Group Health Insurance NY
HealthplansNY.com helps small business owners take control of the spiraling cost of group health insurance and supplemental group benefits.
We provide you with everything you need to find affordable group health insurance coverage for your small business. You can get a free NY health insurance quote in less than 1 minute. To get started, just go to our free quote engine and provide simple census information about your company.
What is a Group Health Insurance Plan?
Group health insurance is a company sponsored insurance plan for small business owners and their employees. In New York, a small business is defined as having 2 to 100 employees.
Group health plans are one of the many benefits that can be offered by an employer and one of the most requested benefits by employees.
A company with less than 30 employees is not required to offer health insurance to their employees but many do because health insurance is a valued benefit used to attract and retain quality workers.
The Federal Government now regulates company sponsored health plans since the implementation of The Affordable Care Act in 2010. Companies with more than 50 employees are required to offer affordable health care coverage to all employees or face a penalty.
Types of Business Health Insurance
There are four main options when it comes to group health insurance in NY. These are as follows:
• Preferred provider organization (PPO)
• Point of Service (POS)
• Health maintenance organization (HMO)
• Exclusive provider organization (EPO)
• HSA-eligible plans
Each type of plan has its benefits and drawbacks, and your business may prefer one over another. It’s important to understand those differences before you commit to any of them.
A preferred provider organization (PPO) health care plan offers the flexibility to go out of your provider network and see a specialist without a referral from a primary care provider.
Getting care outside your network gives you more options than other health plans, but that freedom comes at a higher cost. Out-of-network care typically costs more than if you stay in network and has higher health insurance premiums. Plus, reimbursement for out of network medical care is much lower than if you used a provider in network.
While not common plan type anymore, a point-of-service (POS) plan is similar to a PPO plan. A POS plan allows members to pay less for their care when they visit a medical provider inside the plan’s network. but also allows members to seek care out of network. To receive care outside of your network you must get a referral from your primary care physician and pay the extra cost for your out of network provider.
A health maintenance organization plan requires members to receive medical care in-network only and requires you to choose a specific primary care physician. Typically, your primary care physician coordinates most of the care you receive when you have an HMO. For example, you likely will need a referral to see a specialist. An HMO won’t cover your care if you go outside the plan’s network, except if you need emergency care. However, an HMO is more budget-friendly and has lower monthly premiums.
An EPO is similar to an HMO which requires you to stay in-network, but you do not need a referral from your primary provider. An HMO does not cover any out-of-network care except for emergencies. In other words, an EPO is not as strict as an HMO but not as flexible as a PPO.
Health Savings Account (HSA) are tax-advantaged accounts that let you save pre-tax dollars for future qualified medical expenses including co pays, prescriptions, dental, vision care and much more. These plans have higher deductibles and usually have lower insurance premiums, but no medical expenses are covered until you meet your plan deductible each year.
Funds that are deposited into an HSA grow tax-deferred and any un-used funds roll over each year to be used next year.
What Does Affordable Coverage Mean?
Under The Affordable Care Act (ACA) companies are required to offer health plans that meet certain criteria. This criteria is now represented by the “metal” plan levels such as; Platinum, Gold, Silver and Bronze.
All health plans are designed to provide the same level of coverage to all employees. The tiers are based on the percentage the plan pays for health care expenses while providing the required Essential Health Benefits (EHB) to members:
Platinum Plans: provide the highest amount of coverage (90%) with the least out of pocket expenses to the employee. These plans are also the most expensive
Gold Plans: Pay 80% of medical expenses
Silver Plans: Pay 70% of medical expenses
Bronze Plans: are high deductible plans and pay 60% of medical expenses.
All Health Plans Must Include these Essential Health Benefits (EHB):
1. Outpatient Care: Care you receive without being admitted to a hospital
2. Ambulatory Care: Transportation to the emergency room or urgent care
3. Hospitalization: Treatment in the hospital for inpatient care
4. Maternity Care: Care received before and after pregnancy
5. Mental Health and Substance Abuse: This includes behavioral treatment, counseling, and psychotherapy
6. Prescription Drugs: Medications that are prescribed by a doctor to treat an illness or condition.
7. Rehabilitative Devices: Services and devices to help you recover from injuries, disabilities or a chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more
8. Laboratory Services: Tests provided to help a doctor diagnose an injury, illness.
9. Preventive Services: Includes counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease
10. Pediatric Services: This includes dental care and vision care for children
How does Small Business Health Insurance Work?
Here’s what you need to know:
You typically need at least two W-2 employees working at least 20 hours per week to qualify for group health insurance. One employee could waive coverage with a valid waiver (spousal coverage, Medicare or Armed forces coverage) and the other worker or the owner can obtain coverage.
- Coverage in New York is guaranteed issue
- You cannot be turned down for group coverage
- You need at least one employee to qualify
- Employers must contribute a percentage toward employee premiums
Group Health Plans Designed to Fit Your Small Business
Shop hundreds of group health plans from the top insurance carriers in New York with our Free Quote Engine. Browse plans from, Oxford, EmblemHealth, Empire Blue Cross, Oscar, HealthFirst and more! There is no cost or no obligation to enroll.
Small Group Employer
If you employ 2 to 100 employees in New York, you are considered a small group employer. Small group health plans are known as “community rated plans” which means, every employee pays the same rate regardless of their age or gender.
Large Group Employer
Large group health plans for 101 employees or more are customized with resources and benefits to fit your employees needs. Large companies can offer more plan choices, often at lower rates to their employees. Large group employers pay rates based age, gender, residential zip code and claim experience in their industries.
At Healthplansny we believe that when business owners can compare health insurance quotes on their own terms, they win. If this approach seems new to you where you can actually see our online quotes it’s because we‘re not your typical health broker.
We work with the best New York health insurance companies such as: Aetna, Emblem Health, Empire Blue Cross, Oxford, Oscar and more. So our advice is unbiased and we are beholden to no one company but you, our client.
If you’ve ever gone shopping for other types of insurance, you know what a challenge it can be. Finding the right health Insurance plan is no different. From the time it takes you to find a competent agent or broker and request quotes, to the daunting task of evaluating a real apples-to-apples comparison, it’s no wonder so many business owners get frustrated and let the insurance companies and the brokers hold all of the cards.
With over four decades of combined experience working with all of the major insurance companies, we put business owners in the driver’s seat to buy a company policy on their terms and their budget. Most business owners enjoy the transparency and the peace of mind of an affordable group health insurance policy that’s aligned with their needs and the needs of their employees.
We offer group health insurance and more for your small business or even insurance planning for your personal needs. Just scroll down below to choose an insurance plan that you are looking for.