Healthy NY

Small Businesses

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. 
3. At least 30% of the employees must earn $44,075 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:

• 50% of the eligible employees will participate in the program and at least one participant earns annual wages of $44,075 (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 $44,075* or less enrolls.
• The employer will offer HealthyNY to all employees who are working 20 or more hours per week and earning $44,075 (adjusted annually) or less if the business meets the four criteria above.

For Employer Groups with 20 or fewer employees:

• Medicare eligible employees are ineligible for enrollment in Healthy NY.
• Members who age into Medicare during a covered Healthy NY plan year will be eligible to remain on Healthy NY until the end of that plan year. Upon the group’s next recertification, that member will no longer be eligible for Healthy NY coverage.
• Spouses and dependents who are Medicare eligible are also ineligible for enrollment in Healthy NY if they are Medicare eligible.
• Medicare eligible employees may still obtain Healthy NY coverage for their spouse or dependents as long as the dependents are not Medicare eligible.

For Employer Groups with 21 to 50 employees:

• Due to federal law, Medicare eligible employees are eligible for coverage through Healthy NY and may obtain coverage on behalf of their dependents.
• Medicare eligible dependents are eligible to obtain Healthy NY coverage.

The Healthy NY Small Employer Group Plan is subject to a deductible for covered services. A deductible is a fixed amount during the annual benefit period that enrollees must pay before a plan starts to make payments for services.  Prescription Drug and Preventive services are not subject to deductible.

Once your deductible has been satisfied, covered services are subject to a copayment. A copayment is an amount that members must pay at the time they receive services.