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Healthy NY

Affordable health insurance for small businesses

Healthy NY is a state-sponsored program offered through BlueShield of Northeastern New York. Healthy NY is designed to provide health insurance coverage to:

  • Small businesses, their employees, and dependents

Enrolling in the Healthy NY program through BlueShield of Northeastern New York gives you the same quality care and service that you get from any plan offered by BlueShield. With many physicians and specialists to choose from, Healthy NY gives you access to the care you need when you need it.
 

Healthy NY Benefits

Healthy NY offers important medical services such as regular medical checkups, hospital care and prescription benefits. Covered services are subject to a copayment.

The Healthy NY benefit package consists of all Essential Health Benefits as defined in the Affordable Care Act including:

  • Office visits
  • Diagnostic and x-ray services
  • Emergency services
  • Inpatient and outpatient hospital services
  • Maternity care
  • Physician services
  • Preventive health services
  • Mental health and substance use services
  • Prescription drugs
  • Wellness
  • Pediatric vision

Plan Information

2021 Benefit Summaries

2021 Healthy NY Product Portfolio

2021 Summary of Benefits and Coverage (SBCs)

2019

Eligibility
 

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.

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.

Copayments and Deductibles

Covered services are subject to a copayment. A copayment is an amount enrollees must pay at the time they receive services. The Healthy NY Small Employer Group Plan is also subject to a deductible. A deductible is a fixed amount during the annual benefit period that enrollees must pay before a plan starts to make payments for services.

To Apply

In order to apply, you are required to provide a completed application with documentation verifying your current residence, current income and/or proof that you had worked within the past year. All Healthy NY applications must be in our possession by the 20th of the month in order to be eligible for the following first of the month's coverage.

Mail applications to:
Government Programs
P.O. Box 5204
Binghamton, NY 13902-9964

If you feel you qualify, and you have questions or need other information, please call BlueShield of Northeastern New York at (518) 220-4600 or (800) 888-1238.