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Private Health Insurance

Private health insurance can be purchased through NY State of Health (NYSOH) or outside of it. Information about private insurance available outside of NYSOH for individuals and small businesses is provided below.

Individuals

NYC residents can purchase insurance directly from an insurance carrier. This coverage is generally available to anyone, regardless of immigration status. You can buy a plan even if you have access to job-based coverage.

  • When you buy directly from the insurer, however, you cannot get a tax credit or other financial help to lower your costs. Tax credits are only for plans purchased through NY State of Health.

The health plan you buy will cover exactly or almost the all of the same benefits that you d get through NYSOH. That s because all plans must meet the same benefit package standards, regardless of where you buy them.

  • Whether you buy a plan in or outside of the Marketplace, you are still subject to the same open enrollment and qualifying event rules .

Some insurers offer plans both through NYSOH and outside of it. If an insurer offers the exact same plan both in and out of the Marketplace, they are required to charge the same premium.

You may find plans offered by insurers that do not participate in NYSOH by visiting HealthCare.gov s Plan Finder. a federal government website that helps you find and compare private health plans. It is not a health insurance marketplace but rather a tool to help you search for plan options in your area.

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Small Businesses

NYC small business owners can shop for and purchase coverage outside of NY State of Health (NYSOH). You can work with a broker or agent, go through a purchasing alliance/private exchange or, in some cases, buy directly from the insurer.

  • If you buy coverage outside of NYSOH, you cannot get the small business health care tax credit . Tax credits for up to 50% of your premium costs are only available for plans purchased in NYSOH.

The health plan you buy will cover exactly or almost the all of the same benefits that you d get through NYSOH. That s because all plans must meet the same benefit package standards, regardless of where you buy them

  • You can visit finder.healthcare.gov to see some of the plans offered outside of NYSOH. This plan finder is not a health Insurance marketplace but rather a tool to help you search for plan options in your area.

Some small businesses can get coverage through private purchasing cooperatives or alliances, now often called private exchanges. Privately-run exchanges are intermediaries between small businesses and health insurers that may offer businesses some administrative ease and a choice of plans from different insurers.

  • HealthPass and NY Health Alliance are privately-run exchanges serving NYC.
  • NYSOH offers similar administrative support and plan choice as those found in private exchanges.

While the cost of each health plan available through a purchasing alliance is the same as the cost of buying the same plan directly from the insurance company (insurers can t offer them lower prices), some alliances also charge a membership or enrollment fee in addition to the cost of coverage.

Brokers and agents can help small businesses offer coverage. Some brokers and agents are also certified by NYSOH so they can sell coverage both in and out of the Marketplace.

  • You can search for broker or agent near you on the National Association of Health Underwriters website. NYSOH also lets you search for a broker who is certified to sell their products.

Small businesses with lower-wage workers may be able to get lower cost coverage through Healthy NY. Healthy NY is a NYS-run program to help small businesses start offering health insurance. It often costs less than other plans because the State provides funding to carriers to keep the premiums down.

All Healthy NY plans offer the same benefit package a Gold-level benefits package. For a full list of benefits covered click here .

To be eligible, a small business must meet certain criteria. For example, it must:

  • Have fewer than 50 eligible employees
  • Have at least 30% of the employees who will be offered coverage earn $40,000 or less in annual pre-tax wages (this amount is adjusted yearly for inflation)
  • Not have provided health insurance to these employees in the last 12 months. (Businesses that provided limited benefits only, such as hospital-only coverage and businesses in NYC that contribute less than $75 per employee per month for coverage may still qualify for Healthy NY.)
  • Contribute at least 50% of the premium for full-time employees (part-time and seasonal employees can also be covered but employer contribution is not required)

For more detailed eligibility and application information, visit the New York State Department of Financial Services Healthy NY website .

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