Healthy New York Insurance – Sign Up Now

What is Healthy New York Insurance?

Healthy New York Insurance is a low-cost full-coverage health insurance program offered to New York businesses with 50 employees or less. It was established in 2000 under the New York State Health Care Reform Act to make health insurance more accessible and affordable. At that time, it was offered to individuals, freelancers, the self-employed, and small groups; however, as of January 1, 2014, Healthy NY became exclusive to small businesses.

 

How to Enroll

Contact us at (888) 215-4045 to check if you qualify for Healthy New York medical insurance. We’ll then compare all health insurance companies offering the Plan in your area and ensure your current doctors, hospitals, and labs are included in the network.

 

Healthy New York Insurance Guide

Download our free Healthy New York Insurance guide to get the most up-to-date and complete information on the Healthy New York Insurance Program

 

 

 

What Does a  Plan Cost?

Cost is based on several factors including the following:

• Location of the business
• The health insurance company you decide to insure with
• Your group census
• Date of enrollment

For the most up-to-date rate information, contact us at (888)215-4045

 

Which Small Businesses Are Eligible for Healthy New York Medical Insurance?

A small business is eligible  for Healthy New York insurance if it meets the following criteria:

• The business must be located and registered in New York State
• It must have 1-50 full-time employees within the last 12 months
• At least 30% of employees must have annual wages of $53,650 or less.
• The business must not have offered and provided group health insurance coverage to its employees within the last 12 months

If eligible, the small business must ensure that at least 50% of the full-time employees will participate and at least one employee is earning $53,650 or less in annual wages (the employee should be part of the 50% that will participate). The business is required to pay at least 50% of the premium of the participating employees. Lastly, the company must offer Healthy New York insurance to all employees, actively working 20 or more hours per week and earning $53,650 (adjusted annually) or less.

 

What is Covered?

NYS Healthy NY plans cover a wide range of essential health services. While this list is not exhaustive, it provides an overview of the benefits typically included in the coverage:

Medical Benefits:

• Office Visits: Both PCP and specialist visits.
• Preventive Care: includes annual physical exams, immunizations, mammograms, family planning services, bone density tests, and screenings for prostate cancer.
• Emergency and Urgent Care: Ambulance services, emergency room visits, and care at urgent care centers.
• Professional and Outpatient Services: These include advanced imaging (MRIs), allergy testing and treatment, outpatient surgeries, chemotherapy, chiropractic services, diagnostic testing, dialysis, and home health care.
• Additional Services, Equipment, and Devices: Health NY covers autism diagnosis and treatment, hospice care, diabetic equipment, durable medical equipment, hearing aids, cochlear implants, and prosthetic devices.
• Inpatient Services and Facilities: Hospital stays, care in skilled nursing facilities, and rehabilitation services.
• Mental Health and Substance Use Services: both inpatient and outpatient mental health services, as well as substance use disorder treatments.
• Prescription Drugs: Medications prescribed by your healthcare.

Pediatric Dental Benefits:

• Basic Dental Care: includes fillings and extractions.
• Orthodontia: misaligned teeth correction with braces or devices.
• Major Dental Care: Includes root canals, crowns, and dentures.
• Routine Dental Check-Up: Regular cleaning and exams for prevention.

Pediatric Vision Benefits:

• Eyeglasses coverage: prescription eyeglasses reimbursement.
• Routine eye exam: regular vision check-ups to monitor eye health.
• Contact lenses: prescription contact lenses reimbursement.

 

The table below shows the summary of NYS Healthy NY benefits and costs:

All Costs are after deductible unless otherwise specified.

 

Does NYS Healthy New York have Restrictions?

Healthy New York Insurance operates through a network of medical providers, meaning you must use doctors and healthcare providers who participate in the plan’s network, except in emergencies. It’s important to confirm with your health plan whether your preferred healthcare providers are part of their network to ensure smooth access to care.

 

Who can be covered?

If your business participates in the NYS Healthy New York medical insurance program, you may offer coverage to:

• Employees: This includes all employees, including yourself as the business owner.
• Employees’ Spouses: Both same-sex and opposite-sex spouses are eligible for coverage if they reside in the employee’s household.
• Employees’ Domestic Partners: If you wish, you can make coverage available to domestic partners. You can also decide whether to offer coverage to same-sex domestic partners, opposite-sex domestic partners, or both.
• Employees’ Children: Children are covered up to age 26. This includes stepchildren and children not living in the employee’s household.

By offering comprehensive NY health insurance coverage options like Healthy NY, your business can provide valuable benefits to employees and their families, enhancing their access to essential healthcare services.

Recertification and Changes

Each year, you’re required to confirm that your business still meets the eligibility for the Healthy NY program. The recertification happens on your policy’s renewal date, and your insurance company will send you the form at least 90 days before that date.

For recertification, you must verify that:

• Your business had 50 or fewer full-time employees last year.
• The business covers at least 50% of premiums for full-time, non-seasonal employees.
• At least 30% of employees earn $53,650 or less annually (adjusted yearly).

Your coverage will end if you don’t submit the form by the due date. If your business no longer qualifies, it will be removed from the program. The insurance company will give you at least 45 days’ notice before coverage ends.

Changes in group size, wages, or employee participation mid-year won’t affect your coverage immediately. However, if you no longer meet the requirements during recertification, you won’t be able to continue in the program.

 

2025 Healthy NY Insurance Companies and the Counties They’re Offered In

 

Frequently Asked Questions

Can my out-of-state employees participate in Healthy NY?

No, the plan is specially designed to benefit NY businesses and employees.

 

Some of my employees have private insurance, do I need to offer Healthy NY to them as well?

The employer must offer Healthy NY to all employees. It is up to the employee whether they want to waive the coverage.

 

How does Healthy NY compare to health insurance plans offered on the NYS of Health Exchange? 

Healthy NY offers services similar to Gold plans in the Exchange, but Healthy NY plans require employers to pay at least 50% of the premium.

 

My company has only 2 employees, which are myself and my spouse. Can we still qualify?

You can still qualify as long as one of you earns  $53,650 or less in annual wages.

 

Can I sign up for Healthy NY any time of the year or is there an open enrollment period?

You can apply for Healthy NY any time of the year.

 

If my employee leaves the company, do I still need to cover them and pay 50% of their health insurance? 

Employers are generally not required to continue paying for their health insurance. However, you must offer them the option to continue their coverage via COBRA, if the employee and the small business qualify for it.

 

Can I have a better health insurance plan for the employers and Healthy NY for the employees?

The employer can waive his coverage and get a different plan.

 

Does Healthy NY cover the 10 essential health benefits?

Yes. Like every plan on the NY State of Health Exchange, Healthy NY plans are regulated to cover the 10 essential health benefits.

 

What happens if our company no longer qualifies for NYS Healthy NY, does the plan terminate immediately?

If the company no longer meets eligibility during recertification, the Healthy NY plan will terminate on the renewal date. The health insurance company will send you a notice 45 days before termination.

 

If we’re not happy with our health insurer, can we switch anytime or do we have to wait until our plan is up for renewal?

You can send a new application for a different carrier anytime, as long as the company is still eligible for NYS Healthy NY.

 

What happens during our anniversary, do we need to go through recertification to see if we still qualify?

The small business must undergo recertification to prove that the business still qualifies for Healthy NY.

 

When does Healthy NY renew?

The plan renews 12 months after the application’s start date. You must also undergo recertification on your renewal date to prove that the business still qualifies for Healthy NY.