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Healthy NY

Are you a start-up? Can’t afford health coverage? Is your NY Group Policy increasing 15% in 2023?

The Health Care Reform Act of 2000 introduced the Healthy NY program to provide more affordable health insurance to New Yorkers who need it most.  Healthy NY insurance program was designed to promote and provide affordable insurance coverage to eligible small businesses without health insurance coverage for their employees and, also, for eligible working uninsured. 

The Healthy NY program includes benefits that cover essential health needs including:
  • Inpatient and outpatient hospital services
  • Emergency and Urgent Care
  • Office Visits: Primary Care and Specialist
  • Preventive Care
  • Wellness
  • Prescription Drugs
  • Physician services
  • Maternity care
  • Preventative health services
  • Diagnostic and x-ray services
  • Mental Health and Substance Use Services: Inpatient and Outpatient
  • Additional Services, Equipment & Devices: Autism Spectrum Disorder Diagnosis and Treatment, Hospice, Diabetic Equipment andSupplies, Durable Medical Equipment and Braces, Hearing Aids, Cochlear Implants, Medical Supplies and Prosthetics
  • Pediatric Dental & Vision
Metallic Level
Gold
Product/Network/GatekeeperG HNY HMO Metro Gated OHP
In­Network Copayment$25/$40
Out­ of ­Network ReimbursementN/A
In­Network Coinsurance %80%
In­Network Maximum Out of Pocket$4000/$8000
In­Network Deductible$600/$1200
Out­ of ­Network Coinsurance %N/A
Out­ of ­Network Maximum Out of PocketN/A
Out­ of ­Network DeductibleN/A
Deductible Accumulation PeriodContract Year
Pharmacy$10/$35/$70
Dependent Cutoff Age26 Dependent – Standard

ELIGIBILITY:

30% of the small employer’s eligible employees must earn $45,450 or less in annual wages and those small employers must offer Healthy NY to all employees who work 20 or more hours per week and earn $45,450 or less in annual wages. Additionally, at least one employee who earns $45,450 or less annually must enroll in Healthy NY.

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.

Applicants may now also choose a benefit package with a limited prescription drug benefit or a benefits package without a prescription drug benefit.

APPLICATION & RECERTIFICATION: Healthy NY will only be available to groups with 1-50 FTE’s in 2022 per guidance from the NYS DFS. Please see the attached guidance released. It is important to note that while the definition of “small employer” is increasing from an employer with 50 or fewer employees to an employer with 50 to 100 employees as of January 1, 2022, only employers with 50 or fewer employees will be eligible for Healthy NY. Please see  on page 2 of the attached here

MONTHLY RATES for 2022

Plan Type

Rate

Individual$809.52
Two Adult$1,619.04
Parent & Child(ren)$1,376.18
Family$2,307.13

For more rates and eligibility

For more information on how HNY can make difference for your small business please contact us at [email protected] or 855-667-4621.

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