Common Mistakes That Disqualify a Business from Healthy NY
Applying for the Healthy NY program can be a great way for small businesses to access affordable health insurance. However, many applications are rejected due to simple eligibility mistakes. Below are the most common errors — and how to avoid them.
Mistake 1: Offering Health Coverage in the Past 12 Months
If your business has offered group health insurance that includes both medical and hospital benefits within the past 12 months — and contributed more than $50/month per employee — you are generally ineligible for Healthy NY.
Exception: If you offered only limited coverage or contributed below the threshold, you may still qualify.
Mistake 2: Misunderstanding the Wage Requirement
To qualify, at least 30% of employees must earn ≤ $53,650 annually. Common errors include:
- Counting bonuses or overtime in wage calculations
- Using outdated payroll data
- Not documenting part-time or seasonal wages correctly
Mistake 3: Incorrect Full-Time Equivalent (FTE) Count
Businesses must have 1–50 full-time equivalent employees. Errors often occur when:
- Part-time employees are under- or over-counted
- Independent contractors (1099s) are mistakenly excluded or included
- FTE hours are not calculated using IRS guidelines
Mistake 4: Missing or Incomplete Documentation
Healthy NY applications must include documents such as:
- Employee census with wage data
- Payroll records
- Proof of business location in New York State
- Signed contribution agreement
Missing even one required document can result in denial or processing delays.
Mistake 5: Low Participation or Incorrect Class Offering
Your business must:
- Offer Healthy NY to all employees working 20+ hours/week, earning ≤ $53,650
- Have at least 50% of those eligible employees enroll (or have other coverage)
- Ensure at least one enrolled employee earns $53,650 or less
Missing any of these criteria disqualifies your group.
Tips to Ensure Eligibility
- Use current payroll and wage data
- Double-check FTE counts against IRS rules
- Prepare all documents before applying
- Get help from a licensed broker to review eligibility
Need help avoiding these mistakes? Call (888) 215-4045 to speak with a licensed NY Health Insurer advisor or get a quote online.
Or return to our Healthy NY overview page to learn more.