at the time of claim.

If you’d like to know more about the HCRA, you can find more information here: https://www.health.ny.gov/regulations/hcra/