Key Takeaways
- New York group health insurance is regulated under both state and federal law (ERISA, ACA)
- COBRA continuation coverage applies to employers with 20 or more employees
- New York has state continuation coverage for employers with fewer than 20 employees
- Small group defined as 1-100 employees in New York
- Mental health parity (Timothy's Law) requires equal mental health benefits
New York Group Health Insurance
New York group health insurance is heavily regulated at both state and federal levels to protect employees and their dependents.
Regulatory Framework
| Regulation | Applies To |
|---|---|
| ERISA | Most private employer plans |
| ACA | All health plans |
| NY Insurance Law | Insured group plans |
| Timothy's Law | Mental health parity |
Group Size Definitions
New York uses these group size definitions:
| Market Segment | Employee Count |
|---|---|
| Small Group | 1-100 full-time equivalent |
| Large Group | 101 or more full-time equivalent |
Note: New York extended the small group definition to 100 employees, which is larger than the federal definition of 50 employees.
Small Group Requirements
New York small group health insurance must provide:
- Guaranteed issue (cannot deny coverage)
- Community rating (no health-based rates)
- Essential health benefits
- Mental health parity (Timothy's Law)
- No pre-existing condition exclusions
COBRA Continuation Coverage
The federal COBRA law requires continuation coverage:
COBRA Basics
| Aspect | Requirement |
|---|---|
| Applies To | Employers with 20+ employees |
| Duration | 18-36 months depending on event |
| Premium | Up to 102% of group rate |
| Coverage | Same as active employees |
Qualifying Events
| Event | Duration |
|---|---|
| Employment termination | 18 months |
| Reduced hours | 18 months |
| Divorce/legal separation | 36 months |
| Death of employee | 36 months |
| Medicare entitlement | 36 months |
| Dependent child aging out | 36 months |
Exam Tip: COBRA applies to employers with 20 or more employees. For smaller employers, New York provides state continuation coverage.
New York State Continuation Coverage
For employers with fewer than 20 employees, New York provides continuation coverage:
State Continuation Coverage
| Aspect | New York Requirement |
|---|---|
| Applies To | Employers not subject to COBRA |
| Duration | 36 months |
| Premium | At group rate (plus 2% admin) |
| Coverage | Continuation of group benefits |
Important: New York's state continuation is 36 months - more generous than federal COBRA's 18 months for termination events.
When State Continuation Applies
- Employee loses coverage due to termination or reduced hours
- Dependent loses coverage due to qualifying event
- Not eligible for COBRA
Mental Health Parity - Timothy's Law
New York's Timothy's Law requires mental health parity in group health plans:
Parity Requirements
| Aspect | Must Be Equal |
|---|---|
| Copays | Same as medical/surgical |
| Deductibles | Same as medical/surgical |
| Annual Limits | Same as medical/surgical |
| Lifetime Limits | Same as medical/surgical |
| Treatment Limits | Same as medical/surgical |
Covered Conditions
Timothy's Law applies to:
- All mental health conditions
- Substance use disorders
- Autism spectrum disorders
- Behavioral health conditions
HIPAA Portability
Group health plans must comply with HIPAA portability:
Key HIPAA Provisions
- Cannot deny enrollment based on health status
- Must provide certificate of creditable coverage
- Limits pre-existing condition exclusions
- Protects against discrimination
What is the minimum employer size for federal COBRA to apply?
What does Timothy's Law require in New York group health plans?
What is the definition of a small group in New York?
How long is New York state continuation coverage?