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FREQUENTLY ASKED QUESTIONS

Self employment questions

  • Q: I’m an independent contractor, is that the same as being self employed or a sole proprietor.

    YES. The general rule is that an individual is an independent contractor if (the person for whom the services are performed) has the right to control the work.

    People such as lawyers, contractors, subcontractors, public stenographers, and auctioneers who follow an independent trade, business, or profession in which they offer their services to the public, are generally not employees (but rather self employed). The earnings of a person who is working as an independent contractor are subject to Self-Employment (SE) tax.

  • Q: How is self employed defined?

    You are self-employed if any of the following apply to you:

    You carry on a trade or business as a sole proprietor (someone who owns an unincorporated business by himself or herself)
    You are a member of a partnership or limited liability company that files a Form 1065, U.S. Return of Partnership, that carries on a trade or business; or
    You are otherwise in business for yourself.

  • Q: I just left my job a few months earlier and have been working on my own, can I still qualify as self employed.

    Yes, as long as you can legally document that you’re self employed. However each insurance company has different requirements

    Atlantis will require a business certificate, W-4 & 3 months of recorded income (cancelled checks).
    HIP will require a business certificate & a letter from your CPA (stating that you’re self employed working a minimum of 20 hours per week, & when you expect to have tax forms available for review).
    GHI will require a Letter of Certification

  • Q: I recently started my business and don't have any tax documentation, can I still qualify?

    Yes, though each insurance company has different requirements.

    Atlantis will require a business certificate, W-4 & 3 months of recorded income (cancelled checks).
    HIP will require a business certificate & a letter from your CPA (stating that you’re self employed working a minimum of 20 hours per week, & when you expect to have tax forms available for review).
    GHI will require a Letter of Certification

Business associations

  • Q: Which insurance comp antes require that I become a member of a business association to purchase health insurance

    HIP, however by having the business associations pool together all of their Self Employed members, they are able to negotiate better health insurance rates. As such, in order to qualify for those lower rates, you need to be a member of the business association.

  • Q: Which business associations & what benefits do they offer besides health insurance

    The business associations are NYSBG (New York State Business Group), LIA (Long Island Alliance) USFSB (United States Federation of Small Businesses) & IRBA (Independent Retail Business Association). Many of the associations include Life/Accidental insurance, shopping discounts and vision/dental discounts

  • Q: What are the business association dues

    Depending on the Association the membership fees range from $35 to $60annually.

  • Q: I have insurance through another business association but the rates are higher. Can I switch to one of your plans listed?

    Yes

Healthy NY questions

  • Q: Healthy NY rates are very competitive, how can I qualify for healthy NY?

    In order to be eligible for the Healthy NY self employed program you must meet the following criteria:

    • You must live in New York State
    • You must be currently self employed (or your spouse)
    • You have not had health insurance in effect for the past 12 months or have lost your coverage due to one of the events listed below
    • Loss of employment
    • Death of a family member
    • Change to a new employer
    • Change of residence
    • Discontinuation of a group health plan
    • Termination or cancellation of COBRA coverage
    • Legal separation, divorce or annulment
    • Loss of eligibility for group health insurance coverage
    • Reaching the maximum age for dependent coverage
    • You cannot be eligible for Medicare

    Your current gross household income meets the income guidelines of the program (listed on your 2005 1040tax form line 37 adjusted gross income)

    Healthy NY Income Guidelines*
    Family Size Monthly Household Income
    1 Up to $2,257
    2 Up to $3,036
    3 Up to $3,815
    4 Up to $4,594
    5 Up to $5,373
    6 Up to $6,153
    Each Additional Person    Add $780

    Pregnant women count as two people for the purpose of determining family size.

  • Q: I was told that if I currently have insurance I cannot qualify for healthy NY, is that true?

    Not under certain conditions

  • Q: I’m on cobra now, but it’s expensive. If I qualify for healthy NY based on income can I sign on?

    Yes, healthy NY allows exceptions to their 12 month rule (no insurance in place for the last 12 months). If you have lost or stopped your coverage due to one of the events listed below

    • Loss of employment
    • Death of a family member
    • Change to a new employer
    • Change of residence
    • Discontinuation of a group health plan
    • Termination or cancellation of COBRA coverage
    • Legal separation, divorce or annulment
    • Loss of eligibility for group health insurance coverage
    • Reaching the maximum age for dependent coverage
  • Q: I would like to get healthy NY just for myself but there are 4 people in my family. On your healthy NY income guidelines am I considered a single or a family 4?

    You’re considered a family of 4 even though you’re the only member purchasing coverage.

  • Q: I currently have healthy NY but I'm not happy with the insurance company. Can I switch to another company?

    Yes

  • Q: How many plans does healthy NY OFFER?

    there are 4 plan options available; 2 HMO plans (1 with prescriptions) & 2 High deductible health plans (1 with prescriptions)

  • Q: I see that every company offers healthy NY but what are the difference between the companies.

    The Size & participation of the Network providers (doctors, hospitals & Labs) is the major difference between the companies.

  • Q: What is healthy NY?

    Healthy NY is a program designed to help promote comprehensive and quality health care for small business owners and their employee's. The Healthy NY program also helps sole proprietors and those whose employers do not provide health insurance for them please visit our learning center for additional information.

Application questions

  • Q: If I have any questions completing an application, who do I call

    Please call us from 8:30 AM -5:30 PM M-F at (888)215-4045

  • Q: On your online form I see that you’re asking for my social security number and Date of Birth. I don’t feel comfortable providing that information online. Can I leave it Blank?

    Yes that’s not a mandatory online field.

  • Q: Once I submit the online form what happens next?

    you will receive an email with instructions and a completed application. The email with indicate that you have to print the application; sign it & either fax email or snail mail it back to us. Along with the application you will need to include tax forms that verify your self employed (listed here) & the first month premium.

  • Q: How long does it take to process my application?

    it depends on the Insurance Company and plan. HIP, Oxford, GHI & Atlantis can usually be processed in under two weeks. Healthy NY plans take a minimum of three weeks to process. HOWEVER, if we don’t receive the required documentation or the application is missing then process takes longer.

  • Q: I’m having trouble opening the application that I received in your email can you fax it or snail mail it.

    Yes, just email us your request.

General questions

  • Q: Can I purchase the health insurance plans at a lower rate by going direct

    No, Insurance companies and business associations do not make self employed health plans available direct.

  • Q: What happens if I decide to terminate my health plan, will I be penalized

    No, your only obligation is to inform the business association in a timely manner (usually two weeks prior to termination date) that you’re terminating your plan.

  • Q: I currently have an insurance plan that will expire in the middle of the MONTH; can I start a new plan in the middle of the month?

    it depends on the insurance carrier, Oxford & HIP & Healthy NY plans only allow first of the month effective dates. GHI & Atlantis allow middle month effective dates.

  • Q: How can I find out if my doctor accepts the plan I’m interested in?

    Please follow the links listed below for each insurance carrier

    Empire Healthcare     Oxford     HIP     Atlantis     GHI

  • Q: I’ve heard bad things about several insurance companies, where can I find unbiased information.

    we provide excerpts from the NY state Insurance department on Consumer complaint ratios here

  • Q: I’m the only one in my family that needs health insurance; do I have to cover my dependents?

    No

  • Q: My current insurance is expiring and I have a pre-existing condition, will I be covered under the plans listed?

    An excerpt from the HIP application concerning pre-existing conditions.

    "I understand that pre-existing conditions will not be covered during the first 12 months of my enrollment under my group’s contract. A pre-existing condition is a condition (whether physical or mental) regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended by a duly licensed medical professional or received within the six (6) month period ending on the enrollment date. Except that, pregnancy is not considered a pre-existing condition and genetic information may not be treated as a pre-existing condition in the absence of a diagnosis of the condition related to such genetic information. HIP will credit the time I/we were covered by the previous policy, provided that the break in coverage under this plan does not exceed sixty-three (63) days, exclusive of any waiting periods. I agree that after enrolled, I will upon request provide HIP and/or my medical group with information on pre-existing conditions and any previous coverage I had. Subject to the applicable State and Federal laws pertaining to pre-existing conditions and creditable coverage, benefits for pre-existing conditions may not be payable for up to twelve months from my effective date under my group’s contract."

  • Q: I just found out that I'm pregnant and don’t have insurance. Can I purchase an insurance policy and be covered?

    Pregnancy is not considered a pre-existing condition, under the 3rd trimester.

  • Q: One of my children is in college, will they be covered under my family plan?

    Yes, as long as they meet the following definition.

    He/she is at least 19 years of age, unmarried, receives at least half of his/her support from the member, and is enrolled full-time in an accredited educational institution. The institution must grant a degree or diploma. The student must be listed as a dependent when you enroll for coverage.

  • Q: I don’t understand some of the insurance terms that you have on your web site.

    please visit our Insurance Terms Glossary which is part of our learning center.

  • Q: Where can I get information on your company.

    Most people turn to our Testimonials, BBB & the New York state insurance Department.