A guide to Health Insurance for small businesses in NY
As a small business owner or someone who manages the health insurance for a small business, knowing how to research options for new or renewing health insurance is vital. In this article, we will show you how to compare carriers, networks, and coverage options for all of the New York City, Long Island, and Westchester County insurance carriers.
Health insurance for small businesses in NY
To be eligible for coverage you will need to have at least 2 people in the company who work a minimum of 20 hours per week. You can enroll down to 1 person in the plan as long as the other person has valid other coverage somewhere else. Depending who those 2 people are in the company will determine who has to enroll, and how few can enroll. Usually, a non owner employee can enroll on a plan with no issues. When the only enrolling person on the plan is an owner, then there are considerations to note that may or may not allow the owner only to enroll. For details on this situation please read this article on the subject of owner only enrollment.
Most insurance companies have what is called participation requirements. This means they require a certain percent of the eligible employees to be enrolled in the plan. Those with other coverage can often ‘waive’ out and do not count against the participation.
What health insurance plans are available to NY small businesses?
Below is a listing of health insurance for small businesses in NY for the downstate NY area (NYC, Long Island, Westchester, Dutchess, Ulster, and Sullivan counties).
United Healthcare / Oxford Health Plans: (Freedom network, Liberty network, Metro network). Largest network option available of all carriers. Prices on the mid to high side. Options for plans with and without referrals. All plans require 60% enrolled after valid other coverage waivers. No other carrier can be written alongside Oxford. MGMT carve-outs allowed.
Empire BC/BS – 2 Networks to choose from starting January 2019 – Mid to high range pricing depending on plan. Has excellent PPO/EPO no referral NY and National network. Also has lower priced, much smaller Blue Access Network. All plans require 60% participation after valid other coverage waivers. PPO/EPO no referrals, Blue Access plans are plan specific with some requiring referrals and some not.
Health Pass NY – private exchange comprised of multiple carriers and plan options at all Metal Tiers under one roof. Requires 75% loose participation that includes any other coverage waivers. Great for groups with diverse employee needs as only way to offer multiple carriers under one program and one bill. Also has optional Dental, Vision, Identity Theft, and Life/LTD options along with Free Cobra administration.
Oscar NY – 2 networks as of January 1 2019. Quality mid size provider network called Circle that covers full downstate area. Technology driven carrier with Qualcare network access for NJ residents. No referrals required. Buy up network option called Circle Plus adds Northwell, WestMed, Memorial SK, and out of area coverage via MultiPlan PHCS. Circle Plus network competes well with most other large network carriers. Currently Oscar has 51% participation rate and MGMT carve-outs allowed.
EmblemHealth– has 2 networks in 2019: PRIME TriState Network. Larger of the 2 networks. Some plans require, and some do not require a referral to see an in-network specialist. Mid to high prices. NO participation requirements. SELECT CARE Network. Smaller of the 2 networks, again some of these plans require referrals and some do not. Mid to high level prices and NO participation requirements.