IMPORTANT CHANGES are coming to the Healthy NY program. Beginning January 1, 2014, Healthy NY will no longer provide coverage for individuals or sole proprietors. The program will be limited to small employers only. Individuals will be forced to select a new plan in the NY state Health insurance exchange. Businesses will have to decide if they want to continue with the new Healthy NY benefit for small businesses or pick a new plan in or out of the health insurance exchange.
If you currently have Healthy NY coverage, it will terminate on December 31, 2013. If you plan to enroll in Healthy NY in 2013, your coverage will also terminate on December 31, 2013.
The new Federal Healthcare Reform Law is making important changes to health insurance. These important changes include:
ñAccess to dependent coverage for adult children under the age of 26
ñNo pre-existing condition exclusions for children under age 19
ñNo cost-sharing for preventive services (no co-payments, coinsurance or deductibles)
ñAnnual limits on essential covered services cannot be less than $1.25 million per year
Coverage that was in effect on March 23, 2010 might be considered to be “grandfathered" so long as certain changes to that coverage have not been made. However, many of the new Federal reform rules will impact both newly issued coverage and grandfathered coverage.
Important Changes to Prescription Drug Coverage Under Healthy NY
If you are enrolled as an individual and have grandfathered status, you can keep your limited prescription drug coverage ($3,000 annual limit).
Most members will see their annual prescription drug limit removed or significantly increased (minimum $2,000,000 per year) as they are enrolled or their coverage is renewed.
You may change your benefit selection at the time of annual recertification or whenever you experience a premium rate change. Please note that a change in benefit package selection may result in loss of grandfathered status.
Healthy NY will however to continue to provide coverage for small business. This includes businesses with 1-50 employees. It is highly likely that small businesses will see a significant increase in premiums starting in January 2014.Small Business Eligibility
Reduced-cost health insurance is available under the Healthy NY program to eligible small businesses and their employees.
In order to participate, the small business must meet all of the following criteria:
1.The business must be located within New York State.
2.The business must have 1-50 eligible employees.
3.At least 30% of the employees must earn $41,250 or less in annual wages.
The wage level is adjusted annually for inflation.
4.The business must not have provided group health insurance coverage to its employees within the last 12 months.
A business is considered to have provided health insurance if the business has arranged for comprehensive coverage that includes both hospital and medical coverage and contributed at least $50 per employee per month towards health insurance ($75 if the business is located in the Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk or Westchester counties).
The business may still be eligible for Healthy NY if:
ñThe business arranged for health insurance coverage for employees but did not contribute more than the previously noted amounts.
ñThe business arranged for health insurance coverage for employees but it was not comprehensive (i.e., only medical benefits or only hospital benefits but not both).
ñIndividual employees had insurance coverage through other sources, such as individually-purchased coverage, a public program, COBRA from prior employment or a spouse’s job.
ñThe business owner has coverage for himself or herself but did not provide the coverage to employees.
ñThe business provided insurance coverage to one or more classes of employees and now wants to provide coverage to additional classes of employees. Classes of employees may be based on wages, method of payment (e.g., hourly vs. salaried), job duties or job location.
If the business meets the four criteria above and opts to enroll the business in Healthy NY, the employer must assure that:
1.50% of the eligible employees will participate in the program and at least one participant earns annual wages of $41,250* or less. A small employer may count employees who have health insurance coverage through another source, such as a spouse or other government program, towards the 50% participation requirement.
2.The employer will contribute at least 50% of the premium.
3.At least one eligible employee earning $41,250* or less enrolls.
4.The employer will offer Healthy NY to all employees who are working 20 or more hours per week and earning $41,250* or less.
* Adjusted annually.
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.
It will be important for small business owners and HR people to keep in contact with Cliff Grekin at NYSmallgroupplans.com. Cliff can provide you with the latest updates in your health insurance plan. He will also help navigate you throught the potentially confusing waters of New York's Health Insurance Exchange.