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, in partnership with HMOs and other insurance companies in New York State, offers comprehensive health insurance to small businesses. DFS oversees the program.
Healthy NY includes comprehensive coverage for essential health benefits including inpatient and outpatient hospital services, physician services, maternity care, preventive health services, diagnostic services, mental health services, chiropractic care, prescription drugs, ambulance and emergency services.
As of January 1, 2014, Healthy NY no longer provides coverage for individuals or sole proprietors. Instead, the New York State of Health Marketplace can help individuals and sole proprietors shop for and enroll in health insurance. You may qualify to receive assistance to help pay for insurance offered through the Marketplace.
The DFS issues guidance to insurance companies participating in Healthy NY to assist in program implementation. Below are a selection of Healthy NY guidance memoranda. This is not an exhaustive list of all guidance memos.
| Date | Guidance Subject |
|---|---|
| October, 2023 | Updated Small Employer Wage Level |
| December 2022 | Updated Small Employer Wage Level |
| September 2021 | Updated Small Employer Wage Level |
| October 29, 2019 | Guidance for Insurers Participating in Healthy NY |
| October 12, 2017 | Guidance for Insurers Participating in Healthy NY section |
| July 28, 2015 | Employer Eligibility for Healthy NY coverage issued or renewed on or after January 1, 2016, New Healthy NY Recertification Form, Loss of Eligibility for Healthy NY Coverage |
| June 20, 2013 | Small Employer Groups |
| February 7, 2013 | Federal Health Care Reform Benefit and Annual Limit Updates, Spouse as Primary Policyholder, High Deductible Health Plan (HDHP) Deductible Amounts, Current Wage Level for Small Employers, 2013 Individual Income Eligibility Levels |
To participate in Healthy NY, a small business must meet all of the following criteria:
If the business meets the four criteria above and opts to enroll the business in Healthy NY, the employer must assure that:
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.
The health plans that offer Healthy NY coverage have their own medical provider networks. This means that benefits are provided a network of medical providers. You must use the doctors and health care providers who participate in your insurance company’s network, except in an emergency. Contact your health plan directly to confirm whether your health care providers are in their network.
This is not intended to be a complete list of covered benefits. Please refer to your health plan coverage documents for a full description of covered benefits.
Please consult your health plan coverage documents for a more extensive description of your cost sharing responsibility. Some examples of copayments and coinsurance are included below.
| Deductible | $600 individual / $1,200 family |
| Maximum out of pocket costs | $5,900 individual / $11,800 family |
| Primary Care Physician (PCP) visit | $25 |
| Specialist visit | $40 |
| Preventive Care | No cost sharing |
| Ambulance | $150 |
| Emergency Room visit | $150 (waived if admitted) |
| Urgent Care | $60 |
| Chemotherapy, radiation therapy | $25 per visit |
| Chiropractic care | $40 |
| Physical therapy, occupational therapy, speech therapy | $30 |
| Diagnostic and routine laboratory and pathology | $40 |
| Diagnostic and routine imaging | $40 |
| Surgical Services – inpatient, outpatient, and ambulatory surgical centers | $100 |
| DME / Medical supplies | 20% coinsurance |
| Hearing aids | 20% coinsurance |
| Inpatient Facility / Skilled Nursing / Hospice | $1,000 per admission |
| Mental Health & Substance Use Disorder Services | $1,000 per admission (inpatient) $25 (outpatient) |
| Prescription drugs Ask your health plan about mail order. | $10 Tier 1 (generally generics) $35 Tier 2 $70 Tier 3 |
| Pediatric dental - office visit | $25 |
| Pediatric vision – eye exam visit Prescribed lenses and frames or contact lenses | $25 20% coinsurance |
Many different insurance companies offer Healthy NY. The chart below contains links to a list of insurance companies that offer Healthy NY in each county, contact information and premium rates. Rates are current as of October 1, 2024 and may vary depending upon the month in which you enroll. To verify the rates listed, please contact the insurance company directly.
In addition to offering coverage for employees, your business may choose offer coverage to employees’ families. As the business owner, you do not have to contribute to the cost of premiums for employees’ dependents. By making coverage available to employees’ dependents, you can allow them to access health insurance coverage at affordable group rates.
If your business offers Healthy NY, you may offer coverage to:
Children do not need to live in the employee’s household in order to be covered. Stepchildren may also be covered.
You may be able to purchase coverage for certain eligible children through the age of 29 via an "Age 29" Dependent Coverage Extension. Contact your insurance company for more information regarding eligibility and the cost of the coverage
For a list of insurance companies, their addresses, and premium rates, visit the Insurers and Rates section above.
If the insurance company receives your completed application and first month’s premium payment by the 20th of the month, coverage will start the first of the following month.
DFS does not process Healthy NY applications. Direct all questions regarding application status to the insurance company to which you applied. For insurance company contact information, visit the Insurers and Rates section above.
If you are unable to print an application, contact DFS at (800) 342-3736 (Monday through Friday, 8:30 AM to 4:30 PM) or email [email protected] to request an application by mail.
Once a year, you must recertify that the business continues to meet the eligibility requirements of the Healthy NY program. The recertification date is on your policy’s annual renewal date. Your insurance company will provide you with the recertification form at least 90 days before your annual renewal date.
At recertification, you must confirm that:
If you do not complete and return the recertification form by the due date, then your business’ coverage will terminate. If the business does not continue to meet the eligibility requirements of the program at recertification, then it will not be able to continue in the program. Your insurance company must provide you with at least 45 days written notice that coverage will end due to not meeting the eligibility requirements.
Mid-year changes in group size, wage levels and employee participation will not result in immediate termination of Healthy NY coverage. If the business does not meet the eligibility requirements at the time of recertification, it will be unable to continue in the program.
You may change insurance companies at any time.
To do so, you must reapply to the Healthy NY program and send your completed application and premium check to the insurance company with which you want coverage. The business must meet the eligibility criteria at the time of application.
For information on which insurance companies offer Healthy NY in your county and premium rates, visit the Insurers and Rates page. If the insurance company receives a completed application and first month’s premium payment by the 20th of the month, coverage will start the first of the following month.
You will also need to terminate your existing coverage according to the terms of the contract. Usually you must give at least one month prior notice.
It is not possible to transfer enrollment with one insurance company to another insurance company.
NY State of Health is an organized marketplace designed to help people shop for and enroll in health insurance coverage. Individuals, families and small businesses can use the Marketplace to help them compare insurance options, calculate costs and select coverage. The Marketplace has a section specifically for small businesses called “The Small Business Marketplace” that can make it simple and easy for you to offer high quality, affordable health insurance coverage to your employees while taking advantage of the small business health care tax credit. For more information, please contact the the Small Business Marketplace by phone at (855) 355-5777 or visit the NYSOH Small Business Marketplace online.
New York State has a health insurance plan for children through age 18 called Child Health Plus. Child Health Plus is run by the Department of Health and provides free or reduced-cost coverage. For more information on Child Health Plus eligibility and covered services, please visit the Department of Health or call (800) 698-4543. You can apply for Child Health Plus coverage through the New York State of Health Marketplace.
The Office of Citywide Health Insurance Access (OCHIA) is a resource for small businesses and people living in the metropolitan New York area that helps people determine if they qualify for any public health insurance programs, and if not, helps to find other affordable insurance. It also helps small businesses find coverage. For more information, please visit the OCHIA website.