HealthPass is a private insurance exchange offering employers and their employees in the New York Metropolitan area flexible cost effective solutions for their healthcare needs. Since 1999, the HealthPass choice model has empowered members to individually select their plans based upon their unique needs and budgets. HealthPass offers a well-rounded menu of options offered through industry leading carriers with choices including health, dental, vision, life and disability coverage. Agents, employers and members benefit from the state of the art technology and extensive support provided by the HealthPass team including a streamlined administrative process, member-claims advocacy, COBRA Administration and knowledgeable client services.
Health insurance exchanges are an innovative concept based on economist Alain Enthoven’s theory of managed competition and supported by stakeholders on both sides of the political aisle, a health insurance exchange creates a structured marketplace where employees can chose their health insurance based on quality and value.
Employees of a small and medium size business are typically given very limited choice – usually only one or two options – when it comes to health insurance. Exchanges transform that dynamic by creating an organized and competitive marketplace that offers a choice of health benefit designs, health insurance carriers, and provider networks. Exchanges also provide the business owner with a comprehensive set of “back office” services that streamline employer-based health benefits administration while simultaneously supplying employees with personalized support to help them navigate their healthcare from initial sign-up to renewal.
Through HealthPass, each employee can choose a different insurance carrier and health plan design through the HealthPass Online Portal (HOP) or by using one universal enrollment form.
After electing HealthPass as their group coverage, employers select the premium tier structures, set a defined dollar contribution and designate which ancillary offerings will be made available to employees.
Employees then choose a medical carrier, health plan and ancillary products (if made available by their employer).
The employer receives one consolidated list invoice from HealthPass and makes one payment per month regardless of the number of different plan options chosen by employees.
Throughout the plan year, members can take advantage of robust in-house Client Services as well as health and medical cost advocacy services.
Under the Affordable Care Act (ACA), health insurers must offer plans within health insurance exchanges that meet distinct levels of coverage in the "metal tiers": Platinum, Gold, Silver and Bronze. Each metal tier corresponds to an actuarial value, and the actuarial value of a plan is based on the percentage of costs a health plan covers in relation to how much the member is expected to pay. The actuarial value of each metal tier is as follows: Platinum 90%, Gold 80%, Silver 70%, Bronze 60%.
There are several ways HealthPass saves employers and their employees money. By setting a defined contribution (DC) amount for each employee, employers can easily set a benefits budget. Also, employees can choose a plan which meets their needs without overspending for unused benefits. With access to over 70,000 providers, collectively participating in our networks, employees are more likely to find their doctors in one of our carrier’s networks - thus reducing potential out of pocket costs.
Businesses and non-profits with a company address in New York City (5 boroughs), Long Island, Westchester, Rockland, Orange, Putnam, Dutchess, Sullivan or Ulster counties can enroll. Employees of those companies who live in New York State, New Jersey, Connecticut and Bucks County, Pennsylvania are eligible to enroll. Additionally, up to 75% of enrolling employees who live outside these areas can be enrolled in HealthPass.
Yes, all plans cover prescription drugs with benefits varying by plan. All of our medical carriers offer a mail order program to receive certain medications conveniently at your home.
75% of eligible employees must be covered through HealthPass or have other medical coverage such as spousal, individual, COBRA, government, employer sponsored, parental or exchange coverage. To offer HealthPass, groups must have 1 to 100 employees based on the Full Time Equivalent (FTE) method calculation which is
FTE = total number of FT employees who work 30 hours per week + total hours for PT employees divided by 30. Groups must have an active business address in one of the five boroughs of NY (Manhattan, Brooklyn, Queens, Bronx or Staten Island), Nassau, Suffolk, Westchester, Rockland, Orange, Putnam, Dutchess, Ulster or Sullivan counties.
No, there must be another eligible common law employee in the group.
All of them! Through HealthPass, each employee can choose a different plan using the HealthPass Online Portal (HOP) or one universal enrollment form, while you get one invoice and make only one payment a month, regardless of the number of plans your employees choose.
Yes! HealthPass gives employees the power to access to over 700,000+ providers. In addition, each employee will be able to select a plan with an out-of-network benefit if their physician does not participate in their chosen network. To find your physician, hospital or dentist, click here. Each of our partner carriers offer added value benefits and discounts. Members can take advantage of these discounts in addition to the comprehensive benefits included in their respective plan designs. Some of these added value benefits include, but are not limited to: discounts at participating vision centers, fitness clubs, weight loss centers, apparel and footwear retailers, child safety products, vitamin/ herbal supplements and much more!
HealthPass has one effective date, the 1st of any month. Enrollment material must be received by the 20th day of the preceding month.
HealthPass offers a number of dental options through two comprehensive carriers; Guardian and Solstice. The dental options available allow members and their families the ability to access quality and affordable dental care.
HealthPass offers two vision plans through Guardian and Solstice. Both plans access the Davis Vision network. Exams and materials, such as lenses, contact lenses and frames are covered and members can visit any doctor they wish using both in and out-of-network benefits.
EverGuard and EverGuard Plus are bundled security products offered by HealthPass through Guardian. The EverGuard family of products make it easy to offer your employees the personal protection they need at affordable rates. No medical evaluation is required and no industry is excluded.
All employees enrolled in medical coverage, excluding COBRA members, have access to this advocacy. Health Advocate uses registered nursed to help members solve problems and find solutions related to their healthcare and health insurance needs, such as finding doctors and hospitals, resolving insurance claims, and obtaining approval for needed services.
A Premium Only Plan is one of the simplest benefits an employer can offer and it delivers real savings to employers and their employees. By allowing employees to pay their portion of premium costs BEFORE taxes, employees typically save 25% or more, and the employer benefits from nearly 8% in FICA savings.
By consulting a licensed NYS insurance broker or HealthPass directly, together we will take the time to review your current benefits package and evaluate how to best structure HealthPass as a solution for your business. If you are in need of assistance, please call us at 888.313.7277.