Cigna

IMPORTANT MESSAGE

New York State Health Care Reform Act Surcharges

Public Goods Pool election status request

This communication is to notify you about the New York State Health Care Reform Act (NYHCRA), which imposes a system of surcharges and Covered Lives Assessments in order to fund uncompensated care, professional medical education, and other health care initiatives in the state of New York.

The surcharges and assessments instituted for medical claims since the law was first enacted in 1997 apply to inpatient and outpatient hospital/ambulatory surgical procedures and services rendered in New York by a New York surchargeable provider. They are not based on the situs of the client or the residency of the employee. The amount is determined by the election status of the payer in the NYHCRA Public Goods Pool

Clock Icon NYHCRA

In the coming months, dental and/or pharmacy claims rendered in New York by a New York surchargeable provider will also be subject to the NYHCRA surcharges. For elect clients, these additional surcharges will apply as early as August 16, 2021.


Clock Icon Action required July 16 for clients with standalone Administrative Services Only (ASO) Dental and/or ASO Pharmacy and clients with Insured Medical and ASO Dental and/or ASO Pharmacy

As a client with ASO Dental and/or ASO Pharmacy, you must sign either a New York Surcharge Election Form or a waiver form that indicates that you have been advised of NYHCRA requirements, but choose to remain non-elect. The signed forms (links below) must be returned via email to your Cigna Client Manager by Friday, July 16, 2021.

Due to significant financial savings, Cigna recommends ASO Dental and/or ASO Pharmacy clients elect to pay into the Public Goods Pool regardless of whether you have New York membership. Please review the document below for more information.

• NYHCRA Client Letter

Form 4264 | Form 4399 | Form 4403

Clock Icon Questions

We encourage you to discuss your elect or non-elect status with your legal counsel. More information is available at New York State Health Care Reform Act.

Together, all the way.