Small Businesses
- Individuals & Families
- Living with a Disability/Visually Impaired
- 65 and Older
- Young Adults
There are many reasons you may provide health insurance to your employees. Businesses with 50 or more employees must offer health insurance under the Affordable Care Act . However, even if it is not required, offering health insurance can have many benefits such as:
- Tax benefits for you, including tax deductions and credits. Tax credits are only available through the NY State of Health Marketplace .
- Tax benefits for workers when they pay a portion of their insurance with pre-tax salary deductions
- Better employee retention and healthier workers
Download small business health insurance fact sheets:
Are you Interested in Offering Health Insurance to Your Employees?
The Small Business Health Care Tax Credit
How to Apply
Applying for health insurance is easier than ever, and small businesses have many options.
- NY State of Health Small Business Marketplace : If you have 100 or fewer than employees, you can offer employees a choice of plans through the NY State of Health Small Business Marketplace. The Small Business Marketplace is open all year round. Note that sole proprietors enroll through the NY State of Health Individual Marketplace . Get help to apply .
- Directly with Plans: You can shop for and purchase health insurance outside of the NY State of Health Marketplace. Remember, tax credits are only available through the NY State of Health. Compare plans on the federal Plan Finder website .
- Private Exchanges: You can shop for and purchase health insurance on a private exchange. Some private exchanges charge additional fees. HealthPass New York NY Health Alliance
- Healthy NY : If you employ lower wage workers and haven't offered insurance in the last year, you may be able to get lower cost health insurance through Healthy NY.
Helpful Links
COVID-19 Updates and Resources Access HRA NY State of Health Small Business Marketplace NYC Small Business Services Healthcare.gov How the Affordable Care Act affects small businesses
Where do you have or need coverage?
Small Business Health Insurance In New York
Finding the right small business health insurance and providing cost-saving coverage for your New York employees has never been more important. Here at Empire, we’re ready to help you find reliable, affordable coverage that makes sense for your budget and your employees.
- Small Business Plans
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Group Health Plans Tailored To Small Businesses In New York
At Empire, we believe we can help solve the toughest healthcare challenges by offering:
A transformative, digital-first experience.
Meaningful connections through whole-person care.
Collaborative expertise with our network advantage.
Our New York small business portfolio includes a variety of PPO, EPO, and high deductible health plans along with a choice of networks for groups with 2 to 100 employees.
Why Choose Empire Small Business Health Insurance
We offer a broad range of benefit and cost-share options to meet different situations and budgets. Whether PPO, POS, or other plan types, we have something that will fit your unique business needs.
Empire features one of the broadest networks in the nation. As a Blue Cross Blue Shield card holder, your employees will have access to a network that includes 95% of doctors and 96% of hospitals in the U.S. One in three Americans carries a BCBS card — over 106 million members. (bcbs.com).
You’ll save valuable time managing your team’s benefits with EmployerAccess, our secure online tool. It’s a quick and easy way to review your account, enroll members, check eligibility, and order ID cards — all in one spot.
Your employees will benefit from 24/7 online visits with board-certified doctors; 1 access to quality providers within 10 miles of their home; and Sydney Health, 2 our mobile app that lets employees access their health plan anytime, anywhere.
Small Business Health Plans
Our small business health insurance portfolio includes a wide variety of plan options, along with broad network coverage for groups with 2 to 100 employees. We connect and coordinate all our benefits to work together and enhance all aspects of care. This helps lower your overall costs and makes benefit management easier, all while delivering more value to your employees.
Medical And Pharmacy Coverage
All of our small business medical insurance plans feature integrated pharmacy coverage. Plans are designed to work seamlessly together so physicians and medical professionals can deliver the right care, in the right setting, at the right time.
Include in-network preventive care coverage at 100% in compliance with the Affordable Care Act.
Powered by our custom-built pharmacy benefits manager, CarelonRx.
Additional Coverage
We offer additional insurance plans that you can combine with medical plans to offer a full range of coverage for your employees. When you combine Empire plans, you automatically receive Empire Whole Health Connection ℠ . It integrates medical, pharmacy, and other coverage to make managing all aspects of care simpler, smarter, and more cost-effective. By bundling medical with our other coverage options, you may also save up to 5%, depending on eligibility.
Competitive plans with 100% in-network coverage for preventive services.
Access to one of the largest vision networks in the nation, including over 40,000 eye doctors at more than 30,000 locations. (NetMinder data, November 2021.)
Benefits and services your employees and their families can take advantage of today.
Short and long term disability plans that integrate with your medical plan for seamless claims and faster returns to work.
Whole Health Options
Because health is more than an annual checkup, we support whole-person care, including:
Integrated Wellbeing Solutions programs to provide holistic care for a healthier, more productive workforce.
Products and strategies for promoting behavioral health at work and beyond.
Assist with work and life challenges ranging from stress to finding care for loved ones to dealing with legal issues – at no added cost to your employees.
Did You Know?
You can buy health insurance coverage at any time; there is no special enrollment period for health insurance for small businesses.
To learn more about which Small Business plans may be right for you, or to get a quote, please reach out to your Agent or Broker.
Select Request A Quote to get a personalized quote that fits your unique business needs.
Don’t have a broker? Just give us a call at tel
The Confidence Of Community
Our associates live and work in the same places you do. We’re all members of the communities we serve and partners in helping those communities thrive.
In New York, Empire is proud to have 4.8 million members, 4,661 associates and 88 years in the local market.
In 2021, we supported New York communities and local nonprofits by donating:
$4.7 million in open community giving activity.
$609,000 generated through associate donations and volunteer hours.
8,086 employee volunteer hours through Empire’s Dollars for Doers.
Take The Next Step
Let us help you get started today.
1. Member cost share for primary care physician office visit may apply.
2. Sydney Health is offered through an arrangement with CareMarket, Inc., a separate company offering mobile application services on behalf of Anthem Blue Cross and Blue Shield ©2021-2022.
Not connected with or endorsed by the U.S. Government or the federal Medicare program.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent or insurance company. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, please contact your agent or the health plan.
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ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a nuestro número de Servicio de Atención al Cliente (TTY: 711).
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Small Business
Small business health insurance in new york, by vaughn himber updated on october 27, 2022.
New York is home to many small and medium-sized businesses while having one of the largest economies in the U.S.
According to a 2021 Empire State Development report , 98% of New York businesses have fewer than 100 employees. This makes small employers a significant part of the state economy.
As a New York business owner, you may have questions about how small business health insurance works in your state. Read below for the answers to all your questions about small business health insurance in New York:
1. How do I qualify for small business health insurance in New York?
You must meet the following New York State small business health insurance requirements, per the Department of Financial Services, to be eligible for group plans in the state:
- Your business must be located within New York State.
- Your business must have had between 1 and 50 full-time or full-time equivalent (FTE) employees over the past calendar year.
- At least 30% of your employees who are offered health coverage earn $45,450 or less in annual wages. The wage level is adjusted every year to account for inflation.
- Your business must not have previously provided group health insurance coverage to your employees within the past 12 months.
If you are the owner of a sole proprietorship in New York, you should know that you usually would not qualify for small business health insurance unless you had eligible full-time or full-time equivalent employees. As a sole proprietor with no employees, you would instead qualify for individual health insurance in New York. Learn more about affordable individual health insurance plans with eHealth.
Another option for small business owners may be ICHRA (Individual Coverage Health Reimbursement Arrangement) plans. This is an affordable option for small business owners who wish to offer health coverage for workers. Here’s how it works: employers set aside a certain dollar amount per employee to go towards their health coverage. The employee chooses and buys a health plan on his own and is then reimbursed by the employer with pre-tax funds. One benefit on the employee end is they can choose the exact plan they want, and many employers find the ICHRA program to be easier to manage when it comes to healthcare costs.
2. What are my obligations as a small business after enrolling in a New York group plan?
According to New York’s Department of Financial Services, in order to participate in HealthyNY, employers must meet all of the following New York State small business health insurance requirements:
- As the employer, you contribute at least 50% to paying for monthly employee premiums.
- 50% of your eligible employees participate in the group health insurance program. Employees who have health insurance through another source (including a spouse or government program) can count toward the 50% participation requirement.
- The plan is offered to all employees who work 20 or more hours per week and are paid $43,450 or less (adjusted annually).
- At least one employee who earns wages of $43,450 or less enrolls in the plan.
Once you offer group health insurance coverage and meet New York State requirements, your business may have access to significant tax advantages.
For example, the monthly employee premiums that your business pays are usually 100% tax deductible. Offering small business health insurance can also mean reduced payroll taxes.
3. How do I qualify for the small business insurance tax credit?
As a New York small business owner, you may be eligible for a health tax credit to help you afford the cost of offering group health insurance to your employees.
Typically, the requirements to qualify for a small business health insurance tax credit in New York are:
- Your business has 25 or less full-time or full-time equivalent employees.
- Your business pays an average annual salary or wage of less than $53,000 a year per worker (this amount is indexed annually for inflation).
- Your business contributes at least 50 percent toward paying for the cost of employee premiums (specifically, your employees’ lowest cost single tier coverage).
- Your business offers Small Business Health Options Program (SHOP) plan coverage to all full-time employees.
If your business qualifies for the small business health insurance tax credit, then the maximum available federal reimbursement for your company is up to 50% of the premiums you pay for employees’ medical, dental, and vision coverage for up to 2 consecutive years.
The small business health insurance tax credit is offered on a sliding scale. This means that the smaller your group, the more likely your New York business will benefit from the tax credit.
For example, if your New York business has less than 10 full-time equivalent employees who are paid wages less than $25,000 annually, then your company may be eligible for the maximum tax credit amount.
4. How do I find small business health insurance in New York?
It’s fast, free, and easy to use eHealth to get affordable New York health insurance for your business.
With eHealth’s online marketplace, you can:
- Compare plans from multiple insurance companies
- Find personalized quotes
- Get unbiased support and advice from licensed health care agents
You can get started today from the comfort of your own home. Just enter your zip code into the plan finder tool on this page to start shopping. Or, if you need help along the way from a trusted licensed insurance agent, contact us today to speak with an eHealth agent and get your questions answered.
This article is for general information and may not be updated after publication. Consult your own tax, accounting, or legal advisor instead of relying on this article as tax, accounting, or legal advice. Group and employee definitions vary by insurance company and state, so be sure to check with a licensed insurance agent to find out the details for your specific situation.
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- Healthy NY for Small Business
- Healthy NY Overview
Eligibility for Small Business: Reduced-cost health insurance is available under the Healthy NY program to eligible small businesses and their employees. > View small business eligibility criteria
Monthly Rates by County: Rates may vary depending upon the month in which you enroll. > View monthly rates by county
How To Apply: Complete the following forms and mail directly to CDPHP.
- Healthy NY Small Business Group Application
- Copy of your most recent NYS 45
- CDPHP Member Enrollment Application
Mail to Capital District Physicians' Health Plan, 500 Patroon Creek Blvd., Albany NY 12206.
If you have questions, please call CDPHP at 1-800-993-7299 or email CDPHP Healthy NY small group for assistance.
When Will Coverage Begin? If CDPHP receives your completed application, supporting documentation and first month’s premium payment by the 20th of the month, coverage will start the first of the following month.
Get More Information: Visit the Healthy NY website for full details on coverage for small business.
Healthy NY Resources
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- Small Business Eligibility
- Monthly Rates for Small Business
- Healthy NY Website
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© 2023 CDPHP. All Rights Reserved | Capital District Physicians' Health Plan, Inc. | 500 Patroon Creek Blvd. | Albany, New York 12206
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New York Small Business Health Insurance Information
The purpose of this guide is to provide a general overview of new york small business health insurance. the guide reviews small business health insurance options for new york small businesses..
Building a successful business is hard work. Finding affordable small business health insurance doesn’t have to be. All small businesses face special challenges when it comes to finding and getting health insurance coverage. Luckily, recent health care reform legislation provides small businesses with special opportunities to secure affordable health insurance.
New York Core Small Business Health Insurance Options
When evaluating your small business health insurance options in New York, you should immediately compare the costs and benefits of the following three options:
Offering Traditional Small Business Health Insurance Coverage,
Offering a Defined Contribution Health Plan that Reimburses Employees for Individual Health Insurance Coverage, and
Offering Nothing
New York Small Business Health Insurance Overview
There are two primary categories of health insurance for small businesses to choose from:
Individual health insurance,
Group health insurance.
1) Individual Health Insurance
Individual health insurance plans are health insurance plans purchased by individuals to cover themselves or their families. Anyone can apply for individual health insurance. Small business owners who can’t offer group coverage due minimum contribution (or minimum participation) requirements typically purchase individual and family plans for themselves and their families. In 2014, insurance companies will no longer be able to decline individuals for individual health insurance based on a pre-existing medical condition. Also, starting in 2014, there are new special tax incentives available to businesses and employees when employees purchase individual health insurance. In some cases, self-employed persons who purchase their own health insurance may be able to deduct the cost of their monthly premiums. When small businesses decide on the individual health insurance route, they often create a "Pure" Defined Contribution Health Plan to reimburse employees tax-free for individual premiums .
2) Group Health Insurance
Group health insurance plans are a form of employer-sponsored health coverage. Costs are typically shared between the employer and the employee, and coverage may also be extended to dependents. In certain states, self-employed persons without other employees may qualify for group health insurance plans.
Four Types of New York Small Business Health Insurance Plans
Whether you’re looking at individual health insurance or group health insurance, there are several different types of health plans available. The four you should absolutely know are:
PPO Health Insurance Plans,
HMO Health Insurance Plans,
HSA-Qualified Health Insurance Plans, and
Indemnity Health Insurance Plans.
The plan type that is best for you and your employees depends on what you and your employees want, and how much you are willing to spend. Here’s a brief review of the four popular types of health insurance plans:
1) PPO Health Insurance Plans
PPO or “Preferred Provider Organization” plans are the most common. Employees covered under a PPO plan need to get their medical care from doctors or hospitals on the insurance company’s list of preferred providers in order for claims to be paid at the highest level.
2) HMO Health Insurance Plans
HMO stands for “Health Maintenance Organization.” HMO plans offer a wide range of health care services through a network of providers that contract exclusively with the HMO, or who agree to provide services to members. Employees participating in HMO plans will typically need to select a primary care physician (“PCP”) to provide most of their health care and refer them on to HMO specialists as needed.
3) HSA-Qualified Health Insurance Plans
HSA-qualified plans are typically PPO plans designed specifically for use with Health Savings Accounts (HSAs). An HSA is a special bank account that allows participants to save money – pre-tax – to be used specifically for medical expenses in the future. Section 105 Healthcare Reimbursement Plans (HRPs) are often used in place of HSAs due to their advantages for employers.
4) Indemnity Health Insurance Plans
Indemnity plans allow members to direct their own health care and generally visit any doctor or hospital. The insurance company then pays a set portion of the total charges. Employees may be required to pay for some services up front and then apply to the insurance company for reimbursement.
New York Small Business Resources*
New York Health Insurance Coverage:
Group Plans: There is a maximum 6-month look-back/12-month exclusionary period for pre-existing conditions on enrollees that do not have prior coverage. Benefits will vary depending on the chosen plan. Pre-existing health conditions covered.
Individual Plans: Assorted plans depending on medical needs. There is a maximum look-back period of 60 months and a maximum exclusion period of 24 months for pre-existing conditions on enrollees that do not have prior coverage. Elimination riders are permitted . Limits on pre-existing health conditions may apply.
COBRA: Coverage available for 18-36 months depending on qualifying events. Benefits are what you had with your previous employer. Pre-existing health conditions covered.
HIPAA: Benefits are based on program selected. There is no expiration of coverage. Pre-existing health conditions covered.
HIPAA: Premium assistance that pays employer-sponsored health insurance or Cobra premium available. Pre existing health conditions covered.
New York Health Insurance Eligibility:
Group Plans: Guaranteed coverage for companies with 2-50 employees. Eligible employees must work at least 30 hours a week. Owner can count as an employee. Owner name on business license must draw wages from the company.
Individual Plans: Eligibility is subject to medical underwriting. If you are denied coverage for a medical condition, you may be eligible for AHIP, or PCIP.
COBRA: Guaranteed coverage available for employees who work for businesses with 20 or more employees. Employees have 60 days from date of termination to sign-up.
HIPAA: Must have had 18 months of continuous coverage and completely exhausted Cobra or state continuation coverage. Must not have lost coverage due to fraud or non-payment of premiums. You have 63 days to enroll.
HIPAA: Must qualify for Medicaid and have access to Employer-Sponsored Insurance or Cobra.
New York Health Insurance Monthly Cost:
Group Plans: Costs depend on employer contribution and the + 20% of the Insurance company’s Index rate.
Individual Plans: Costs for Individual coverage vary. There are no rate caps.
COBRA: Costs vary between 102% to 150% of group health rates.
HIPAA: Premiums will depend on plan chosen.
HIPAA: Reimburses the full employer-sponsored insurance premium amount by check monthly. Pays the insurance company directly for people on COBRA or eligible small businesses.
*Source: www.coverageforall.org
New York : Average “Single” Premium per Enrolled Employee for Employer-Based Health Insurance, 2011*
New York : Average “Family” Premium per Enrolled Employee for Employer-Based Health Insurance, 2011*
New York : Average “Employee-Plus-One” Premium per Enrolled Employee for Employer-Based Health Insurance, 2011*
New York : Average Per Person Monthly Premiums in the Individual Market, 2010*
*Source: statehealthfacts.org
Small Business Health Insurance Reform
Are you ready for health care reform ("ACA") in 2014?
Today, employers are more stressed than ever. Here’s why:
The business environment is uncertain,
Employer-sponsored health insurance costs increase annually, and
New fees and penalties take effect next year, and most employers don’t fully understand how this will affect their financials.
It is time for employers to examine the specifics of healthcare reform, and start thinking strategically vs. emotionally. Change is hard. However, employers that educate themselves and plan ahead can avoid severe financial impacts.
The more change and disruption your business can embrace, the more cost savings (for both the company and your employees) you will be able to realize over the long term. In order to embrace this change, you must be familiar with the key aspects of ACA. For many small businesses, the solution to healthcare reform is simple: Offer a “Business Expense Account” for Healthcare. A new vehicle, called a Healthcare Reimbursement Plan (HRP), allows employers to get out of the health insurance business, and simply give select employees monthly allowances to spend on their own health insurance policy in a state health insurance exchange.
Listed below are key ACA components to consider when choosing small business health insurance.
Individual Health Insurance Tax Subsidies
Beginning 2014, individuals will have access to tax subsidies to buy private health insurance through the public exchange. These subsidies will be for those who enroll in a silver plan through the exchange. The subsidy caps the cost of individual health insurance at 2% - 9.5% of their household income if their household income is less than 400% above the federal poverty line. This equates to roughly $90,000 per year for a family of four.
Click here for more information on the premium subsidies.
Individual Health Insurance Tax Penalties
The Individual Mandate requires most individuals to purchase health insurance, or else pay a penalty on their tax return each year. The intention of the individual penalty is to reduce the "Free Riding" effect in the health insurance market (a free rider is someone who is healthy and does not purchase health insurance until they need it.
Click here for more information on individual tax penalties.
Small Business Health Insurance Tax Credits
Small businesses with up to 25 full-time equivalent employees may qualify for a tax credit for offering employee health benefits. The credit is broken in to two phases. Phase 1 (2010-2013) includes a tax credit worth up to 35% of a small business’s health insurance costs. Phase 2 (2014 and beyond) includes a tax credit up to 50% of a small business’s health insurance costs.
Click here for more information the tax credits.
Small Business Health Insurance Tax Penalties
Starting January 1, 2015, Employers with 50 or more full-time equivalents who do not offer minimum essential coverage can face monthly penalties if at least one employee uses a premium tax credit to obtain health insurance through the state health exchange. If you do not have more than 50 employees, you are not subject to these penalties.
Click here for more information on the business tax penalty.
The Future of Small Business Health Insurance - Defined Contribution Plans
Defined Contribution Plans allow employers to offer health benefits without offering a traditional group health insurance plan. Instead of paying costs for a specific group health plan, employers allocate tax-deductible monthly allowances for their employees to spend on private health insurance and other medical expenses tax-free.
Features of defined contribution plans include the following:
Employee Choice – employees choose a health insurance plan that best fits their needs.
Fixed Cost – employers control health care costs by allocating fixed monthly allowances for their employees.
Savings – employers using Defined Contribution Plans typically cost less than group health plans which results in saving for both the employer and employee.
Next Steps – Evaluate Your 3 Core Options
Immediately compare the costs and benefits of the following three options:
Offering a Defined Contribution Health Plan that Reimburses Employees for Individual Health Insurance Coverage, and
Offering Nothing.
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How to Apply · NY State of Health Small Business Marketplace: If you have 100 or fewer than employees, you can offer employees a choice of plans through the NY
Small Business Health Insurance In New York ; Medical And Pharmacy Coverage · Medical Plans · Pharmacy Coverage ; Additional Coverage · Dental · Absence & Disability
The Small Business Marketplace (SHOP) can help employers offer high quality, affordable health insurance coverage to employees directly from NY State of Health
The Small Business Marketplace will help small businesses and employees shop for and enroll in health plans. Find Out More: Tax Credit and Premium Estimator:
The federal tax credit will reimburse qualifying small businesses for up to 50% of the premiums they pay towards employee medical, vision and dental insurance.
Another option for small business owners may be ICHRA (Individual Coverage Health Reimbursement Arrangement) plans. This is an affordable option
We believe in transparency, you can review all of our NY small business health insurance plans on our site at anytime. Please contact us today for friendly
We Make Shopping for 2023 NY Small Business Health Insurance Plans Affordable & Easy · 1. Oxford Health insurance quotes. (a UnitedHealthcare company) EPO, PPO
Eligibility for Small Business: Reduced-cost health insurance is available under the Healthy NY program to eligible small businesses and their employees.
Small businesses with up to 25 full-time equivalent employees may qualify for a tax credit for offering employee health benefits. The credit is broken in to two