What Brokers Need to Know
We want to make you aware of a significant regulatory update impacting fully insured group health plans in New York State.
Effective January 1, 2025, New York has introduced a new Managed Care Organization (MCO) Tax, designed to help the state secure additional federal funding for its Medicaid program. While this public funding mechanism supports state health initiatives, it also introduces additional costs and administrative obligations for carriers, employers, and brokers.
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The MCO Tax will be embedded in a per-member-per-month (PMPM) rate, varying by group size.
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Premiums may reflect the tax retroactively to January 1, 2025 depending on carrier, and continue monthly going forward.
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The NY Department of Financial Services (DFS) has approved a rolling window for updated rate filings.
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This is a state-mandated tax—all NY insurers must comply.
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The tax does not apply to Medicaid, Child Health Plus, or Essential Plan members.
Click on the links below for information on how each New York carrier will be handling this new MCO tax requirement.
Note: We are still waiting on guidance from Emblem and will send an update as soon as it becomes available.