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New York State Department of Financial Services

Eligibility

To participate in Healthy NY, a small business must meet all of the following criteria:

  1. The business must be located within New York State.
  2. The business must have had 1-50 Full-Time Equivalent (FTE) employees over the previous calendar year. (More information on how to calculate the FTE counting methodology is available at FAQs For Small Group Expansion to 1-100 Employees.)
  3. At least 30% of the employees must earn $41,250 or less in annual wages. The wage level is adjusted annually for inflation.
  4. The business must not have provided group health insurance coverage to its employees within the last 12 months.

    A business is considered to have provided health insurance if the business has arranged for comprehensive coverage that includes both hospital and medical coverage and contributed at least $50 per employee per month towards health insurance ($75 if the business is located in the Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk or Westchester counties).

    The business may still be eligible for Healthy NY if:

    • The business arranged for health insurance coverage for employees but did not contribute more than the previously noted amounts.
    • The business arranged for health insurance coverage for employees but it was not comprehensive (i.e., only medical benefits or only hospital benefits but not both).
    • Individual employees had insurance coverage through other sources, such as individually-purchased coverage, a public program, COBRA from prior employment or a spouse’s job.
    • The business owner has coverage for himself or herself but did not provide the coverage to employees.
    • The business provided insurance coverage to one or more classes of employees and now wants to provide coverage to additional classes of employees. Classes of employees may be based on wages, method of payment (e.g., hourly vs. salaried), job duties or job location.

If the business meets the four criteria above and opts to enroll the business in Healthy NY, the employer must assure that:

  1. 50% of the eligible employees will participate in the program and at least one participant earns annual wages of $41,250* or less. A small employer may count employees who have health insurance coverage through another source, such as a spouse or other government program, towards the 50% participation requirement.
  2. The employer will contribute at least 50% of the premium.
  3. At least one eligible employee earning $41,250* or less enrolls.
  4. The employer will offer Healthy NY to all employees who are working 20 or more hours per week and earning $41,250* or less.

* Adjusted annually.

Tax Advantages and Benefits of Providing Health Insurance

Significant tax advantages may be available to your business by offering health insurance coverage. Health insurance premiums that businesses pay on their employees’ behalf are generally 100% tax deductible. Providing health insurance coverage may also result in reduced payroll taxes. Additionally, if a business establishes a Section 125 plan, employees’ share of the premiums can be paid with pre-tax dollars, resulting in tax savings for both employees and the business.

 

 

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