The Department of Financial Services recognizes that small businesses are the backbone of our economy. As doing business online becomes indispensable, it is essential that small businesses protect themselves and their customers from cybercrime.
To help small businesses improve their cybersecurity, DFS has partnered with the Global Cyber Alliance (GCA) to provide free cybersecurity resources. GCA has created a Cybersecurity Toolkit for Small Business that contains a set of free tools, guidance, resources, and training for small businesses. It is targeted at small businesses that are too small to have a dedicated cybersecurity staff – for DFS-regulated entities, these are businesses that are so small as to be exempt from the requirement to have a Chief Information Security Officer pursuant to 23 NYCRR 500.19.
DFS recognizes that cybersecurity can be especially challenging for small businesses and is committed to supporting small businesses as they address the risk of cybercrime.
Because governance is critical to effective cybersecurity, DFS also partnered with GCA to develop a set of sample cybersecurity policies based on cybersecurity best practices. These policies are designed to help small businesses install the governance and procedures necessary for effective cybersecurity. The sample policies provide a helpful starting point for all small businesses.
The sample policies include:
- Cybersecurity Policy
- Access Control Policy
- Asset Inventory & Device Management Policy
- Data Classification Policy
- Physical & Environmental Security Policy
- Risk Assessment Policy
- System & Network Security Policy
- Third Party Service Provider Policy
All cybersecurity policies created by a business should be tailored to the business’s specific needs, risks, resources, and structure. Some businesses may require additional actions beyond those suggested in the sample policies; likewise, not every action suggested will be required for every business. Policies based only on the samples therefore may not constitute full compliance with state and federal laws and regulations, including DFS Cybersecurity Regulation. Best practices can also change over time.
Businesses should review their policies for accuracy, completeness, and applicability, and update them as needed based on their risk assessments.
To access the Toolkit and sample policies, please visit Cybersecurity Toolkit.
Property/Casualty Insurance Guide
Running a small business presents many challenges. As a small-business owner, you must try to minimize the financial risks your business faces. Some risks you may consider to be acceptable, while others are unacceptable because the loss would seriously harm your business or even force it to close. Many of these unacceptable risks can be transferred to an insurance company. The information in this guide is designed to help small-business owners make informed decisions regarding their insurance needs.
Why do Small Businesses Need Property and Casualty Insurance?
Small businesses need property and casualty insurance:
- to protect their assets
- to replace property damaged by loss or theft
- to provide for lost income
- to cover liability for negligent acts
- to provide coverage for auto, workers’ compensation, crime, etc.
If you are not adequately insured, you risk losing your business! Businesses large and small must protect themselves from financial loss. An important part of such protection centers on insurance covering property loss exposures, which include the costs to repair or replace the property in the event of a covered loss. The property and casualty insurance business plays a major role in keeping the American economy moving. It provides economic protection for individuals, business owners and professionals from losses resulting from damage to or loss of property and from legal liability. There are a few types of insurance every business needs. If you’re already a business owner, you have probably bought policies that covered those areas when you first opened
Types of Insurance
BUSINESS OWNERS POLICIES
Many insurance companies have bundled property and liability coverage into what is commonly called a business owner’s policy (BOP), or a package policy. It allows you to obtain broad coverage with affordable premiums. Since no two businesses are the same, property insurance can be tailored to fit your needs. For example, a furniture store has different needs than a restaurant; a two-person accounting office has liability exposures that are different from a retail business with lots of customer interaction or a builder with a contractual obligation to erect a building.
Monoline policies provide a single line of insurance, e.g.: fire, or liability, or auto, etc. BOPs and package policies are created by combining two or more monoline coverages. There are occasions where insurance for your type of risk may not be available as a package policy. Thus, it would be necessary to purchase your property and liability coverage as separate policies. It’s prudent for any business to purchase a number of basic types of insurance. Some are required by law, others simply make good business sense. The types of insurance listed below are among the most commonly used.
Property insurance protects the contents of your business against fire, theft and other perils. There are many different types of property insurance and levels of coverage available. It’s important to determine the property you need to insure for the continuation of your business and the level of insurance you need to replace or rebuild. You must also understand the terms of the insurance, including any limitations or exclusions.
Consider increasing your deductible to reduce your premium, and spend the savings by increasing your coverage. Learn the difference between replacement cost, actual cash value, agreed amount and functional replacement cost.
Casualty insurance includes the coverage commonly referred to as Liability insurance. Liability coverage should protect your assets in the event you, or your employees are negligent, cause bodily injury or property damage to another. Businesses may incur various forms of liability in conducting their normal activities. This is what covers the cost of lawsuits stemming from accidents that cause bodily injury (i.e., a customer slips on your steps) or property damage (you sell a defective lubricant that burns out a customer’s car engine), and other miscellaneous claims such as libel, slander and false advertising. Liability insurance will not only pay the cost of the damages, but also the
attorney fees and other costs associated with your defense in a lawsuit, whether or not the lawsuit has merit. However, liability insurance might not protect you against claims arising from non-performance of a contract, wrongful termination of employees, sexual harassment, or race and gender lawsuits. This is another good reason to carefully read your policy.
While property insurance may pay enough to replace damaged or destroyed equipment or buildings, how will you pay costs such as taxes, utilities and other continuing expenses during the period between when the damage occurs and when the property is replaced? Business interruption (or business income) insurance can provide sufficient funds to pay your fixed expenses and lost business income during a period of time when your business is not operational. Business income means the net income (net profit or loss before income taxes) that would have been earned or incurred, as well as continuing normal operating expenses incurred, including payroll. Extra expense coverage will reimburse you for covered expenses while temporarily relocated at another premise during your reconstruction due to a covered loss.
It may seem obvious that a vehicle owned by your business should be insured for both liability and physical damage. What is less obvious is that you may also need special insurance, called non-owned automobile coverage, if you or your employees use your personal vehicles on company business. This policy covers the business’s liability for any damage that may result from such usage. Do you realize that if you send an employee out to pick up pizza for the crew and he/she gets in an auto accident, your business could get sued even if the vehicle is not company owned? This policy may also cover rental cars when you travel on business. Read the fine print or ask your agent to be sure. Hired and non-owned coverage is a real bargain.
Worker’s compensation insurance covers workers against a job-related accident or disease. This statutory insurance pays for medical bills, disability income benefits, and death benefits to dependents of an employee whose death is job related. Rates are based on payroll, and depend heavily on your industry, i.e., rates for clerical payroll are nominal, while a roofing company will be charged much more. If your work force is expanding, you should update your workers’ comp coverage as you go along to avoid being hit with an audited additional charge at the end of the year.
NEW YORK DISABILITY BENEFITS LAW (NYDBL)
Disability Benefits are another employee disability coverage mandated by New York State. It provides disability income for employee injury or illness off-the-job. This wage continuation starts after the seventh day of off-the-job illness or injury and continues for up to six months.
Excess Liability is commonly referred to as an “umbrella” policy. What happens when a lawsuit filed against you brings in a verdict that exceeds the limits of your primary liability protection? It’s bad news for you, unless you have adequate limits of liability coverage. An umbrella policy kicks in only when the limit of the basic, underlying policy is reached. Buy an umbrella policy and you can dramatically extend your coverage for a relatively small additional cost. How much coverage do you need? That’s your decision, and your answer should hinge on the total value of your assets. Your insurance agent should be able to guide you in picking an amount of coverage that will bring you peace of mind.
EMPLOYMENT PRACTICES LIABILITY
Ten years ago, this coverage was virtually non-existent, but now it is widely available. It’s also widely needed. You are protected if any employee sues your company for wrongful termination, job discrimination or any of the other increasingly popular claims alleging failures in your employment practices.
OFFICER AND DIRECTOR LIABILITY
Under some circumstances, officers and directors of a corporation may become personally liable for their actions on behalf of the company. This type of policy covers such liability.
OFFICE AT HOME
If you’re establishing an office in your home, it’s a good idea to contact your homeowners’ insurance company to update your policy to include coverage for office equipment and business liability. This coverage is not automatically included in a standard homeowner’s policy.
If you (and/or any other individual) are so critical to the operation of your business that it cannot continue in the event of your illness or death, you should consider “key person” insurance. This type of policy is frequently required by banks or government loan programs. It also can be used to provide continuity in operations during a period of ownership transition caused by the death or incapacitation of an owner or other key employee.
PROFESSIONAL LIABILITY is incurred by a professional such as a physician, nurse, attorney, or architect for negligent acts occurring as professional, services are performed.
ALL-IN-ONE PACKAGE POLICIES
Too many choices? Insurance companies understand that busy entrepreneurs don’t want to spend days studying the minutiae involved in evaluating numerous policies. The result is an increasing popularity of one-stop shopping policies, called BOPs, combining many coverages under one policy, usually at a competitive price.
A package policy offers protection for:
- buildings and other structures,
- leased or owned
- furniture, equipment and supplies
- leased equipment
- business income
- extra expense
- business liability
- medical expense
- losses from crime
Specific Industry Coverage
Many insurance companies have determined that certain businesses are eligible for a specifically designed insurance program. These policies usually include specialty coverage that is advantageous to those businesses. Some of these special classes include, but are not limited to:
- Artisan Contractors
- Barber and Beauticians Professional Liability
- Dental Professional Liability
- Engineers and Architects Professional Liability
- Farm Property and Liability
- Funeral Directors Professional Liability
- Garage and Auto Dealers Liability and Physical Damage
- Liquor Legal Liability
- Medical Malpractice Professional Liability
- Optical and Hearing Aid Professional Liability
- Pastoral Professional Liability
- Printers Errors and Omissions
- Retail Merchant Package
- Veterinarians Professional Liability
- Shopping for Insurance
Premiums charged for business insurance vary widely from company to company. It pays to shop around to obtain the best value for your insurance dollar. Insurance premiums are dependent on a number of factors including location, age and type of building, use of building, local fire protection, choice of deductibles, application of discounts, and scope and amount of insurance you purchase. Selecting the insurance program most appropriate for the needs and resources of your small business is a complex task. There are three groups of insurance professionals who can guide you in making the best decision:
Agents are licensed representatives of insurance companies who are responsible for marketing its products. They usually earn commissions based on their sales. They might represent only one company (captive), or several companies (independent).
Brokers are licensed representatives who represent a number of different carriers. They earn commissions based on their sales. Brokers are construed to represent the buyer.
Insurance consultants can help evaluate a business’s needs, design a plan and recommend the most economical carrier. But for small businesses, a qualified agent/broker can do the same thing. The consultant is paid by the buyer, based on a contract or agreement.
CHOOSE AN INSURANCE COMPANY CAREFULLY
Remember that when you select a carrier, you should base your decision not only on the plan it offers, but also on its reputation, stability and record in serving the small-business market.
DETERMINE THE FINANCIAL STABILITY OF THE CARRIER
Ask for a copy of its rating by A.M. Best & Co., Standard & Poor’s, or Duff & Phelps from the broker, agent or the company itself. For more information, contact the New York State Department of Financial Services, which is responsible for licensing carriers and monitoring their operations.
Minimizing actual claims can have an impact on your premium. While we buy insurance for protection against loss, claims can tend to result in higher insurance premiums. While you may decide to accept more risk by selecting higher deductibles, it’s equally important to take preventive steps to reduce the likelihood of loss. Protecting your premises from fire with good housekeeping, building code compliance, fire protection systems and alarms could help avoid claims. Injuries to others might be avoided by installing lights where needed, keeping walkways and steps in good repair, posting signs in hazardous areas, and eliminating other hazards whenever possible.
Problems Obtaining Insurance
Occasionally your type of business might not be insurable by “standard” insurance companies, in the “standard” marketplace. If you’re unable to find an insurance company that will sell you BOP or monoline policies, or if you cannot obtain certain coverage such as fire or flood insurance, you can turn to special insurance facilities. They include:
NEW YORK PROPERTY INSURANCE UNDERWRITING ASSOCIATION (NYPIUA)
NYPIUA is a pool of insurance companies writing fire insurance in New York State. It offers fire and extended coverage, as well as coverage for vandalism, malicious mischief and sprinkler leakage to consumers who are unable to purchase this type of insurance from individual insurance companies. Business income insurance may be provided to manufacturing and non-manufacturing operations. However, since coverage offered through NYPIUA is sold at a higher premium than coverage offered in the voluntary market (as a general rule) you and your agent/broker should make every effort to get this insurance from a voluntary insurer. Detailed information is available from New York Property Insurance Underwriting Association, 100 William Street, New York, NY 10038, (212) 208-9700, or from any licensed agent or broker in this state. Outside New
NATIONAL FLOOD INSURANCE PROGRAM (NFIP)
Insurance coverage for losses resulting from floods is for the most part not provided in any of the previously mentioned monoline or BOP policies. However, property owners can purchase insurance protection against losses from flooding through the NFIP if the property is in a community designated as a special flood hazard area that implements and enforces measures to reduce future flood risks. Additional information is available from the Federal Emergency Management Agency, Federal Insurance Administration, 500 C Street, S.W., Washington, DC 20472, or by calling 1-800-638-6620.
EXCESS AND SURPLUS LINES BROKERS
If your property or liability exposures are uninsurable in the traditional insurance market, your agent or broker can represent you to an “excess lines” insurance company or broker, possibly obtaining the required coverage from an insurance company that specializes in special risk situations. These companies are often non-admitted carriers (not licensed by the NYSDFS), so special caution and procedures are required. Your agent or broker can assist you, and the NYSDFS requires him/her to carefully advise you of possible pitfalls.
Risk management is a process of well-defined steps that will enable you to identify situations that could create exposures and risks that would be detrimental to your business. Here are five techniques that will help you better manage risk:
Avoid performing dangerous activities. Consider outsourcing any process hazardous to your health or premises.
A store owner might install video surveillance to reduce petty thefts.
Assume some risk via higher deductibles, eliminate collision coverage on lower value vehicles, etc.
RISK TRANSFER BY CONTRACT
If you lease out part of your premises, you might require your tenant to protect you from liability claims of people they allow in the building.
RISK TRANSFER BY INSURANCE
You agree to pay a premium, and the insurance company agrees to pay certain losses that may occur.
Don’t make the following mistakes:
- Carrying no coverage at all. (Surprisingly, some businesses don’t.)
- Not obtaining commercial insurance on company cars.
- Purchasing inadequate liability coverage.
- Not buying disaster insurance, e.g., flood or earthquake.
- Failure to use a professional agent who knows your business.
- Not purchasing employment practices liability.
- Not covering family members under workers’ compensation.
- Not obtaining competitive quotes for your insurance quotes.
- Filing frivolous claims.
- Not doing annual insurance checkups. Sustained business success requires you to review your needs regularly.
- Failing to report a loss to your insurance company within the time limits specified in your policy.
Few things in life are riskier than launching and running your own business. Don’t compound that risk by neglecting your business insurance needs. Protecting your business from financial disaster will not only preserve all of your hard work and long hours, but will also let you sleep better.
Commercial Property Forms
Use the information listed below as a guide to help select specific insurance coverage most appropriate to protecting your operation from financial disaster. Please note, however, that this information is intended as a guide only. Some insurance companies may not offer all of the coverages listed, or may offer a variation. Always deal with a licensed insurance representative and read your policy carefully.
BASIC FORM COVERAGE
This coverage protects your business against these perils or causes of loss:
Fire, plus extended coverage, consisting of:
- Windstorm or hail
- Aircraft or vehicles
- Riot or civil commotion
- Sprinkler leakage
- Sinkhole collapse
- Volcanic action
BROAD FORM COVERAGE
Includes Basic Fire, extended coverage, plus:
- Breakage of glass
- Falling objects
- Weight of snow, ice or sleet
- Water damage (accidental discharge as a direct result of broken water system)
SPECIAL FORM COVERAGE
Provides “all risk” protection. The term “all risk” is a misnomer. This excellent coverage includes basic form, plus broad form coverage (above). In addition, this form covers any other loss, unless the peril is specifically excluded, such as flood, earthquake, war, nuclear accident, etc. Check your policy for a complete listing of perils excluded.
Options might include one or more of the following endorsements:
- Accounts receivable
- Additional insured endorsement
- Automatic annual increase in building limit of insurance
- Automatic seasonal increases in business personal property
- Backup of sewer and drains
- Boiler and machinery
- Builder’s risk and building material
- Civil authority
- Condominium coverage
- Consequential loss
- Contractors equipment
- Data processing
- Debris removal
- Difference in conditions
- Electronic media and records or computer coverage
- Employee dishonesty
- Equipment breakdown
- Equipment dealers form
- Fine arts
- Fire protective equipment discharge
- Forgery and alteration
- Full coverage for glass as part of the building limit(s) of insurance
- Increased cost of construction
- Inland marine
- Intangible property such as goodwill, trademarks
- Loss of rents
- Mechanical breakdown
- Mobile property
- Money and securities
- Newly acquired or constructed property
- Ocean marine cargo
- Ordinance and law
- Personal property of your employees
- Personal property of your customers
- Personal property off premises
- Pollutant cleanup and removal
- Product tampering and accidental contamination
- Property of others in your care, custody and control
- Refrigerated food spoilage coverage
- Satellite dishes
- Signs, fences and other outdoor property
- Trees, shrubs, landscaping
- Tool floater
- Truckers form
- Utility services – direct damage and time element
- Valuable papers and records –cost of research
When you obtain property insurance, you and the insurance company must agree on what valuation method you will use to determine the value of your structures, thus insuring a fair settlement at the time of a loss. You must be aware of the following methods of valuing your property:
ACTUAL CASH VALUATION – the replacement cost minus depreciation.
REPLACEMENT COST VALUATION – the replacement cost without deducting depreciation.
AGREED AMOUNT OR FUNCTIONAL REPLACEMENT COST – commonly used to value art objects and other unique items.
LIABILITY COVERAGE — Options might include one or more of the following endorsements:
- Boat owners
- Employees as additional insured(s)
- Fiduciary liability
- Fire legal liability
- Hired auto and
- Host liquor liability
- Non-owned watercraft
- Personal injury (libel, slander, etc.)
- Premises medical payments
- Products and completed operations
SURETY BONDS — Provides monetary compensation if the bonded party fails to perform certain acts. Although surety bonds are not uniform and have different characteristics, they can generally be grouped into the following categories:
- Contract Bonds include bid, performance payment and maintenance bond
- License and permit bonds
- Public official bonds
- Judicial bonds include fiduciary and court bonds
- Miscellaneous includes financial institutions, ERISA compliance, etc.
AGENT — Licensed producers (sales), primarily representing the insurance company to the buyer. May also be a licensed broker.
ALIEN INSURERS — Insurance companies domiciled outside of the United States.
AUTHORIZED/LICENSED/ADMITTED — Insurance companies that are licensed to operate in New York.
BROKER — Licensed producers (sales), primarily representing the buyer to the insurance company. May also be a licensed agent.
DOMESTIC INSURERS — Insurance companies domiciled and licensed in New York State.
ENDORSEMENTS — Written provision that adds to, deletes or modifies the provisions of the original contract.
EXCESS AND/OR SURPLUS LINES — Insurance placed with unauthorized insurance companies that are not licensed in New York
FOREIGN INSURERS — Insurance companies domiciled in a state other than New York, but may be licensed by New York.
INSURED — A person entitled to benefits under the terms of a policy. Generally, could include your employees, related entities, etc.
NAMED INSURED — Same as the policyholder.
POLICYHOLDER — The person(s) or entity whose name appears on the policy.
RIDER — Term used in insurance contracts to describe a document that amends or changes the original policy.
UNAUTHORIZED/NON-LICENSED/ NON-ADMITTED — Insurance companies that are not licensed by New York.
Independent Livery Insurance Programs
Insurance Companies with Approved Independent Livery Programs
The following insurers may be actively writing or accepting new business. You may contact the companies directly or a Professional Agent or Broker for information on each companies' underwriting activity. Companies who have provided the Department with names of contact persons, indicated their intention to accept new business in accordance with their underwriting guidelines.
|American Country Insurance Company||John Vessecchia||(609) 296-6650|
|American Transit Insurance Company||Lloyd Clement||(212) 857-8200 x 404|
|Crum & Forster Indemnity Company|
|Delos Insurance Company|
|Fireman's Fund Insurance Company|
|Global Liberty Insurance Company of New York||Hossni Elhelbawi||(718) 729-8100|
|Hereford Insurance Company||Tricha Higgins||(718) 361-9191 x 7149|
|Hudson Insurance Company|
|Kingstone Insurance Company|
|Lancer Insurance Company||Mickey Bayard||(516) 431-4441|
|Maya Assurance Company||K. J. Singh||(718) 937-2010 x 14|
|North River Insurance Company|
|One Beacon Insurance Group|
|Pacific Employers Insurance Company|
|Star Insurance Company|
|United States Fire Insurance Company|
The Health Care Reform Act of 2000 introduced the Healthy NY program to provide more affordable health insurance to New Yorkers who need it most. Healthy NY, in partnership with HMOs and other insurance companies in New York State, offers comprehensive health insurance to small businesses. DFS oversees the program.
Small Business Owners
Healthy NY includes comprehensive coverage for essential health benefits including inpatient and outpatient hospital services, physician services, maternity care, preventive health services, diagnostic services, mental health services, chiropractic care, prescription drugs, ambulance and emergency services.
As of January 1, 2014, Healthy NY no longer provides coverage for individuals or sole proprietors. Instead, the New York State of Health Marketplace can help individuals and sole proprietors shop for and enroll in health insurance. You may also qualify to receive assistance to help pay for insurance offered through the Marketplace.
Guidance for Insurers Participating in Healthy NY
The DFS issues guidance to insurance companies participating in Healthy NY to assist in program implementation. Below are a selection of Healthy NY guidance memoranda. This is not an exhaustive list of all guidance memos.
- October 29, 2019 - Guidance for Insurers Participating in Healthy NY.
- October 12, 2017 - Guidance for Insurers Participating in Healthy NY section.
- July 28, 2015 - Employer Eligibility for Healthy NY coverage issued or renewed on or after January 1, 2016, New Healthy NY Recertification Form, Loss of Eligibility for Healthy NY Coverage.
- June 20, 2013 - Small Employer Groups.
- February 7, 2013 - Federal Health Care Reform Benefit and Annual Limit Updates, Spouse as Primary Policyholder, High Deductible Health Plan (HDHP) Deductible Amounts, Current Wage Level for Small Employers, 2013 Individual Income Eligibility Levels.
To participate in Healthy NY, a small business must meet all of the following criteria:
- The business must be located within New York State.
- The business must have had 1-50 Full-Time Equivalent (FTE) employees over the previous calendar year.
- At least 30% of the employees must earn $45,450 or less in annual wages. The wage level is adjusted annually for inflation.
- 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:
- 50% of the eligible employees will participate in the program and at least one participant earns annual wages of $45,450 (adjusted annually) 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.
- The employer will contribute at least 50% of the premium.
- At least one eligible employee earning $45,450* or less enrolls.
- The employer will offer Healthy NY to all employees who are working 20 or more hours per week and earning $45,450 (adjusted annually) or less. If the business meets the the four criteria above.
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.
The health plans that offer Healthy NY coverage have their own medical provider networks. This means that benefits are provided a network of medical providers. You must use the doctors and health care providers who participate in your insurance company’s network, except in an emergency. Contact your health plan directly to confirm whether your health care providers are in their network.
This is not intended to be a complete list of covered benefits. Please refer to your health plan coverage documents for a full description of covered benefits.
- Office Visits: Primary Care and Specialist
- Preventive Care: Well-Child Care, Adult Annual Physical Examinations, Adult Immunizations, Well-Woman Examinations, Mammograms, Family Planning & Reproductive Health Services, Bone Mineral Density Testing, and Screening for Prostate Cancer
- Emergency and Urgent Care:& Ambulance Services, Emergency Department and Urgent Care Center
- Professional Services and Outpatient Care: Advanced Imaging Services, Allergy Testing and Treatment, Ambulatory Surgery Center, Anesthesia Services, Cardiac & Pulmonary Rehabilitation, Chemotherapy, Chiropractic Services, Diagnostic Testing, Dialysis, Habilitation Services, Home Health Care, Infertility Treatment, Infusion Therapy, Inpatient Medical Visits, Laboratory Procedures, Maternity & Newborn Care, Preadmission Testing, Diagnostic and Therapeutic Radiology Services, Rehabilitation Services, Second Opinions, Surgical Services
- Additional Services, Equipment & Devices: Autism Spectrum Disorder Diagnosis and Treatment, Hospice, Diabetic Equipment andSupplies, Durable Medical Equipment and Braces, Hearing Aids, Cochlear Implants, Medical Supplies and Prosthetics
- Inpatient Services & Facilities: Hospital Services (including Inpatient Stay for Mastectomy Care, Cardiac & Pulmonary Rehabilitation, and End of Life Care), Skilled Nursing Facility, and Rehabilitation Services
- Mental Health and Substance Use Services: Inpatient and Outpatient
- Prescription Drugs
- Pediatric Dental & Vision
Cost Sharing 2020
Please consult your health plan coverage documents for a more extensive description of your cost sharing responsibility. Some examples of copayments and coinsurance are included below.
$600 individual / $1,200 family
Maximum out of pocket costs
$4,000 individual / $8,000 family
Primary Care Physician (PCP) visit
No cost sharing
Emergency Room visit
$150 (waived if admitted)
Chemotherapy, radiation therapy
$25 per visit
Physical therapy, occupational therapy, speech therapy
Diagnostic and routine laboratory and pathology
Diagnostic and routine imaging
Surgical Services – inpatient, outpatient and surgicenters
DME / Medical supplies
Inpatient Facility / Skilled Nursing / Hospice
$1,000 per admission
Mental Health & Substance Use Disorder Services
$1,000 per admission (inpatient)
Pediatric dental - office visit
Pediatric vision – eye exam visit
Insurers and Rates
Many different insurance companies offer Healthy NY. The chart below contains links to a list of insurance companies that offer Healthy NY in each county, contact information and premium rates. Rates are current as of October 1, 2021 and may vary depending upon the month in which you enroll. To verify the rates listed, please contact the insurance company directly.
Who Can be Covered
In addition to offering coverage for employees, your business may choose offer coverage to employees’ families. As the business owner, you do not have to contribute to the cost of premiums for employees’ dependents. By making coverage available to employees’ dependents, you can allow them to access health insurance coverage at affordable group rates.
If your business offers Healthy NY, you may offer coverage to:
- Employees, including the business owner;
- Employees’ same-and opposite-sex spouses, if residing in the household;
- Employees’ domestic partners, if you wish to make domestic partner coverage available (the employer may also decide whether to make coverage available to same-sex domestic partners, opposite-sex domestic partners, or both);
- Employees’ children to age 26.
Children do not need to live in the employee’s household in order to be covered. Stepchildren may also be covered.
You may be able to purchase coverage for certain eligible children through the age of 29 via an "Age 29" Dependent Coverage Extension. Contact your insurance company for more information regarding eligibility and the cost of the coverage.
How to Apply
You may print out the application, complete it and mail it, or complete the application online and then print it out and mail it. Applications cannot be submitted online or via e-mail.
How to Submit Your Application
- Complete and sign the application.
- Enclose a check for the first month’s premium, made payable to the insurer to which you are applying. Mail your completed application directly to the insurance company through which you want Healthy NY coverage. Please do not mail your application to the Department of Financial Services. This will delay the application process.
For a list of insurance companies, their addresses, and premium rates, visit the Insurers and Rates section.
When Coverage will Start
If the insurance company receives your completed application and first month’s premium payment by the 20th of the month, coverage will start the first of the following month.
DFS does not process Healthy NY applications. Please direct all questions regarding application status to the insurance company to which you applied. For your insurance company’s contact information, visit the Insurers and Rates section.
If you are unable to print the application, please contact DFS at (800) 342-3736 (Monday through Friday, 8:30 AM to 4:30 PM) or email [email protected] to request an application.
Recertification and Changes
Once a year, you must recertify that the business continues to meet the eligibility requirements of the Healthy NY program. The recertification date is on your policy’s annual renewal date. Your insurance company will provide you with the recertification form at least 90 days before your annual renewal date.
At recertification, you must confirm that:
- The business must have had 50 or fewer full-time equivalent employees in the prior calendar year,
- The business will continue to contribute at least 50% of the cost of premiums for full-time, non-seasonal employees, and
- At least 30% of employees earn $45,450 or less in annual wages (wage levels are adjusted annually).
If you do not complete and return the recertification form by the due date, then your business’ coverage will terminate. If the business does not continue to meet the eligibility requirements of the program at recertification, then it will not be able to continue in the program. Your insurance company must provide you with at least 45 days written notice that coverage will end due to not meeting the eligibility requirements.
Mid-year changes in group size, wage levels and employee participation will not result in immediate termination of Healthy NY coverage. If the business does not meet the eligibility requirements at the time of recertification, it will be unable to continue in the program.
You may change insurance companies at any time.
To do so, you must reapply to the Healthy NY program and send your completed application and premium check to the insurance company with which you want coverage. The business must meet the eligibility criteria at the time of application.
For information on which insurance companies offer Healthy NY in your county and premium rates, visit the Insurers and Rates section. If the insurance company receives a completed application and first month’s premium payment by the 20th of the month, coverage will start the first of the following month.
You will also need to terminate your existing coverage according to the terms of the contract. Usually you must give at least one month prior notice.
New York State of Health: The Official Health Plan Marketplace
NY State of Health is an organized marketplace designed to help people shop for and enroll in health insurance coverage. Individuals, families and small businesses can use the Marketplace to help them compare insurance options, calculate costs and select coverage. The Marketplace has a section specifically for small businesses called “The Small Business Marketplace” that can make it simple and easy for you to offer high quality, affordable health insurance coverage to your employees while taking advantage of the small business health care tax credit. For more information, please contact the the Small Business Marketplace by phone at (855) 355-5777 or visit the NYSOH Small Business Marketplace online.
Child Health Plus
New York State has a health insurance plan for children through age 18 called Child Health Plus. Child Health Plus is run by the Department of Health and provides free or reduced-cost coverage. For more information on Child Health Plus eligibility and covered services, please visit the Department of Health or call (800) 698-4543. You can apply for Child Health Plus coverage through the New York State of Health Marketplace.
The Office of Citywide Health Insurance Access (OCHIA) is a resource for small businesses and people living in the metropolitan New York area that helps people determine if they qualify for any public health insurance programs, and if not, helps to find other affordable insurance. It also helps small businesses find coverage. For more information, please visit the OCHIA website.
Other New York State Agencies
- Department of Labor
- Department of State
- Small Business Development Center
- Taxation and Finance
- Empire State Development Division for Small Business
Minority and Women-Owned Business Development (ESD)
Other Outside Resources
If you have feedback, or have a question about a small business issue or small business insurance email our Small Business mailbox. Include your name, mailing address and telephone number along with your questions and concerns.