Healthy NY FAQ

Healthy NY FAQ

Healthy NY FAQ

FULL Rate and Benefits:  2014 Healthy NY

The goal of the Healthy NY program is to promote and provide affordable insurance coverage to eligible small businesses that are not currently offering health insurance coverage to their employees. It is also available to eligible uninsured working individuals and sole proprietors. Listed below are some frequently asked questions by small employers about the Healthy NY Program.

This program does not allow employers to participate if they have “provided” group health insurance to their employees in the past year. Under what circumstances is my business considered to have “provided” group health insurance?

An employer is considered to have “provided” health insurance if the employer arranges for group health insurance and contributes more than $50 (or $75 if the business is located in the Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, and Westchester counties) per month per employee towards the premiums for coverage. If an employer has merely arranged for health insurance coverage for employees but has not contributed more than the previously noted amounts, then the business may still be eligible for Healthy NY.

What if my business has provided other health insurance during the past twelve months, but the insurance had limited benefits?

If your business has provided other insurance during the past twelve months, but the coverage included only limited benefits (for example – only medical benefits or only hospital benefits, but not both) then your business may still be eligible for HNY.

What if my business has not provided group health insurance coverage in the past twelve months, but some of the employees have been covered through other sources, like their spouse’s employer plan?

The coverage of individual employees through other sources does not affect a small employer’s eligibility to participate in the HNY program.

I have 5 employees. One is enrolled in Medicare and two others receive health insurance through a spouse. The remaining two employees wish to enroll in Healthy New York. Is my business eligible?

Your business would be eligible because the three employees who have other coverage count towards satisfying the minimum 50% participation requirement.

Why is this program available only to small employers who did not provide insurance during the twelve months preceding application? Doesn’t this penalize the “good guys” who struggled to maintain coverage for their employees over the past few years?

HNY was designed to target those individuals who were completely uninsured. These so called “crowd out” provisions of the legislation are also designed to ensure that employers and individuals do not drop existing coverage in favor of this new product.


If my business offers family coverage through Healthy NY, does my business have to contribute towards the cost of the premiums for my employees’ dependents?

No. Employers are encouraged to share in the cost of the Healthy NY premium for their employees. However, there is no requirement that the employer contribute towards the cost of dependent coverage.

Can my business offer Healthy NY coverage to my employees’ families?

Yes, the employer may choose to offer coverage for dependents through the HNY program. Qualifying dependents include dependent children up to age 19 and full time students up to age 26. However, it may be financially beneficial to employees to obtain health insurance coverage for their children through New York’s Child Health Plus program, rather than HealthcoreFor more information about Child Health Plus, contact New York’s toll free hotline at 1-800-698-4543.

 Is there a re-certification process?

Yes. On an annual basis, employers participating in the HNY program are required to submit a re-certification that attests to their continued eligibility for the Healthcore program. The employer’s health plan will notify participating employers of when this re-certification is due and will provide them with the necessary forms.

What if my business qualifies for HNY and things change? What if I hire more employees and it brings my workforce total over 50? What if some of my employees drop coverage and my business no longer satisfies the 50% employee participation requirement? Would the coverage then be terminated?

Mid-year fluctuations in group size, wage levels and employee participation will not result in immediate termination of HNY coverage. However, HNY requires an annual re-certification process at which time your business’ eligibility would be reevaluated. If your business does not meet the eligibility criteria at the time of re-certification, you will be unable to continue to participate in the program. Please note that the wage levels set forth in the eligibility criteria for the HNY program are increased annually to account for inflation.

Can my business offer coverage to part-time and seasonal workers?

Yes, employers may offer coverage to part-time and seasonal workers who work less than 20 hours weekly, but they are not required to do so. If they choose to offer coverage to these employees, the employer may choose to contribute toward the cost of their premium but is not required to do so.

Can I count the wages of part-time and seasonal workers in determining if my business is eligible for participation in the Healthy NY program?

Yes, the annual wages of part-time and seasonal workers may be included for the purpose of determining an employer’s eligibility if the employer also extends coverage to part-time workers.

Which employees must be offered Healthy NY coverage?

Small businesses must offer HNY to all employees working more than 20 hours weekly and earning $40,000 or less annually.

My child just graduated from college and will no longer be eligible to remain on my policy. Would my child be eligible for Healthy NY?

Students who are graduating from high school or college who are aging off a parent’s policy may be eligible for HNY if they meet the other eligibility guidelines of the program.

If I do not qualify for Healthy NY, are there other affordable health insurance products available?

Yes, there are several other affordable options available to individuals, sole proprietors and small businesses. For a list of other programs, contact information and general eligibility requirements, please visit Millennium Medical Solutions Corp.

Healthy NY Slashed!

Healthy NY Slashed!




As reported by Crains, the Healthy NY program will be undergoing significant cuts. Beginning January 1 2012, the high deductible health plans (HDHP) option will only be offered by Healthy NY.


With rates averaging 30% below market and reasonable benefits such as $20 Office Copays this was an important safety net for NYS Small Businesses.  Since its inception 10 years ago the program has enrolled approx.180,000 members covering small groups, sole proprietors and working individuals.   The program is not Medicaid and allows members to keep their Doctors and enroll in private insurance EPO/HMOs such as Empire Blue Cross, Oxford, Emblem GHI etc.   One of the reasons the program is 30% less expensive is that the state has a pooled stop loss fund that reinsures health care companies.  This fund has been underfunded with rapid growth and stagnant funding the past 3 years.


Currently, the less expensive Healthy NY HIgh Deductible Plan is $1200/single and $2400/family. Outside of preventive care, members must self insure on the entire deductible including Pharmacy.  The good news is that this plan is a qualified HSA (Health Savings Account) and can be reinsured by members.  For healthy members the HSA unspent money is not use it or lose and can be rolled over year to year.


Existing Healthy NY groups can still keep their plans as long as long they qualify. However, Healthy NY only allows 1st of the month effective date with only an 11.1.11 and 12.1.11 still available to prospective new groups looking to lock in the regular Healthy NY.


To view current Healthy Benefits and rates click here.  For  more information or to enroll Contact us today.




10th Year Anniversary

We are pleased to announce our 10th year anniversary this past March. Back in 1998, the average HMO was only $325/month with office copays at only $10. Then again, gas prices were $2.50, there was Monicagate saga, Google was just a neophyte startup, the Y2K looming as the world’s demise, Seinfeld was still funny, and the US dollar dominated.

At the time, I was working out of my home office wondering will I get a client before my unemployment checks run out? I was short on time and money for creating a web presence, organizing a marketing plan and seeking outside lending. I was way in over my head as they say.

Healthcare was volatile at the time with carriers shifting the costs burden onto businesses. I suppose nothing has changed in 10 years with the exception of less companies vying for our business as consolidation was abound. Since that time, Aetna bought U.S. healthcare which bought NYL Care and PruCare. Oxford almost went out of business, their stock dropping from $86 to $6 in a matter of weeks. Five years later United Healthcare bought out Oxford. Empire survived 9/11 but was bought by WellPoint 2 years later. The Blue Crosses stopped competing against each other with Horizon Blue Cross dropping out of NY and Empire leaving NJ.

At the same time, new players have entered the industry. Healthpass has become a great way for small businesses to offer multiple plan options and carriers and compete with larger corporations. Atlantis Health Plans has become a medical inflation controller with rates still below $300/month. There was no Healthy NY to offer state supplemented corporate plans. The online functionalities has also evened the playing field for small businesses by keeping costs down, reaching the end users quickly and carving market niches.

By being a small business ourselves, this experience has made us more in tune and sensitive to our client needs. We are batting virtually 100% with claim and billing disputes and help employers maximize their benefits while discovering market inefficiencies. Borrowing from Google’s creed, “don’t be evil”, has helped us grow to over 300 employer groups and over 3500 members strong.
We are proud of our achievements and have been awarded the industry’s 2008 NAHU Golden Eagle Award for outstanding sales & achievement. Last summer’s move to Armonk, NY has allowed us to merge with a long time Property & Casualty brokerage firm, Avanti Associates. This will give our clients competitive markets for building, auto, malpractice insurance, professional liability and workman’s comp that they may not have had.

What’s next? We are ramping up an HR Kiosk service from the existing “physician locator” and “forms warehouse” links on our website. Many of you have already been using these tools when shopping for the annual plan renewals. But what about offering an intranet like kiosk where your employees can view, for example, their Aetna medical and Oxford dental plans from on one site? Or having the ability to post HR policies on vacation days, COBRA information or 401k documents?

We’ve enjoyed our experience and learned a lot from challenges faced but we really learn the most from our clients at the end of the day. You are the reason we have been fortunate to be in business and we depend on your suggestions and referrals to sustain our business model. We offer many extra’s and help you stretch your healthcare dollars as a way of thanking you and hope to continue to grow as a valuable part of your business.

Finally, I want to congratulate my brother Jonathan on his recent marriage this past Valentine’s Day. Also, he has dedicated 5 years at MMS, Inc. and I owe him a world of gratitude for realizing many of the goals of the firm. He has distinguished himself from a young college grad to a marketing and accounts manager who runs everything from renewal proposals to managing the day to day nuts and bolts that makes the agency work.


Alex Miller