October 23, 2013

NYSAHU Local Chapters Host NY State of Health (NYSOH) Exchange Meetings

On October 22, 2013, the GCNYAHU and NENYAHU Chapters hosted meetings for members on the the NYSOH Exchange.   A special thank you to Joe Maldoon and Kelly Smith for taking the time to address NYSAHU members.


Erin Nevins graciously submitted her notes on the NENYAHU meeting:



  1. NYS Confirmed that the Child Health Plus (CHP) meets the Pediatric Dental requirement, and that the ped. Dental benefit was mirrored after CHP
  2. NYS sent out a Survey Monkey to all brokers - they really want our feedback - please check to see if you got the email or request from Amy Graybeck
  3. Large Group & NYS Exchange:  There was discussion about this scenario:
    1. A group of 80 employees, only 49 are FTE (based on the COMPANY definition of Full time - 40 hours week) (Group gets to define their FULL TIME status) - No need for NYS-45 - group or broker can sign an attestation to NYS that would allow this company size to participate on NYS SHOP Exchange.  When uploading the employees to the SHOP - only upload ELIGIBLE employees, not total employees.
    2. Also - if a group is either at or below 50 at the time they enter the SHOP - and group grows during the course of a year - they are considered grandfathered and allowed to continue on the SHOP platform.  The reason for this decision was because the Federal Definition of 2-100 will take effect on 1/1/16 and they do not want businesses that grow to move off then back on to the SHOP - it is disruptive
  4. There was a discussion about broker information not being correct on the NYS exchange - NYS responded by saying that there is a problem with the FEED from DFS and they are aware and actively working on it.  Although the "Cell Phone" is showing for all brokers, you can leave it as a cell phone category but change the number to your actual business number for now - since it pulls from the "CELL PHONE" field at DFS
  5. It appeared that in broker dashboard you could only select one business size, one carrier affiliation, etc.  State responded and said in order to select multiple options, you must hit "Ctrl" or "Shift" on your keyboard to select multiple criteria.
  6. NYS discussed their billing policy and cycle.  Kelly Smith stated that SHOP would not allow a 30 day grace period - however a NAHU member from the audience pointed out to her that it was in the LAW that there had to be a 30 day grace period.  Kelly Smith called me later that evening to retract her statement and said that indeed there is a law in place to allow 30 day grace.  She said she would send me the billing policy for SHOP - I will forward to you when received.
  7. NYS walked through a couple of on-line videos to demonstrate the process to complete the certification process and get online with NYS, as well as how to add a GROUP.  Kelly Smith stated that these tutorial videos will be available and posted to their website by end of business today. 
  8. NYS said that the Tax credit is tied to the 2nd lowest Silver Plan by County
  9. NYS stated 4 Value Propositions to use NYS Exchange -
    1. Choice
    2. Administrative Simplicity
    3. Tax Credits
    4. Contribution options (multiple options offered)
  10. Some brokers asked questions pertaining to employees that live both in and out of state -  Kelly Smith stated that there are NO MINIMUM Participation or Contribution Requirements for small businesses on the SHOP. She did stress that NETWORK may dictate that decision for a small business.
  11. A questions was asked about companies where employees do not have emails or access to a computer.  NYS suggested that a business could set up free GMAIL accounts for the employees and place a computer in a location within the company for employees to utilize.
  12. NYS stated that GROUPS on SHOP would renew based on plan year and that all the individuals would renew on a calendar year cycle.


A reminder, NYSAHU is working in close collaberation with the NY State of Health to resolve issues as quickly as possible.  If you identify an issue that is effecting the entire broker community, please email nysahu@gmail.com.

NYSAHU Member Questions?
You asked, NY State of Health Answered

NYSAHU received several questions in our mailbox.  Several have been answered by our local experts.   If you asked a question and do not see an answer below, please be patient as we work with New York State for a response. 


NYS needs to hold a webinar to review how to enroll individuals on the exchange and also how to enroll a gorup on the exchange?


Now Available: Video Demonstrations of Individuals & Families Application and Producer Registration & Account Set Up - Click here


When one spouse is applying for coverage and the other is not (has through employer, Medicare, etc) and they file separately, can one spouse who is seeking a subsidy only use that persons income?


Subsidy is based on household income, filing status is irrelevant in this sense, so both incomes would apply.  Remember, eligibility for a subsidy is based on the spuse being offered affordale insruance as well, so if one spouse is offered affordable single insurance at work, it will negate the spouse's ability to get a subsidy, even if they file separately.



If you have a question or suggestion for NYSOH, you can submit to the NYSAHU member mailbox at nysahu@gmail.com. Please keep in mind that NYSAHU is a 100% VOLUNTEER organization.  The volunteers feel strongly about protecting our industry and working for the best interest of the entire broker/agent community in NYS.   Please keep your comments and questions professional and correctly written. 


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NYSAHU encourages you to seek any professional advice, including legal counsel and/or a professional tax consultation, regarding how the new requirements will affect you, your business or your client's specific plans.  Information presented by NYSAHU is prepared using the most current information available and will not necessarily be updated if guidance should change.  Insurance and tax laws and interpretations of those laws are complex and subject to change.  None of the information herein is intended or written to be used, and it cannot be used, for the purpose of avoiding taxes or penalties that may be imposed.

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