Sole Proprietor Plans
Sole proprietor health plans are dead thanks to The Affordable Care Act (ACA). But, we do have some creative health plan options.
Finding self-employed health insurance nowadays is not an easy task. Not too long ago, if you were self employed or a sole proprietor, you could qualify for a very robust sole proprietor plan from any major insurance company.
But those days are long gone.
However, if you are looking for a sole proprietor health plan,there are still a few options that are available.
New York Sole Proprietor Health Insurance Options
Option # 1: Employer Association Health Plans
Association plans are group health plans provided by an organization of like minded people who want access to quality health insurance coverage.
Our sole proprietor plans are your solution to comprehensive health coverage that fits your budget without sacrificing quality. PPO health plans feature in-network and out-of-network coverage. National coverage protects you anywhere in the United States.
We have more than 15 quality health plans designed specifically for the Sole Proprietor, 1099 employee and independent contractors. The plans are offered by insurance companies you know and trust. Such as, Anthem Blue Cross, Cigna and Northwell Health.
The Association uses the power of its group buying (over 80,000 members) to offer benefits that previously were not available to the self-employed and at rates that are substantially lower than those plans purchased on an individual basis.
These plans have open enrollment all year! You do not need a qualifying event to access our health plans.
Premier National PPO Health Plans
Affordable National PPO Health Plans are available with the Cigna Open Access Plus, Anthem Blue Cross National networks, and the Emblem Prime PPO network.
Complete the green form on this page for rates and benefits and to get your personal secure website portal and access code to enroll today. Open enrollment available all year.
Anthem Blue Cross PPO Plans (5 health plans)
Anthem is one of the largest insurance companies in the Country. The have an extensive network of doctors, hospitals and medical facilities. Their “Blue Card” network is accepted Nationwide.
With coverage in all 50 States, Anthem has plans to fit your needs and budget.
Cigna PPO National Plan
To qualify for a Cigna PPO plan, a business must have more than 100 employees but because of the power of group buying by the Employer Association, a sole proprietor can now enjoy the benefits of a National Cigna health plan.
There are 3 Cigna plans to choose from:
- Advantage 5000
- Silver 3000
- Elite 1000
Northwell Health and Anthem Blue Card (5 health plans available)
The Emblem Network (HIP Prime) has now changed to a dual option network. Northwell Health and Anthem are the new networks. Members can choose doctors/facilities/hospitals in either network and the deductibles are separate for each network. However, the out-of-pocket maximum is combined to meet only one out of pocket maximum.
The Northwell Health and Anthem networks are only available to new members who reside in the state of New York. Members who were in the Emblem Network and live out of state can access the Anthem Network which is a national network.
Empire Blue Cross, Blue Shield (3 health plans available)
Empire Gold EPO
Empire Gold PPO
Empire Silver EPO
All plans meet the requirements of Essential Health Benefits (EHB) as required by The Affordable Care Act (ACA).
An annual membership fee is required to join the employer associations and they reserve the right to set their own underwriting guidelines – which means you could be denied coverage if you are being treated for a serious health condition. For example: cancer, heart disease or diabetes.
Association Health Plan Highlights:
- Brand Name Insurance Companies
- National Health insurance Networks
- In and Out of Network Coverage
- Annual Rate Lock
- Benefits include doctor visits, prescriptions, hospitalizations, and more
- Cancel Anytime
- Plans are Designed for The Sole Proprietor
Complete the green form at the top of this page to request your free Sole -Proprietor enrollment kit.
Option # 2: Qualify for Small Group Health Insurance –
Hire a Friend or Family Member – But not your spouse!
You can hire a family member (son, daughter, nephew or etc.) or a friend and pay them part-time minimum wage (must be 20 hours) to help you qualify for group health insurance plans. You can go here to view pricing for group health plans.
* You will have several choices of health insurance coverage
* You can easily add new employees to your group plan as your company grows
* You will have more paperwork
* You will have to file payroll tax and and quarterly wage reports
Option # 3: Qualify For a Group Health Plan by Giving a Share Away
Once upon a time, a small business owner without any employees could simply put their spouse on payroll, pay him or her minimum wage for 20 hours a week and qualify for a group plan.
But the Affordable Care Act (ACA) changed all that and now in order for a sole proprietor to qualify for a small business plan, it would have to have one common-law employee, excluding the owner and spouse.
Just like that, the rules changed leaving small “mom and pop” businesses without coverage. Many small business owners lost their coverage and were forced to go to the individual marketplace.
But there is some good news; A new way for the Sole Proprietor to qualify for a group health plan – The “Give a Share” Program.
Here is how the “Give a Share” Program works:
The “give a share” program is a “loophole” in the insurance industry’s certification process and could be shut down at any time.
However, by simply giving a share of your company to a friend or family member; Mother, Father, Sister, Brother and so on (but not your wife!) it creates 2 shareholders which are eligible and now qualify as a group.
One shareholder enrolls in the health plan and the other shareholder waives coverage. This gives you access to health plan options from some of the top insurance companies in the marketplace.
Pros of “The Give a Share” Program:
1. Can be completed by your CPA or attorney with a simple form
2. Gives you access to a group health plan
3. No payroll tax to pay. No quarterly wage reports
1. Must file a schedule K-1 with tax return
2. Your friend or family member owns a percentage of your business
3. The friend or family member is now your partner
We do not offer tax or legal advice regarding this program. Please check with your CPA or attorney if the “Give a Share” Program is right for your business.
For more information on this perfectly legal method and how it can work for your small business, call our office at: 914-633-1717. But you better hurry, the insurance companies might close this loophole too.
Option # 4: Buy an Individual Insurance Policy
You can purchase a Individual Health Plan for yourself and or your family. We represent private insurance plans from the top insurance carriers: Oscar and MVP (upstate only).
These are private insurance plans and not Obamacare plans which many of the doctors and specialists are not accepting in the tri-state area.
For more information about any of these options or if you have any questions, feel free to contact our friendly staff at: 800-234-3702