New York Group Health Plan

The small group market in New York is defined by number of employees. As such, if a company has between 2 and 49 employees in New York they are considered small by insurance carriers and as a result effected by community rating. In New York the community-rated system is a guaranteed issue pool, so insurance companies are not allowed to medically underwrite groups. That means for companies whether they have lots of healthy young employees, or very sick employees that are older, the rate is the same.

Rates in New York are not low though. As a result of the pool in the community, the rate base relative to other states in the US is very high, but it is important to remember the “claims experience” of a group does not impact its insurance rate.

There are normally 5-7 leading carriers in the health market in New York: Empire Blue Cross Blue Shield, Aetna, Cigna, Oxford Health Plans(owned by United Healthcare), Health Net, Emblem Health. Atlantis Health is a smaller physician-owned and operated HMO. In addition, the former HIP is now a part of the Emblem Health Plan, along with GHI.

Most carriers offer products along the full spectrum – PPO, HMO, POS, NG POS, NG HMO, EPO, H.S.A qualified plans, and also HRA products.