Eligibility Criteria for Small Employers

The Healthy NY program is designed to encourage small employers that do not currently provide comprehensive group health insurance coverage to purchase reduced cost coverage for their employees.

In order to participate in the Healthy NY program for small employers, the business must meet the following eligibility criteria:

• The business must be located within New York State.
• The small employer must have 1-50 eligible employees.
• 30% of the employees must earn wages of $40,000* or less.
• The business must not have provided group health insurance coverage to its employees within the last twelve months. A small employer is considered to have provided health insurance if the employer has BOTH arranged for and contributed 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 employee per month toward health insurance.

If an eligible employer opts to enroll the business in Healthy NY, the employer must assure that:

• 50% of the eligible employees will participate in the program and at least one participant earns annual wages of $40,000* or less. A small employer may count employees who have health insurance coverage through another source, such as a spouse or another government program, towards the 50% participation requirement for Healthy NY.
• The employer will contribute at least 50% of the premium.
• The employer will offer Healthy NY to all employees who are working 20 or more hours per week and earning $40,000* or less. The employer does not have to offer coverage or contribute to premiums for part-time or seasonal workers or dependents.

* Adjusted annually for inflation