• Westchester Businesses Get First Glimpse of Health Exchange Plans at WCA Lunch and Learn


  • With Open Enrollment Just Days Away, Many Questions Remain; Is the SHOP Exchange Right for You?

  • Only two health insurance carriers in Westchester have opted to participate in New York’s SHOP (Small Business Health Option Program) exchange, and you’ve probably only heard of one of them...

    Jill Bergman, vice president of compliance in group health & welfare services at CohnReznick. Photo: Lynda Shenkman Curtis

    Surprised? So were Westchester business leaders gathered at the WCA Lunch and Learn at Tappan Hill to hear from local healthcare experts what they needed to know ahead of the Oct. 1 opening date for enrollment New York’s health benefits exchange.

    The Freelancers Co-Op, through a new nonprofit health insurance company called Health Republic, and UnitedHealthcare’s Oxford Health, will be open for business on the state SHOP exchange next week, according to James Schutzer, vice president of J.D. Moschitto & Associates, who provided a detailed overview of the New York State of Health, the name of New York’s recently branded health exchange.

    What we know is that each carrier will offer standard plans meeting the ACA’s essential health benefits requirements with cost sharing that varies by metal level category: bronze, silver, gold and platinum. Bronze plans feature the lowest monthly premiums but have higher deductibles and only have an actuarial value of 60 percent; platinum plans have higher premiums and lower out-of-pocket costs and have an actuarial value of 90 percent. The current range of rates for SHOP plans (subject to change) for Freelancers Co-Op is $334 to $561 and for Oxford Health, $473 to $773.

    What we don’t know are details about the networks, Schutzer said, a message echoed by the two experts who rounded out the WCA panel: Chris Jardin, president and director of marketing at The Maxon Companies, and Jill Bergman, vice president of compliance in group health & welfare services at CohnReznick. But they’re likely to be more limited, as reported in the New York Times this week.

    Schutzer said word on the street is that Oxford’s network could be similar to the size of its current Liberty network. Freelancers Co-Op is leasing its network from MagnaCare. But it’s not yet clear which physicians will be considered in-network, what the prescription drug coverage will be or what out-of-pocket expenses will cost. 

    You Better SHOP Around!

    So should your small business be one of the 450,000 statewide expected to purchase group coverage on the health exchange? Is SHOP right for you?

    SHOP offers value to small business, Schutzer noted. Employers get a single monthly bill and send one check back to the exchange, which is responsible for sending payment to the insurers.

    But the most attractive reason to shop on SHOP is the chance to put money in your pocket through health care tax credits of up to 35 percent (25 percent for tax-exempt entities) that offer insurance to employees. However, to be eligible for the Small Business Health Care Tax Credit, businesses are required to have fewer than 25 full-time equivalent employees, pay at least 50 percent of employee premiums, and employee salaries have to average $50,000 a year or less.

    In Westchester, that isn’t going to be a scenario that plays out for a large number of businesses. But follow our experts’ advice: Work with a tax advisor to determine your tax credit eligibility.

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