Traditional Group Health Plans for Employers
Employer-sponsored health insurance is one of the most valuable benefits a company can offer its employees. Whether purchasing directly from an insurance carrier or through HealthyNY, businesses have options to provide quality coverage while balancing costs.
Clear Benefits Advisors helps companies navigate plan selection, subsidy structuring, and compliance requirements to ensure a seamless and compliant health insurance offering.
Types of Employer Group Health Plans
With help from us, employers have two main options for traditional group health insurance:
- Direct to Carrier – Standard group health plans purchased directly from an insurance company.
- HealthyNY – A state-supported plan for small businesses meeting specific requirements.
- HealthyNY has strict eligibility guidelines that some businesses may not qualify for or want.
Learn More About HealthyNY → ER Group Plans àHealthNY
- HealthyNY has strict eligibility guidelines that some businesses may not qualify for or want.
Eligibility for Traditional Group Plans
- Employers must have at least two employees, with at least one not being a key owner or family member.
- Plans are available in different metal levels (Platinum, Gold, Silver, Bronze) to provide varying levels of coverage.
- Companies can choose how much to subsidize employee premiums, whether by percentage, flat amount, or varying levels for different employee classes.
- Employers can start a plan anytime of the year but the plan must start on a first of the month.
Comparing Plan Levels: Employer Pros & Cons
| Plan Level | Employer Pros | Employer Cons |
|---|---|---|
| Platinum | Richest coverage; attracts top talent; minimal out of pocket costs | Highest premium cost |
| Gold | Good balance of coverage and cost; lower deductibles; midline out of pocket costs | Higher premiums than Silver or Bronze |
| Silver | More affordable premiums; moderate cost-sharing for employees; hybrid (co-pay/deductible) offered | Employees may face midline to higher deductibles and copays |
| Bronze | Lowest employer premium cost; meets ACA requirements; baseline coverage; good for HSA | High deductibles; employees pay more out-of-pocket |
Employers may offer several mix and match plans for different employee classes (e.g., salaried employees get Gold/Platinum, while hourly employees get Silver/Bronze).
Find the Right Group Plan for Your Business
Employer Health Insurance Subsidies
While not required, many businesses offer health insurance subsidies as part of their employee benefits package.
- Employers may cover a percentage or a flat dollar amount of premiums.
- Subsidies can be limited to individual coverage or extended to dependents/families.
- Subsidy structures must be consistent across employee types to avoid discrimination lawsuits.
We help businesses develop subsidy strategies that align with their budget and compliance requirements.
Schedule a Free Subsidy Strategy Review
High Deductible Health Plans (HDHP) & Health Savings Accounts (HSA)
- Employers offering High Deductible Health Plans (HDHPs) can pair them with Health Savings Accounts (HSAs).
- HSAs allow employees to contribute tax-free money from their paychecks to cover medical expenses.
- Unlike FSAs(Flexible Spending Accounts), HSA funds roll over year after year and can be used during Medicare.
- Yearly maximum contributions are based on household size: single or family. Talk to a payroll specialist or CPA for yearly specifics.
- Employers may choose to contribute to employee HSAs as an added benefit.
The Underwriting & Enrollment Process
Clear Benefits Advisors streamlines the group health insurance application process by reviewing all required documents before submission to the carrier.
What to Expect When Applying for a New Plan:
- Employers submit required documentation. For Example:
- Prior Year Tax Return
- Payroll NYS-45 statement
- EIN & SIC numbers
- Enrollment forms for companies and employees
- Waiver forms
- Rate Sheet Confirmations
- Enrollment Eligibility form
- Clear Benefits Advisors reviews paperwork to minimize delays.
- The insurance carrier’s underwriting team usually requests additional information before final approval.
- Once approved, coverage begins on the 1st of the chosen month and renews annually on that date.
Enrollment Timing & Deadlines
To ensure a smooth and timely enrollment, employers and employees must adhere to strict deadlines.
- All paperwork must be submitted to the insurance company by the 15th of the month prior for the plan to start on the 1st of the following month.
- To allow time for review, we request that all paperwork be submitted to Clear Benefits Advisors by the 1st of the month prior to the start date.
- If any documentation is incomplete, we will notify you promptly to avoid delays in plan approval.
Submitting paperwork early ensures a hassle-free process and prevents last-minute issues with enrollment.
Annual Plan Renewals & Changes
- Employer group plans renew on the same month each year.
- Renewal requires a simple one-page form to keep the plan active.
- Businesses can review plan offerings and subsidies annually to adjust benefits as needed.
- Different employee classes can have different plan options and subsidies (e.g., salaried employees get full single coverage; hourly employees have different choices).
We work with businesses each year to reassess their plans and optimize costs.
Schedule Your Annual Plan Review
Changing Brokers or Insurance Carriers
Changing the Broker of Record (BOR) Without Changing Plans
- Employers can retain their current health insurance plan while switching to Clear Benefits Advisors as their Broker of Record.
- This requires a simple, one form to transfer service and commissions.
Changing Insurance Companies
- Employers are able to switch carriers any time of the year to offer different plans or adjust their renewal date.
- This requires new paperwork and underwriting approval.
Our team can help you determine the best option for your business.
Request a Broker of Record Change
Why Work With Clear Benefits Advisors?
- We simplify the employer health insurance process from selection to enrollment.
- We provide strategic guidance on subsidy structures and plan offerings.
- We assist with renewals, plan changes, and compliance to ensure long-term success.
- We partner with you for annual reviews, employee changes throughout the year and more.
