Health Insurance Exchange FAQs

Get answers to questions that are frequently asked by HealthPass members.

Frequently Asked Questions

What is HealthPass New York?

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.

What is a health insurance exchange?

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. 

How does the HealthPass private insurance exchange model work?

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.

What is a metal tier?

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%.

How will HealthPass help me save money?

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.

Who can enroll?

Businesses and non-profits with a company address in one of the five boroughs of NYC (Manhattan, Brooklyn, Queens, Bronx or Staten Island), Nassau, Suffolk, Westchester, Rockland, Orange, Putnam, Dutchess, Ulster or Sullivan counties. 20% of the total eligible employees must enroll with a HealthPass medical plan and 75% of the eligible employees must either enroll in HealthPass or have other credible medical coverage.

Do the plans cover prescription drugs?

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.

How many employees must participate in the medical plan?

20% of the total eligible employees must enroll with a HealthPass medical plan. 75% of the eligible employees must either enroll in HealthPass or have other credible medical coverage (see page 4 for valid waiver criteria). All employees waiving coverage must complete the required sections of the application.

Who is eligible?

  • Groups must have at least one common law employee and the common law employee cannot be a spouse or a relative with ownership.
  • Partnerships with no common law employee(s) are not considered a group.
  • Corporations (LLCs, S and C Corporations) do not require a common law employee(s) so long as the corporation has at least two owners who are not married to each other.
  • Full-time employees must work a minimum of 20 hours per week. The employer may choose to raise the minimum standard up to 40 hours per week but must remain consistent for all employees.

Can husband and wife only businesses be considered eligible?

No, there must be another eligible common law employee in the group.

How many plans can I offer my employees?

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.

Will my employees and I be able to keep our current doctors?

Yes! HealthPass gives employees the power to access to over 70,000+ 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!

When can I start coverage for my business?

HealthPass has one effective date, the 1st of any month. Enrollment material must be received by the 20th day of the preceding month.

What is HealthPass Dental?

HealthPass offers a number of dental options through Guardian, Solstice and UnitedHealthcare. The dental options available allow members and their families the ability to access quality and affordable dental care.

What is HealthPass Vision?

HealthPass offers vision plans through Guardian, Solstice and UnitedHealthcare. 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.

What is HealthPass EverGuard?

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.


  • $1,000 per month of Disability Income
  • $25,000 of Term Life Insurance
  • $75,000 of Accidental Death & Dismemberment Insurance

EverGuard Plus:

  • $1,500 per month Disability Income
  • $50,000 of Term Life Insurance
  • $100,000 of Accidental Death & Dismemberment Insurance

What is Health Advocate?

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.

What is a Section 125 POP Kit?

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. Get your POP Kit today!

With so many plans what is the right choice for us?

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.

How do I get a quote?

It's easy! Just click here or call 888-313-7277 to speak with a HealthPass representative or contact your broker.