Life, health & Medicare
Group health and employee benefits
Small-group health in New York is community-rated, which makes it simpler to compare than in most states, and two of the benefits you must provide are not health insurance at all and are routinely forgotten.
New York community-rates small-group health insurance, meaning a carrier charges the same rate for a given plan regardless of the health of your particular group. That removes the most opaque part of this market: you are genuinely comparing plans and networks rather than trying to guess how your workforce will be rated.
Alongside health cover, New York requires employers to provide statutory short-term disability benefits and paid family leave. These are separate, compulsory, inexpensive, and the two things small businesses most often discover they were missing.
What compliance actually requires
Statutory disability benefits — DBL — covering off-the-job illness and injury at fifty per cent of wages up to $170 a week for up to twenty-six weeks. Paid family leave, which provides job-protected paid time to bond with a new child, care for a family member with a serious health condition, or assist when a family member is deployed. PFL is normally added as a rider to the DBL policy and is funded by employee payroll deduction.
Neither is optional and neither is workers compensation, which covers work-related injury and is a separate compulsory policy again. A business needs all three. We quote them together because a business with two of the three is not compliant, and the gap is usually invisible until somebody makes a claim.
Group health, and whether you have to offer it
Businesses with fewer than fifty full-time-equivalent employees are not required to offer health insurance. Many do, because it is what recruitment demands rather than what the law does. At fifty or more, the federal employer mandate applies and the analysis changes considerably.
If you do offer it, carriers impose participation and contribution requirements — commonly that a set proportion of eligible employees enrol and that the employer pays a minimum share of the employee-only premium. Failing participation is the most common reason a small group is declined, and it can often be fixed by counting waivers correctly where employees have other cover.
Typical small-group premiums in New York run around $650 to $1,400 per employee per month before employee contributions, varying with the metal tier and network. There is also a small-business tax credit available to some very small, lower-wage employers, which is worth checking rather than assuming.
The benefits that cost little and matter a lot
Dental and vision are inexpensive, are valued out of proportion to their cost, and are frequently the most appreciated part of a small benefits package. Group term life at one or two times salary is similarly cheap. Group long-term disability is worth considering, with the caveat set out on our disability page: employer-paid benefits are taxable and the definition is usually any-occupation.
For very small employers, an individual coverage health reimbursement arrangement — an ICHRA — lets you give employees a defined tax-free amount to buy their own marketplace cover instead of running a group plan. It is not right for everybody and it shifts choice to the employee, but for a small Queens business struggling with participation requirements it is a genuine option and one nobody mentions.
Where we stop
We place cover and we explain how the plans differ. We are not your employment lawyer and not your benefits attorney, and questions about ERISA compliance, discrimination testing or the details of the employer mandate belong with one. We will say so rather than improvise.
For employees buying cover for themselves rather than through an employer, the New York State of Health marketplace is where that happens, and the subsidies available there are frequently better than anything we could place. We will point people at it, and we are paid nothing for doing so.
Sometimes the right call is not to us. Some of what people ring an agency about belongs somewhere else, and saying so costs us a sale. A dispute with a carrier that has exhausted the adjuster and the supervisor is a complaint to the Department of Financial Services, which is free and which insurers take seriously. A settlement figure that needs negotiating on your behalf is a licensed public adjuster. An injury claim against another driver, or a coverage denial you intend to challenge, is a lawyer. Health cover for a household buying it without an employer is the New York State of Health marketplace. We will point you at all four, and we take no fee for sending you to any of them.
Included as standard
How we handle this line
All three compulsory covers quoted
Workers compensation, statutory disability and paid family leave. A business with two of the three is not compliant.
Participation requirements checked first
The commonest reason a small group is declined, and frequently fixable by counting waivers correctly.
Community rating explained
New York removes health-status rating from small groups, so you are genuinely comparing plans rather than guessing at your own risk.
Dental, vision and group life priced
Inexpensive, valued far above their cost, and the cheapest way to improve a small package.
ICHRA considered where it fits
A real alternative for small employers who cannot meet participation requirements, and one very few brokers raise.
The marketplace pointed to
For employees buying individually, where the subsidies are usually better than anything we could place. We are paid nothing for that.
When to ring us
Signs this is worth a conversation
- You have employees and no statutory disability or paid family leave cover.
- You have been declined for a small group plan on participation.
- You are approaching fifty full-time-equivalent employees.
- You offer health cover but no dental, vision or group life.
- You are a very small, lower-wage employer and have never checked the tax credit.
- Your renewal arrived with an increase and nobody explained the alternatives.
Group benefits — what it typically costs
- Typical monthly premium per employee for small-group health cover in New York, before any employee contribution.$650 – $1,400
This is a typical premium range for this area. It is not a quote, and it is not our price. We do not set premiums: a carrier files its rates with the Department of Financial Services and our commission is already inside the filed rate, so the same policy from the same carrier costs the same through any producer in New York. What genuinely moves your own number is which carrier writes it, the limits and deductibles you choose, and the facts on your record — which is what we would go through with you before anything is quoted.
Questions we are actually asked
Group benefits — frequently asked
Do I have to offer health insurance to my employees in New York?
Not below fifty full-time-equivalent employees — the federal employer mandate starts there. But statutory disability benefits and paid family leave ARE compulsory from your first employee, as is workers compensation, and those three are separate policies that are routinely confused with each other.
How much is small group health insurance in New York?
Typically $650 to $1,400 per employee per month before employee contributions, depending on the metal tier and the network. New York community-rates small groups, so your own workforce's health does not change the rate — which makes comparing plans genuinely straightforward here.
What is paid family leave and do I have to provide it?
Yes, for essentially all private employers in New York. It gives employees job-protected paid time to bond with a new child, care for a family member with a serious health condition, or help when one is deployed. It is normally added as a rider to your statutory disability policy and is funded by employee payroll deduction.
What is an ICHRA?
An individual coverage health reimbursement arrangement — you give employees a defined tax-free amount to buy their own marketplace cover instead of running a group plan. It suits small employers who cannot meet group participation requirements, and it shifts plan choice to the employee, which is a genuine trade-off rather than a free improvement.
Related cover
Usually considered alongside this
Workers comp
Compulsory in New York from the first employee, with almost no exceptions and a penalty regime that does not care whether you knew.
$0.30 – $18
Disability income
New York's statutory disability benefit is $170 a week and has not moved since 1989. Everything past that you buy yourself.
1% – 3% of income
Business insurance
The businessowners policy that covers most small Queens businesses properly, and the four risks it is famous for leaving out.
$800 – $2,800
Medicare
New York community-rates Medigap and lets you in all year with no health questions — which removes every deadline anybody will try to sell you on.
$220 – $420Bring the declarations page and we will read it with you
Ask us what it would cost
Send or bring the summary pages of what you already have — those two sheets are where most of the useful conversation is. We will tell you what we would place it with and what that would cost, what we are paid for doing it, and whether you should move at all. Quite often the answer is that your current policy is priced fairly and you should keep it, and that is an answer we give in writing like any other.