Individual Medical Plans — Individuals, Sole Proprietors and Partnerships without a non-spouse employee will need to enroll as an individual due to ACA legislation. Individuals must enroll during Federally mandated open enrollment periods, or any time they have a Qualifying Event such as the loss of employer provided insurance.
Individuals may purchase either Oxford or Empire Blue Cross Blue Shield products through Mercer. The New York State of Health exchange is available for those persons whose income levels qualify for a subsidy. (Information about the exchange can be found at the nystateofhealth.ny.gov.) Please see the Forms tab for more information and enrollment materials from each carrier.
Group Medical Plans — We can assist you to navigate the changes mandated by the Affordable Care Act by evaluating and placing your medical insurance plan in the appropriate market for your situation. Small groups can apply for coverage at any time during the year.
Small groups (2 to 50) may select from 26 PPO/EPO plans and 2 HMO plans offered by Oxford. The Liberty and Freedom networks are both available so that you can get the care you need from the doctors and hospitals that you currently use.
Group coverage is available for all business forms that include at least one non-spouse W-2 employee in addition to the owner(s). Tax form verification of your status as a small group is required. We can help you to determine whether your business structure and enrollment will qualify for small group coverage if you are not sure. Please see the forms tab for enrollment materials.
New with the ACA is the introduction of the Platinum, Gold, Silver, and Bronze classification of health plans. This new concept categorizes plans around “actuarial value”. A Platinum plan represents an actuarial value of 90%, meaning the participant will be expected to shoulder 10% of their projected health costs for the year and the plan should cover 90%. Platinum, Gold, Silver, and Bronze represent 90%, 80%, 70%, and 60% actuarial value respectively.
What this means for you is that plans within a metal level are basically equivalent to each other for a more consumer friendly shopping experience. You can feel confident that a Platinum plan is better than a Bronze plan and that you are not paying more just because the plan is more profitable for the insurance company.
Regardless of metal tier, all the plans include the Minimum Essential Benefits mandated by the ACA, assuring that your plan provides benefits for the most important healthcare services. Any level of plan will also satisfy the Individual Mandate which requires all US citizens to have health insurance coverage.