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the new world of health insurance


Businesses (1-100)

If you own a small business in NY with at least one common law employee, there are a few things you need to know. 


Firstly don’t pay attention to all of the negative hype.

Companies with 50 or fewer employees are not required to offer coverage. The affordable Care Act however  creates new and exciting opportunities for your small business to find quality affordable health insurance.

The biggest game changer for small businesses in NY is the creation of the Small Business Market Place.  Think of it like a large electronic wholesaler where you can bring your employees (As brokers we can help you). 

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Things that we think you should consider as you start searching for your employer sponsored coverage.

Are you a small business?  Do you qualify for Small Group Insurance?

If you have 50 or fewer full time and full time equivalent employees (or you’re as small as having just one common law employee) you should be eligible for group insurance in the small group market.  Please also note there have been significant changes around eligibility.  In the past, businesses which employed only two spouses that were married to each other were eligible for group coverage, now they are not.  Also, businesses which were made up of just owners, with no common law employees, were also eligible; now they are not.  Please review your company roster carefully to ensure you are enrolled correctly.


Do I have to offer coverage?

No employer is required to offer coverage.  However if your company has a total of 50 or more full time and full time equivalent employees, you may be required to make a shared responsibility payment to the IRS.  Such penalty payments become due as early as 2016, based on conduct in 2015.Some employers may think that are “small employers,” but may not be as defined by the law.    If you have a large number of part time or seasonal employees, you need to keep more closely examine how the law counts up your workers. 

Do you qualify for the Small Employer Tax Credit?

If you have fewer than 25 full time equivalent employees making on average $50,000 a year or less (adjusted for inflation beginning 2014) and you pay at least 50% of your employees’ premium costs for coverage on your plan you should speak with your accountant.  You may qualify for a tax credit of up to 50% of your contribution towards your employees’ coverage.  The only way to access this employer tax credit is to purchase coverage on the SHOP through nystateofhealthTM, the official Health Plan Marketplace.


Should you offer coverage in the small business market place or outside of the market place?

We believe you should consider your health insurance coverage options both on and off of nystateofhealthTM  Small Business Market Place. Here’s why:
If you qualify for the Small Business Health Care Tax Credit and you want to use it then you have to purchase your employer coverage through nystateofhealthTM.  There are many other reasons to consider purchasing on the exchange. Employers have much greater flexibility on the exchange than off.  An employer can offer multiple carriers and coverage levels thru the exchange.  There are no participation requirements.  The employer only has to pay one bill as well.   It is our opinion that nystateofhealthTM should be considered in all cases!  Contrary to popular myth, we have found the people who work at the exchange to be helpful and responsive!

There are also reasons to look outside of nystateofhealthTM.  Some health insurance companies only offer coverage outside of the exchange, so if you only look on the exchange you’ll miss them.  Many insurers offer different plan designs outside of the market place. The networks of physicians in many circumstances change when you go outside of the marketplace.   Unfortunately the more robust provider networks tend to be outside of the exchange. In short if you only look to one place for your group health insurance options you are not getting all the facts


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