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New York Changes Small Group Definition Again

November 6th, 2018

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New York Changes Small Group Definition Again

Insurance Legislature  |  Self-funded  |  Group Health Plans

Under New York law and the Patient Protection and Affordable Care Act (ACA), the definition of "small group," as it relates to health plan eligibility, was established to be 1-100 employees, as of January 1, 2016.


Shortly thereafter, NY legislation enacted a series of laws that allowed existing self-funded stop-loss plans for groups of 51-100 to be renewed for up to three years, considering that otherwise the new classification of small groups (1-100) would have been prohibited by law from purchasing stop loss.


In October 2017, Governor Andrew Cuomo signed bill A.8264 into law, allowing grandfathered stop-loss contracts for groups of 51-100 to renew until January 1, 2019. As groups like the Self-Insurance Institute of America (SIIA) had been advocating for years, legislators were now beginning to understand that access to stop-loss insurance is the most cost-effective approach to provide comprehensive group health benefits at the lowest possible cost to the employer and employee—more affordable options means more access to healthcare, which means a healthier market.


Which leads us to today, stop-loss insurance for groups that employ 100+ employees,  but have fewer than 100 employees actually enrolled in the health plan.  These New York groups can self-insure and purchase medical stop-loss insurance.


When these changes go into effect on December 28, 2018, many such NY-based employer groups will find that self-funded insurance, with the added peace of mind that medical stop-loss insurance offers, is an attractive financial alternative to traditional fully-insured plans that may treat the employer as a community-rated small group plan. 


Will these changes impact your clients? Maybe it’s time to reevaluate self-funded health plans for your New York group health clients, to save them money while maintaining or improving their plan of benefits to meet the needs of their unique employee population. For more information on self-funding and how to get started, reach out to Matt Fry at