NY Small Group Health Frequently Asked Questions:

WHAT IS A GROUP HEALTH INSURANCE PLAN?

A group health insurance plan is an insurance plan that provides healthcare coverage to a select group of people. They are one of the major benefits offered by many employers. These plans are generally uniform in nature, offering the same benefits to all employees or members of the group, or a limited choice of 2 or 3 options of plans.

With group health insurance, the employer selects the plan (or plans) to offer to employees. The premium cost is usually split between the employer and employee as a percent of the premium. A fixed monthly contribution by employer is also another popular option. A company with under 50 employees is not required to pay towards the premium, although most do.

  •  Lower Premiums vs Individual market plans
  •  Tax Deductible – not included as income to the employee
  •  More Benefits – Plans and carriers not available in the individual market

In addition to the benefits mentioned above, Group Health insurance provides piece of mind to better ensure the physical, mental and financial health of insured members and their families. Telemedicine, Employee wellness benefits, and dedicated nurse helplines are some benefit examples found in group health insurance plans that are not usually available in individual market plans. Most also include enrollment counseling and advice from licensed brokers during initial and renewal enrollment times, which are not available in the individual market. This benefit helps assure employees and employers are getting the most out of their healthcare dollars.

This depends on the group size. The ACA’s requirement for employers with 50 or more full time equivalent (FTE) employees is to provide ‘affordable’ coverage to all FT employees who work at least 30 or more hours per week to avoid penalties. Employers with under 50 FTE employees can allow for anywhere from 20-40 hours per week as full time, and it is up to the employer to decide those hours.

A small group is 1-100 employees consisting of an owner and at least one common law employee working at least minimum wage, 20 hours per week or more. Common law employee is a NON spouse employee.