Small Business Plans

Applications for small business health insurance are open any time during the year – no need to wait for an open enrollment period. Small business health insurance plans are a form of employer-sponsored health coverage and costs are typically shared between the employer and the employee (may be extended to dependents). In New York, small business insurance is pre-tax as the amount the business spends on insurance premiums is exempt from employer and employee taxes.

EssentialCare is a group of licensed professional insurance agents who will simplify your choice in the complex New York small business health insurance market. We will find for your business the right health insurance plan from insurance carriers that offer coverage in your local region, as certain insurance carriers only participate in certain parts of the state (such as upstate vs downstate).

Small Business Health Care Tax Credit

• A tax credit is available to small businesses that offer insurance coverage to employees:

– Must have fewer than 25 FTE employees
– With an average annual salary of $53k or less (As adjusted for inflation. Excludes the owner and his family)
– Employer must contribute at least 50% of premium

• The tax credit amounts are as follows:

– Up to 50% of employer contribution for a traditional business (35% for tax-exempt)
– The maximum tax credit of 50% may be claimed by businesses that have 10 or fewer employees with an average annual salary of $25k or less
– As the number of employees and average salary increases, the credit decreases
• Marketplace is the only place to access the tax credit


For more information on qualifying for and claiming the tax credit please visit the IRS resource page at https://www.irs.gov/affordable-care-act/employers/small-business-health-care-tax-credit-and-the-shop-marketplace

•To find a SBM-certified health plan, visit https://nystateofhealth.ny.gov/ employerand use the small employer shopping tool
•To estimate if an employer qualifies for the tax credit, go to https://nystateofhealth.ny.gov/ employerand click on the "calculate your estimated tax credit" link

New York Small Business Health Insurance Coverage, Eligibility and Cost:

New York Health Insurance Coverage: There is a maximum 6-month look-back/12-month exclusionary period for pre-existing conditions on enrollees that do not have prior coverage. Benefits will vary depending on the chosen plan. Pre-existing health conditions covered.

New York Health Insurance Eligibility: Guaranteed coverage for companies with 2-50 employees. Eligible employees must work at least 30 hours a week. Owner can count as an employee. Owner's name on business license must draw wages from the company.

New York Health Insurance Monthly Cost: Cost depends on employer contribution and the + 20% of the Insurance company's Index rate.

Four Types of New York Small Business Health Insurance Plans

Looking at group health insurance, there are several different types of health plans available. The plan type that is best for you and your employees depends on what you and your employees want, and how much you are willing to spend. Here's a brief review of the four popular types of health insurance plans:

PPO Health Insurance Plans

The most common plans are "Preferred Provider Organization". Under a PPO plan covered employee need to get their medical care from doctors or hospitals on the insurance company's list of preferred providers in order for claims to be paid at the highest level.

"Health Maintenance Organization" plans offer a wide range of health care services through a network of providers who agree to provide services to members or that contract exclusively with the HMO. Employees participating in HMO plans will typically need to select a primary care physician ("PCP") to provide most of their health care and refer them onto HMO specialists as needed.

HMO Health Insurance Plans

HSA-Qualified Health Insurance Plans

PPO plans designed specifically for use with Health Savings Accounts (HSAs). An HSA is a special bank account that allows participants to save money – pre-tax – to be used specifically for medical expenses in the future.

Indemnity plans allow members to direct their own health care and generally visit any doctor or hospital. The insurance company then pays a set portion of the total charges. Employees may be required to pay for some services up front and then apply to the insurance company for reimbursement.

Indemnity Health Insurance Plans

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