New York Small Business Health Insurance Options

New York Small Business Health Insurance

The HSA for America Guide to Health Plans for New York small business health insurance. This guide is aimed at companies in New York with 30 or less employees. 

The purpose of this document is to assist small businesses, independent professionals, freelancers and other business owners in providing the most effective, cost-efficient employee benefits. You can still be competitive while offering benefits and a compensation package that will keep the top talent on your team.

New York Small Business Health Insurance Benefits Options

New York’s small business owners have many choices when it concerns providing employee health coverage.

One of the most cost-effective, yet most commonly used, options is to adopt a conventional group health insurance program.

Prices differ by age. However, according to statistics from the Kaiser Family Foundation in 2022, an employer sponsored group health plan covering both a worker’s family and a worker was on average $23,450. That is $2,070 above the national average.

New Yorkers pay an average amount of $5,274 towards their insurance.

New York-based businesses can also reduce their cost by a great deal with a number of options. This can include:

  • health savings accounts (HSAs)
  • HRAs are health reimbursement plans
  • Direct Primary Care (DPC), memberships
  • Programs for health sharing

Your business strategy will depend on several factors including the size, age and health requirements of employees, their spouses and dependents, and your budget.

Read on the go, download our Complete Guide To Small Business Healthcare Plans.

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Geographic Considerations for New York Small Business Health Insurance

New York has a very unique health care environment, including both large cities such as New York, Albany and Buffalo and more rural places around Hudson and Hamilton.

New York employers should carefully examine how their workers are distributed throughout the state. If executives at the Buffalo headquarters of their company choose a HMO plan that limits their employees to in-network providers, it is not going to be of much use to their staff and families who live and/or work in Corfu.

New York Small Business Group Health Insurance

Most New York employers choose the traditional group health plan.

It’s cost’s are also staggering. Here’s how it works:

A third party insurance provider, usually a profit-making corporation, is contracted by an employer to provide health benefits not only for the workers but also for their family members if desired.

All employers that have at least 50 employees are required to offer ACA qualified health insurance for all their employees who work over 30 hours a week. If they don’t, then the employer will face a fine.

It must provide the minimum essential coverages, or MEC, required by Affordable Care Act. They are:

  • Patients can receive ambulatory services without needing to go into hospital.
  • Emergency services
  • Hospitalization can include overnight hospitalizations and surgery.
  • The care of newborns, pregnant women, and mothers (both before and afterwards)
  • Treatment for substance abuse disorders, mental illness and behavioral problems (including counseling and therapy)
  • Prescription drugs
  • The Rehabilitation and habilitative Services and Devices (services and equipment to assist people with disabilities or injuries gain mental and physical abilities)
  • Laboratory services
  • Chronic disease management and prevention services
  • Adult dental coverage and adult vision insurance are not considered essential health benefits.

Additional, the ACA demands that health insurance coverage includes birth control as well as breastfeeding.

It is true that traditional health care insurance can be expensive but there are advantages. 

In the event the worker does not enroll during an initial period, when he or she first qualifies for coverage, in a special enrollment window triggered due to a qualifying life experience, or within the November 1st general enrollment period, the insurance provider cannot refuse them or charge higher rates because of medical records.

Small Businesses in New York Can Choose Not To Offer Health Insurance

Employers with less than 50 employees are exempt from offering health insurance.

New York law does not have any requirements. You don’t need to provide health insurance if you employ fewer than fifty people.

As there’s no penalty.

Employers of all sizes should consider offering health benefits. That includes very small businesses, because they may find it difficult to hire and keep quality employees if the health benefits are not competitive. 

Particularly in New York, where there are few unemployed people and the employers compete fiercely for talents.

New York employers are able to save considerable money through a Medical Cost Sharing or Health Share Plan (more details below). They can pay for some or even all costs of their employees.

HRA Alternative

You could also help employees purchase individual health coverage on an essentially tax-free basis by offering a QSEHRA, or a Qualified Small Employee Health Reimbursement Agreement. 
QSEHRAs provide employers with the following benefits:

1.) Minimum contribution limit is not set

QSEHRAs allow you to set your own budget for HRA benefits and change it as needed each year, based on the cash flow in your business. It is up to you as an employer to decide how much money will be allocated for HRA expenses. This budget can change every year depending on the cash flow of your company. 

A QSEHRA allows you to control the budget of your medical benefits.

2.) Flexibility.

It is possible to offer different amounts to employees depending on their marital and family status. It is possible to discriminate and offer a bigger benefit for employees with children than those who do not have any.

3.) The tax exemption is available to both employees and employers. 

Employer contributions are fully deductible by the IRS as a compensatory expense. But unlike cash payments, your employees do not have to pay taxes on QSEHRA benefits if their health insurance plans include the 10 minimum essential protections stipulated in the Affordable Care Act.

A QSEHRA offers a more attractive alternative to stipends for employees that can be used towards health insurance costs or any other expense.

4.)QSEHRAs Promote Employee Choice

There are too many group health plans that limit employees to just two or three options for health coverage.

The HR department and the company’s management select these items, which are overpriced or unsuitable to workers.

A QSEHRA offers workers and families a wide range of options and gives them the power to select a health plan which is right for them.

Taxation of New York Small Business Health Insurance

The premiums for health insurance you pay, as an employer, are fully deductible as business expenses under federal law and New York State Law. The employee is not taxed on these premiums

The overall cost of healthsharing plans is lower. Employees can deduct the monthly costs. Employer assistance in paying for health-sharing costs is taxable.

New York Employer Group Health Insurance Coverage: What Are the Disadvantages?

The traditional group employer health insurance is not without its disadvantages, both for the employers and their employees.

  • Cost

    The cost is much higher and possibly even crippling for a small business.

    Overkill is a major factor in the high cost of traditional health insurance. Washington and Albany, as well as other government agencies have added requirements and coverages to health insurance policies that are not necessary for most workers.

    As an example, many traditional carriers charge for mental and drug addiction coverage as well. They also include maternity and other benefits.

    It makes them less effective, and therefore more expensive.

  • Inflexibility

    Group health insurance programs often provide a one-size-fits-all strategy that may not sufficiently address specific employee’s needs and budgets. Employer-sponsored group health insurance plans by nature tend to offer just one or two solutions that may not be optimal for specific employees.

    In some cases, workers would be better off buying their own plan on the individual market – potentially taking advantage of a subsidy under the Affordable Care Act. 

    They may also be better off with a less expensive health sharing plan, discussed below. These innovative and affordable alternatives to health insurance can be a great solution – especially for workers who are in good health, with no pre-existing conditions. 

    Health sharing plans are discussed in more detail below. 

  • Administrative burden
  • Managing full-featured health benefits involves considerable administrative costs. The administrative costs of managing a full-fledged health benefit are substantial. They are vital to the smooth running of a company’s insurance program.

    The plans can be very burdensome for employers with a small headcount who cannot justify hiring a staff member to handle the HR plan full-time.

    If you prefer, owners of businesses can use other strategies including Health Care Stipends and Reimbursement Arrangements.

    This alternative approach encourages workers to obtain their own insurance through Affordable Care Law. Workers may then be able to take advantage of available subsidies. It removes employers from the process and reduces administrative costs.

Health Sharing Plans New York

New York businesses can choose to use health sharing programs as an alternative for their over-priced coverage.

New York companies are turning to medical cost sharing programs in place of traditional health insurance. These plans offer an alternative that is more budget friendly. When switching from health coverage to health sharing plans, businesses can typically save up to 50% on their existing group health plan premiums.

This means small businesses of New York can save upwards of $10,000 per year on coverage for a family, or $3,500 annually for single coverage.

These innovative programs allow employers to offer employees high-quality health care, while still controlling costs. These programs are based on the idea of sharing resources with a large group of individuals or organisations.

Participants in health-sharing programs pay an annual amount to the insurance company instead of buying traditional insurance.

Health Sharing Plans vs. Health Insurance

A health-sharing plan is different from a medical insurance.

In contrast, healthsharing ministries are non-profit associations that bring together people of similar minds to share in the costs of medical care. Contrary to most health insurance providers, who are for-profit companies, healthsharing ministries are nonprofit.

Mandatory Coverage

While traditional insurance policies are required by federal and state legislation to cover many services that people do not want or require, health plans don’t have any such laws. The health sharing organization is not covered by the ten minimum essential coverage requirements.

It is not necessary for medical cost-sharing to cover addiction treatment costs for individuals who have never used drugs. Also, they do not need to cover any injuries resulting from a member’s drunk driving.

There Are Pre-Existing Conditions

Healthsharing Plans may impose waiting time periods prior to sharing costs for treating existing conditions.

In addition, they may impose waiting times for certain surgeries. However, this is only applicable to accidents and injury that the members could not possibly have anticipated prior their enrollment.

Health sharing companies can provide a range of excellent benefits that are a fraction of those offered by ACA-qualified, unsubsidized group insurance policies or NY State of Health.

Under the Affordable Care act, healthsharing doesn’t qualify to receive subsidies. Although the cost savings can be so large, switching to healthsharing is still a good option for most people, regardless of their eligibility for a subsidy.

New York companies are more likely to benefit from health sharing since they don’t receive a premium credit in the ACA.

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Health Sharing and Network Restrictions in New York

Health-sharing plans are often more flexible when it comes time to choose healthcare providers.

Most healthsharing organizations New York does not limit patients to only in-network providers. Members of health-sharing plans can select their doctor. People should be able to choose the doctors they want.

Do you need health insurance for your employees?

Every business has its own unique characteristics. How to pick the best plan is a matter of careful evaluation.

New York’s business owners can get full analysis of their case, and specific recommendations for your company and staff.

To begin the process, simply Click Here for an appointment with a Personal Benefits manager licensed in New York.

If you’ve prepared a census of your employees, it will make things easier.

In many cases, switching employees to health coverage will allow you to save thousands. If you are dealing with employees who have pre-existing health conditions, it may be best to avoid health sharing.

You can always consult with us and get an analysis for free.

New York Small Business Health Insurance Reimbursements

Employer-funded Health Reimbursement Arrangements (HRAs), which reimburse employees tax-free for personal healthcare costs, are a type of HRA.

New York’s smaller businesses tend to drop their group health coverage altogether. They establish HRAs and give their workers money in advance of tax to pay for individual coverage on the health market.

So, workers can take advantage and reduce their net costs. 

Employees can access their HRA benefit if there is any money left after they pay the premium. This includes prescriptions for durable medical equipment, deductibles, copays and prescriptions. HRA benefits, once again, are not taxed to employees. 

An HRA is a great alternative to a formal plan for group health coverage. It allows your employees to choose the insurance options that are most suitable for them.

Click here if you want to learn more about Health Reimbursement Accounts (HRAs) for small businesses.

HRAs for Small Businesses – The QSEHRAs

QSEHRA, or the Qualified small employer health reimbursement arrangement (pronounced “Cue Sarah”) is a type of HRA that can be used by small businesses.

The benefit is for employers with less than 50 employees full-time or equivalent and those who do not offer any traditional group health plan.

The QSEHRA is a flexible plan that allows businesses to choose their maximum QSEHRA contribution, subject to certain restrictions. New York employers are allowed to make contributions up to $5.850 (upwards of $487.50 a month for an individual employee) or up to $11,800 (upwards of $983.33 a month for familly employees)

They can use the money they receive to purchase individual or family health insurance, either through an Personal Health Benefits Manager site on the internet health insurance exchange. They can still qualify for the subsidy if they purchase their own insurance through an online health insurance exchange or a Personal Benefits Manager in the individual and family market.

The employer can decide to pay the employee’s premiums for health insurance only, or also reimburse them for any extra medical expenses.

The QSEHRA and Special Enrollment Periods

When you cancel your health insurance plan and replace it with an HRA, your employees will qualify for a Special Enrollment Period. This is a 60-day window during which your workers can purchase their own ACA-qualified insurance plan with guaranteed issue rights, without going through medical underwriting.

This helps ensure your employees don’t face a break in coverage when you drop your group health insurance plan altogether and replace it with a QSEHRA. 

The Benefits HRA

Health Reimbursement Arrangements offer many advantages.

Your employees are not taxed on the amount you spent for HRA benefits.

HRAs are not paid to the workers until you give them control. The money is available as capital for your business. The money does not have to be held by a third-party.

HRAs are designed with a lot of flexibility by the employer, including which expenses they will cover.

Employees don’t lose their health insurance coverage when they quit the company or switch to contractor status. The QSEHRA gives the worker control over his/her insurance plan. Employer not.

The Disadvantages HRA

Many workers do not wish to take on the task of researching and selecting their own healthcare plan. It’s possible that some workers need extra assistance to make the switch.

We can help if you are in this situation. There is no one left behind.

Call 800-913-0172 or have your workers simply click on this link for an appointment to receive personalized and individual service.

The Direct Primary Care Advantages

Direct Primary Care plans, or DPCs for short, are an alternative health care model which is exploding in New York as well as across the United States.

This is a model based on membership: Your employees can receive as many consultations as they require, whether in-person or through telehealth, for an affordable flat monthly fee.

DPC’s monthly membership fees start at just $80 and are a viable option for people to take care of their health, without having to pay copays or insurance.

DPC plans offer members unlimited access for routine primary, preventive and chronic care.

The following are some examples of direct primary healthcare services:

Some of the most common medical services offered by doctors who practice Direct Primary care include:

  • Preventive care. DPC doctors are committed to preventive care and offer routine screenings, immunizations and checkups.
  • DPC Doctors treat injuries and illness that are acute, such as minor cuts, infections, skin diseases, and colds.
  • Chronic disease management. DPC doctors assist patients in managing chronic conditions such as hypertension, diabetes, arthritis and more. These doctors offer ongoing treatment, monitor patients, and adjust their plans of care as required.
  • Comprehensive physical exams. DPC doctors provide comprehensive physical exams that help assess health overall, identify possible risks, and offer personalized health recommendations.
  • Urgent care. DPC is often able to offer same-day, or the next-day, urgent care.
    The appointment system allows patients to be seen quickly for medical problems that are not emergencies.
  • Diagnostic services and Laboratory Services DPCs may perform or arrange a range of lab tests including blood work, urine testing, imaging (x-rays, ultrasounds), and ECGs.
  • Medication management. DPC Doctors can prescribe medications. Monitor their effectiveness. And make necessary adjustments. Additionally, DPC doctors provide medication education and counselling.
  • Mental health services DPC practices offer mental health as part of comprehensive care. DPCs may also refer their patients to mental health professionals for therapy or counseling.
  • Minor procedures. DPCs are equipped to carry out minor surgeries in their own offices.
  • Care coordination, referrals. DPC’s doctors coordinate and advocate for their patients, as well as with specialist hospitals and healthcare providers.

No insurance companies are involved so there aren’t any co-pays. A monthly subscription will cover all costs. So, workers with limited funds can receive immediate medical attention. Never again will workers have to avoid seeing their doctors because they cannot afford the deductible and co-pay.

If patients need additional coverage, they can opt for supplemental plans that include high-deductible health plans, accident plans or healthsharing plans. DPC offers routine healthcare as part of membership. Patients can select more cost effective coverage such as healthsharing plans instead of traditional health insurance.

Accounts for Health Savings (HSAs)

The HSA (Health Savings accounts) is a powerful tool that can assist workers in managing their health care costs and also help to keep the premiums of workplace health insurance lower.

New Yorkers, and their businesses in particular, need any tax relief they can find. Good news! Employer contributions to Health Savings Accounts for employees are fully deductible from New York’s corporate income tax.

HSAs enable individuals to pre-tax funds for future medical needs. HSAs can be funded by employees as well as employers. However, the annual contribution limit is set each year by Congress to match inflation.

HSA accounts grow tax-deferred and withdrawing money to pay for qualifying healthcare expenses is free of tax.

HSA Qualification

To contribute to a health savings account, or to enjoy employer pretax contributions to an HSA,  employees must enroll in a qualified high deductible health plan (HDHP).

For 2023, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,500 for an individual or $3,000 for a family. 

An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $7,500 for an individual or $15,000 for a family. (This limit doesn’t apply to out-of-network services.).

Can I Combine HSAs with Health Sharing?

HSA America currently offers only the HSA-SECURE plan. But we are currently working with a provider who will allow us to pair an HSA account with any healthsharing plan. Ask one of our Personal Benefit Advisors about it.

At present, there is only one plan that allows employees to contribute pre-tax money into a Health Savings Account: the HSA Secure Plan. It’s available via HSA For America.

The HSA SECURE Plan offers a great way to combine tax advantages and savings on healthcare with a healthsharing plan. 

However, to qualify, the employee must own a business, be self-employed, or ownership.

HSA SECURE will not be available for straight W-2 workers. HSA-SECURE may work for you if your employees have a side business or are freelancers/contractors and are in good health. 

HSA SECURE Plans are also an excellent way for small business owners to save on expenses And, of course, may be a great money-saving option for you and your partners as a small business owner.

HSA SECURE would require your employees to register on their behalf. After they’ve established their HSAs, you are able to make pre-tax payments on behalf of your employees, subject to the limits set by Congress each year.

Learn more about the HSA SECURE plan.

How Are New York Small Business Health Insurance Benefits Taxed?

Once you’ve learned a little bit more about all the other options that are available for small business owners in addition to health insurance as it is known today, we have a short table showing how they will be taxed.

Plan TypeEmployerWorkers
Traditional health insurance premiumsTax deductible. May qualify for a tax credit (see below)Non-taxable
HSA contributionsTax deductible
Pre-tax, up to certain limits. No income limitations.
Health sharing costsTax deductible as a compensation expenseTaxable as ordinary W-2 income
Health reimbursement arrangementsTax deductibleBenefits are non-taxable to the employee
HSA withdrawalsN/A
Withdrawals for qualified medical expenses are tax-free. Otherwise taxable as ordinary income.
A 20% penalty for non-qualified withdrawals applies up until age 65.
Direct primary care costs

Tax deductible as a compensation expenseTaxable to the employee

New York Small Business Health Insurance Pyramid

Employee health benefit packages should include all aspects of the Employee Healthcare Pyramid. This includes routine preventive healthcare, primary care access, early detection and maintenance, catastrophic incidents as well as the provision of care at all stages of the pyramid.

Care Pyramid for Small Business Health Insurance in New York

We list the most common insurance solutions for each of the levels in the Care Pyramid on the left.

And on the right, we list a variety of alternatives, which are more cost-effective, to provide meaningful protection for the employees in each level of the Pyramid. 

The design of a good plan provides affordable options for employees at every level. This ensures that employees don’t have to put off or delay care for lack of funds. 

Work with your Personal Benefits Manager to create a customized plan for each employee that addresses the Care Pyramid at all levels. The cost is often a fraction of what a group plan would be.

New York Small Business Health Insurance Tax Credit

Small Business Health Care Tax Credit, passed with the ACA allows certain small businesses claim a federal credit up to 50% on their employees’ health insurance costs.

This program is designed for small business owners who have 25 or less employees and tend to hire workers at lower wages

Businesses that are for-profit or non-profit can claim the tax credit.

* Employ fewer than 25 people and pay an average salary of $53,000 (excluding all owner salaries). Owners are generally not considered when calculating the average salary and number of employees for a business. The number of employees are also based on the “full-time equals”. Two half-time workers would be equal to one full-time worker.

*Paying at least 50% of employee premiums;

New York State of Health is the exchange that offers coverage under the Affordable Care act. 

Tax credits will no longer be available to employers who have 25 or more workers or average wages of at least $53,000.

What is the process for claiming credit?

This tax credit can be claimed on your income tax returns with IRS Form 8941 attached (tax-exempt businesses are required to submit a Form990-T to make a claim even though they do not have to).

Contributions to health insurance for your employees do not attract tax.

This year, I haven’t paid taxes on my business. Am I eligible to claim the credit for tax?

Yes. The tax credit may be used as a way to reduce income tax liabilities incurred in the prior year, or it can be carried forward and offset over 20 years.

Credits are refundable if your business is tax exempt. 

Contact your tax advisor to learn more about the Small Business Health Care Tax Credit.

Combining small business health plan strategies

Combining programs to increase your insurance coverage can be smart.

Many employers have found that they can reduce their costs by offering a combination of different healthcare plans, while still providing full coverage for all employees.

Combining a Direct Primary Care Plan (DPC), which covers normal primary care, with a low cost health sharing program that includes catastrophic situations is one way to achieve cost savings.

This alternative to group health coverage can prove more affordable either for the company or for employees.

It is possible to offer employees more flexibility by giving them the option of signing up for an HDHP-qualified HSA or a health share plan.

How to proceed?

Contact us to receive a complimentary, free business health plan assessment and recommendation. 

Your HSA for America Personal Benefits Manager will review your family and work situation with you. They’ll also discuss your budget, needs and employees’ contribution ability. He or she may also ask your employees how much they can contribute and if there are any conditions which need to taken into account when designing the new plan. 

Our PBMs include many successful business owners. These PBMs are business owners themselves and have a deep understanding of your requirements as an entrepreneur.

Is it possible to provide both Health Insurance and Health Sharing at the same?

If you offer both, employees can choose the one that suits them best.

Please note, if you lose too many employees from a Group Health Insurance Plan, your participation rates could drop below what is required to continue a Group plan. HRAs are a great way to reimburse employees who purchase individual health plans, since they will have a similar cost.

New York Small Business Health Insurance: FAQs

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The difference between Health Sharing and Insurance for Small Business

While health insurance plans are offered by traditional insurers, healthsharing allows members to pool their money and cover medical expenses for one another.

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Does New York cover the cost of maternity care under health sharing plans?

TNew Yorkers are accustomed to having maternity benefits included as part of their health insurance and health sharing plans. This includes coverage for prenatal care, labour, and postnatal services. In some cases, health sharing plans will restrict benefits to children born out-of-wedlock.

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New Yorkers: Can contributions made by employers to HSAs qualify as deductions for state income tax purposes?

Yes. New York allows employers to deduct their contributions for employee HSAs from their state income taxes as compensation expenses.

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Does health sharing have a waiting period on conditions pre-existing?

Certain health sharing plans have a wait period to cover conditions that are pre-existing. Review the plan’s guidelines for specific information or talk to your Personal Benefits Manager. New York allows employers to contribute towards their employee’s HSAs. There are annual limits that Congress has set for employers’ contributions to HSAs.

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Do small businesses have a business case for offering Direct Primary Care plans alongside other insurance options in New York State?

Health sharing plans and DPC can be combined to provide small business owners and employees with comprehensive healthcare coverage at a low cost.

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How can I get the Small Business Health Care Tax Credit (SBHCTC)?

Businesses that make a profit may claim this credit with IRS form 8941. However, small businesses who are tax-exempt must use Form 990 -T. HSA for America cannot provide you with tax advice. Employers can consult their own tax advisors for more details about how to apply.A business can still claim a Small Business Health Care Tax Credit, even if it does not owe New York state taxes.If a company does not have any tax obligations in one year, they can use the Small Business Health Care Tax Credit as a way to pay back their income taxes from that year. They can even carry it forward to up to 20 more years.

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Health Savings Accounts – How do they help New York employees to manage their medical costs?

HSAs let individuals set money aside for future medical bills before tax. Contributions from both employers and employees may provide tax savings and help reduce healthcare expenses.

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What are the options for health insurance with cost-sharing that I can choose from in New York to best suit my business?

It’s not worth it to go at it alone. Talk to an Employee Benefits Manager. He or she can perform a free assessment and make recommendations for you based on what is best for your company, the budget available, how many employees are there, and any other factors. You can work with them to design the best plan possible that will benefit your employees and keep you competitive.

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Can HRAs be used alongside other coverage options like health sharing plans or individual health insurance plans?

Yes, HRAs can be used alongside other coverage options. Some small businesses choose to cancel group health insurance altogether and use HRAs to reimburse employees’ premiums for individual policies. However, HRA money cannot be used to reimburse employees directly for health sharing plan costs. 

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Are there restrictions on how large a business can be to qualify for the programs in New York State?

QSEHRAs are only open to employers that have fewer 50 employees. You can still get HRAs if your employer has over 50 employees. 
It is also a requirement of the ACA that employers provide a plan with qualified coverage for their employees. If they don’t, they will be penalized. You should speak to your Personal Benefits Coordinator if your company is about to or plans on hiring its 50th full time worker, or equivalent, in the next few months. Your plan could be affected.

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What exactly is an HRA and how do they work?

HRAs allow employers to reimburse their employees for certain medical expenses, which aren’t covered by the employee’s insurance. Employers set the criteria for what is eligible, and they contribute accordingly.HRAs may be used in conjunction with other insurance options, like individual or group health plans.HRAs work well with many other types of insurance. HRAs may be used as a reimbursement for employees to pay individual insurance premiums by small business owners who have canceled their group policies. HRAs cannot reimburse health-sharing plan costs directly.


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