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Small Business Eligibility

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Employers and Employees

Frequently Asked Questions

Question: This program does not allow employers to participate if they have "provided" group health insurance to their employees in the past year. Under what circumstances is my business considered to have "provided" group health insurance?

Answer: An employer is considered to have "provided" health insurance if the employer arranges for group health insurance and contributes more than $50 (or $75 if the business is located in the Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, and Westchester counties) per month per employee towards the premiums for coverage. If an employer has merely arranged for health insurance coverage for employees but has not contributed more than the previously noted amounts, then the business may still be eligible for Healthy NY.

Question: What if my business has provided other health insurance during the past twelve months, but the insurance had limited benefits?

Answer: If your business has provided other insurance during the past twelve months, but the coverage included only limited benefits (for example – only medical benefits or only hospital benefits, but not both) then your business may still be eligible for Healthy NY.

Question: What if my business has not provided group health insurance coverage in the past twelve months, but some of the employees have been covered through other sources, like their spouse’s employer plan?

Answer: The coverage of individual employees through other sources does not affect a small employer’s eligibility to participate in the Healthy NY program.

Question: I have 5 employees. One is enrolled in Medicare and two others receive health insurance through a spouse. The remaining two employees wish to enroll in Healthy New York. Is my business eligible?

Answer: Your business would be eligible because the three employees who have other coverage count towards satisfying the minimum 50% participation requirement.

Question: Why is this program available only to small employers who did not provide insurance during the twelve months preceding application? Doesn’t this penalize the "good guys" who struggled to maintain coverage for their employees over the past few years?

Answer: Healthy NY was designed to target those individuals who were completely uninsured. These so called "crowd out" provisions of the legislation are also designed to ensure that employers and individuals do not drop existing coverage in favor of this new product.

Question:Can my business offer Healthy NY coverage to my employees’ families?

Answer: Yes, the employer may choose to offer coverage for dependents through the Healthy NY program. Qualifying dependents include dependent children up to age 26 and, under certain circumstance, through the age of 29. However, it may be financially beneficial to employees to obtain health insurance coverage for their children through New York’s Child Health Plus program, rather than Healthy NY. For more information about Child Health Plus, contact New York’s toll free hotline at 1-800-698-4543.

Question: If my business offers family coverage through Healthy NY, does my business have to contribute towards the cost of the premiums for my employees’ dependents?

Answer: No. Employers must share in the cost of the Healthy NY premium for their employees. However, there is no requirement that the employer contribute towards the cost of dependent coverage.

Question: Is there a re-certification process?

Answer: Yes. On an annual basis, employers participating in the Healthy NY program are required to submit a re-certification that attests to their continued eligibility for the Healthy NY program. The employer’s health plan will notify participating employers of when this re-certification is due and will provide them with the necessary forms.

Question: What if my business qualifies for Healthy NY and things change? What if I hire more employees and it brings my workforce total over 50? What if some of my employees drop coverage and my business no longer satisfies the 50% employee participation requirement? Would the coverage then be terminated?

Answer: Mid-year fluctuations in group size, wage levels and employee participation will not result in immediate termination of Healthy NY coverage. However, Healthy NY requires an annual re-certification process at which time your business’ eligibility would be reevaluated. If your business does not meet the eligibility criteria at the time of re-certification, you will be unable to continue to participate in the program. Please note that the wage levels set forth in the eligibility criteria for the Healthy NY program are increased annually to account for inflation.

Question: Which employees must be offered Healthy NY coverage?

Answer: Small businesses must offer Healthy NY to all employees working more than 20 hours weekly and earning $41,250 or less annually.

Question: What physicians participate in the Healthy NY program?

Answer: HMOs that offer coverage in your county contract with certain health care providers in your area. To obtain the most current information about which health care providers are participating providers with an HMO, you should contact the HMO directly. A list of the phone numbers for the HMOs in your county may be found by selecting “Insurers and Rates”.

If you did not see an answer to your question please feel free to email us at askhealthyny@ins.state.ny.us

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