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We are a new nonprofit (incorporated 11/07) operating throughout Westchester seeking its first employee, and want to offer that employee health insurance. My questions:
Can we qualify for a group plan with only 1 employee?
Being new and with just 1 employee, would we typically be rated on our own experience in the second year? Or would our rate be some kind of average?
Are there any buying groups or associations that we could belong to and qualify to participate in a group plan?
Is group insurance significantly less expensive than individual coverage (considering that we could opt to pay the employee to secure his/her own individual health insurance)?
Thank you for any help you can give us.
Robert Waldman
Center for Aging in Place Support
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Robert:
In order to qualify as a group you would need 2 employees. That being said you as director can be considered an employee of your are working full time (minimum of 20 hours per week). You may also waive coverage if you have it elsewhere and still provide coverage for your new employee on a group basis.
In New York State groups under 50 employees are not rated by their experience. All of these groups fall under something called Community Rating. This allows all employees to obtain coverage regardless of their current health.
There are almost no more groups or buying associaitons left since Community Rating was introduced by state legislature in 1993.
Group insurance is not only less expensive but the benefits are better as well. Also there are significant tax advantages for employer and employee obtaining coverage on a group basis.
I hope this is helpful. Feel free to contact me with further questions
David Kane- President Benefits
York International Agency LLC
dkane@yorkintl.com
914-457-1269
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A one person group typically can be established with proof the the employee's W4, paystub or the NYS45 quarterly tax document along with proof of the President who established the organization with the state. This will demonstrate that there are at least 2 "employees" with this organization.
New York is a "community rated" state so no census or underwriting is required (gender, age, health history) and there are no credits or surcharges for health insurance experience.
Individual coverage is typically more expensive than an employer sponsored plan. One can review what health insurance carriers can charge to a consumer on the NYS insurance department's website. ttp://www.ins.state.ny.us/hmorates/html/hmowestc.htm
You may not need to latch onto an organization to just get their health insurance. It depends on the documentation you may or may not have as a corporation.
If you need assistance with exploring your options of implementation, you should speak to an insurance professional to see what are your options and the best course of action.
LINDA REY
Rey Insurance Agency
914-631-7628 ext. 303
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Dear Mr. Waldman,
On behalf of yoru friends at the Allan M. Block Agency Inc. in Tarrytown, NY:
Answers:
1. Group insurance requires 2 on the payroll. One can take the plan if the other waives. There are very limited plans for sole props.
2. Never rated for experience until over 50 employees in NY. No medial questions under 50 employees. All pooled.
3. Any group association would not be less than taking it directly in NY because of NY law. Although there are some trade associations that offer group plans. Most end up more expensive over a five year period.
4. Individual plans are rated much higher for a much lower product. Oxford sole prop plans should be available later this year in Westchester and are rated very well. They currently are only available in New York City and Long Island.
Allan M. Block Inc. is a full service property & casualty insurance agency in Tarrytown NY. We also specialize in Group Insurance, LTC, Disability Income programs and Life insurance, including Survivorship Life and Estate Planning concepts. We offer complimentary reviews on your existing insurance lines and welcome the opportunity to help your organization with complete insurance services.
Please feel free to contact us at:
JMurray@ Allanblockinsurance.com or by phone at 914-631-4353.
Joanne Murray, Vice President
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