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Oxford Health Plans Review

What would our New York Best health Insurance Companies list be without a review of Oxford Health Plans? Oxford is one of the leading providers of small group health insurance in the eastern United States.

Oxford Health Plans operates business in the Northeast and is owned by its parent company UnitedHealthcare. In 2004, Oxford and UnitedHealth Group merged to form one of the largest health insurance companies in the United States. UnitedHealthCare has been ranked by Fortune Magazine seven years in a row as one of the world’s most admired companies in the insurance and managed care sector.

Oxford Health Plans: History

Oxford Health PlanThe beginning of Oxford health plans goes back more than 35 years to New York City where the company was started by entrepreneur Stephen Wiggins. Wiggins whose background was already in the health care industry, teamed up his friend, Dr. Benjamin Safirstein to start the company we know as Oxford.

The company founders wanted to bring an efficient alternative to traditional health insurance and change the delivery of health care to patients. They sought to develop new ways to deliver cost-effective care to patients with chronic health conditions by introducing the Health Maintenance Organization – HMO’s – to health care professionals.

The HMO concept was widely popular across the United States but not on the east coast region. At the time, the new company faced a difficult, up hill battle by trying to convince doctors and hospitals to embrace the new managed care concept.

In 1987, the company’s first full year in business, Oxford generated more than $5 million in annual premium making it one of the fastest growing managed care companies on the east coast. In less than 10 years, Oxford would be grossing nearly $2 billion in annual revenues creating one of the largest health care providers in the eastern region.

Oxford Group Health Plans

The company primarily provides medical insurance to employer groups with less than 100 employees located in Connecticut, New York, New Jersey, New Hampshire and Pennsylvania. Oxford gives its members access to one of the largest networks of doctors and hospitals in the United States.

Members who are outside of the network area can have access to the more than 450,000 doctors across the United States who are a part of the United Health Care Choice Plus Network.

Oxford offers (HMO) plans POS plans, PPO and EPO plans, as well as provides dental insurance, Medicare, and Medicaid plans. In 2016 the company withdrew their individual health plans from the Government and state exchanges as well as the consumer marketplace.

Oxford Metro Network

Let’s begin with Oxford’s newest network – The Metro Network. This network was introduced to small businesses in 2016. Since then the network has grown by 15% and added the state of New Jersey network (Oxford Garden State Network) in 2022.

Out of all 3 Oxford Networks, the Metro is the has the smallest participation of doctors and hospitals.  Metro is also the lowest-priced Oxford plan of all three network options available in the New York and New Jersey service area.

As of 2022, The NY network has grown to approx. 13,000 Primary Care Providers, 32,000 Specialists, and 85 hospitals.

58%: 5 Boroughs – Manhattan, Bronx, Queens, Brooklyn and Staten Island
28%: Nassau/Suffolk
14%: Westchester County

The Oxford Garden State Network  has access to approximately 19,000 physicians and 67 hospitals.

The Metro does not offer National coverage whereas, Liberty and Freedom are accepted Nationwide. Metro plans also require doctor referrals from the Primary Care Physician (PCP).

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The Liberty Network

The next step up from the Metro Network is the Liberty Network. It is estimated that Liberty plans have the second largest network of health care providers compared to the Freedom Network.

Liberty HMO plans do not have employee participation requirements so these plans are a good fit for a business with only a few employees. A small business with only 2 employees could qualify for the HMO plan provided there is at least 1 employee on payroll.

The Liberty HMO and EPO plans require a 60% minimum employee participation to enroll in these plans. Oxford Liberty Network has national coverage through the Unitedhealthcare Core network.

Oxford Freedom Network

The Freedom Plan has the largest network of participation of doctors and hospitals in the eastern region. It also has National coverage through the Unitedhealthcare Choice Plus network.

Freedom plans have the best health care coverage options but they are also the most expensive health plans Oxford has to offer. This network is good for a small business that wants to offer the most comprehensive coverage to its employees and is willing to pay more for highest level of coverage.

Oxford Health Plans – Pros

Oxford makes our list of one of our top health plan providers in New York because it is one of the most widely accepted health coverage in the tristate area. The company offers over 100 health plans within their 3 networks; The Freedom Network, Liberty Network and the new Metro Network.

Within Oxford’s 3 networks, they offer several different health plan designs to fit just about any small business. The plans which are available are; EPO Plans (Exclusive Provider Organization) PPO Plans (Preferred Provider Organization), HMO Plans (Health Maintenance Organization) and HSA’s (Health Savings Accounts).

All plans provide coverage to a vast network of doctors and hospitals in the New York region. Downstate coverage areas include: The 5 boroughs – Manhattan, Brooklyn, Bronx, Queens, Staten Island and Long Island, Nassau and Suffolk counties.

Upstate coverage includes Westchester, Duchess, Orange and Sullivan Counties. The Freedom and Liberty networks provide national coverage through the Unitedhealthcare Choice Plus network.
In short, if you are looking for a health plan with one of the best networks of coverage, Oxford is tough to beat.

Oxford Health Plans – Cons

Most people have a love, hate relationship with insurance companies. While some people love their health insurance plan, others actually despise it. Those that hate their health plan file complaints against the insurance company about not getting reimbursed or approved for some medical procedures or not getting certain medications authorized.

Much of the negativity surrounding any insurance company including Oxford, comes from people not understanding how their insurance plan works. However, there are probably many legitimate complaints about the company not covering certain procedures or being slow to reimburse medical expenses.

If you are having trouble getting through to Oxford about coverage or reimbursement concerns, try this: Call Oxford’s Customer Service at: 800-666-1353. Press 1, say “something else”, then “benefits,” to be put through immediately to the Provider’s Service Department. Compliments of: www.gethuman.com

Another downside to Oxford health plans is they have some of the most expensive health plans in the region. I guess when you are one of top providers of health care, you can charge just about anything you want.

However, some small businesses are willing to pay more to offer their employees Oxford’s better health plan coverage along with their extensive network of providers.

Closing Thoughts

Oxford Health Plans is one of the most premier providers of health insurance in the New York Tri-State area. If your company insures more than 5 employees, Oxford will allow you to offer up to 3 health plans, as long as one plan includes a Health Savings Account (HSA). For more information or a free group health plan quote call: 914-633-1717.