Enrollment and Eligibility
Does my business have to provide Brooklyn HealthWorks coverage to all my employees?
Small businesses participating in the program must offer Brooklyn HealthWorks coverage to all eligible employees working more than 20 hours weekly and earning $41,250 or less annually.
Do all eligible employees have to obtain coverage through Brooklyn HealthWorks?
No. Of the eligible employees, at least 50% must obtain coverage through Brooklyn HealthWorks OR have coverage through another source, such as a spouse.
Can owners and managers of a company have coverage that is different from non-owners/non-managers?
Yes. Insurance regulation allows employers to offer different health plans to employees in distinct categories – as long as all eligible employees within a category are offered the same coverage on an equal basis. For example, managers at a business may have coverage through EmblemHealth or Oxford and non-managers may have coverage through Brooklyn HealthWorks.
Can individuals earning more than $41,250 per year obtain coverage through Brooklyn HealthWorks?
Yes, but at least one person making $41,250 or less must obtain coverage through Brooklyn HealthWorks.
How much does my business have to contribute towards Brooklyn HealthWorks coverage?
Unlike Healthy NY, we leave that choice up to decision makers at a business/organization. We do, however, encourage employers to contribute as much as possible towards monthly premiums and have found that most contribute 80% or more towards individual coverage. Providing and paying for health benefits are proven ways to attract and retain the most qualified employees for your business/organization.
Can my business offer Brooklyn HealthWorks coverage to my employees’ family members?
Yes. You may choose to offer coverage for dependents through Brooklyn HealthWorks. Qualifying dependents include spouses, domestic partners, young adults (married or unmarried) up to age 26, and unmarried young adults up to age 30 who are not eligible for employer-based coverage.
If your company offers spousal benefits, you must now offer same-sex spousal benefits to all legally married couples on an equal basis.
Employees who have a domestic partner may add his or her same-sex or opposite-sex partner during a group's annual renewal period. The only exception to this enrollment policy is if a domestic partner enrolls within 30 days of losing other coverage.
What happens to enrolled dependents when they turn 19? Do they age off a parent's plan?
No. Young adults age 19-25 may stay on an employee/child(ren) or family plan up to age 26. If a child dependent age 19-25 is not currently enrolled, they may be added to an existing employee plan upon a company's annual enrollment anniversary with Brooklyn HealthWorks or within 30 days of losing other coverage.
What happens when an enrolled dependent turns age 26?
Dependents turning age 26 will automatically be removed at the end of the month they turn 26. Unmarried dependents age 26-29 without access to employer-based health benefits may extend coverage through age 30; please contact our office for available options and pricing information.
If my business offers Brooklyn HealthWorks coverage to employees’ family members, do I have to contribute towards the cost of the premiums?
No, but we encourage all businesses to contribute as much as possible towards employee premiums and coverage extended to family members.
When can I sign up dependents or new hires seeking coverage through Brooklyn HealthWorks?
Dependents seeking coverage must sign up within 30 days of becoming eligible for coverage or wait until the annual anniversary date of the group's policy. For example, a spouse must enroll within 30 days of becoming married to a covered employee or within 30 days of losing health insurance coverage from his or her place of employment. Similarly, a newborn must be signed up within 30 days of birth.
New hires at a business must enroll within 30 days of becoming eligible for coverage. When businesses sign up for Brooklyn HealthWorks coverage, they determine their new hire eligibility policy by completing this simple form.
Can my business/organization offer coverage to seasonal workers and those working less than 20 hours per week?
Yes. If coverage is offered to these workers, you may include their wages when determining if your business qualifies for Brooklyn HealthWorks.
Is there a minimum number of hours a part-time employee must work to be eligible for coverage?
No. The only requirement is that a part-time employee be a regular worker and show up consistently on a group's quarterly NYS-45 (official state payroll record).
Can my business/organization provide coverage for independent (1099) contract workers?
Yes. You may provide coverage to legitimate independent contractors who consistently work for your company. Please note that we request a copy of each independent contractor's 1099-MISC annual income statement submitted to the IRS at the beginning of each year.
Can existing employees on payroll be added to my plan at anytime throughout the year?
No. All employees on payroll who want coverage must enroll at the time of original application. Existing employees who do not enroll immediately may be added only during a group's annual enrollment anniversary with Brooklyn HealthWorks. The only exception to this policy is if an employee enrolls within 30 days of losing other coverage.
When is the deadline to sign up for Brooklyn HealthWorks coverage?
To ensure timely approval of your application, please submit your completed application with all supporting documentation by 5 pm on the 15th of the month for coverage beginning the 1st of the following month. For assistance with completing the application and determining what supporting documentation is required, please e-mail Theresa Reyes at firstname.lastname@example.org or call her at 718-943-3884.
Does my business/organization have to be a member of the Brooklyn Chamber of Commerce to obtain coverage through Brooklyn HealthWorks?
No. Your business does not have to be a Member of the Brooklyn Chamber of Commerce. There are advantages to Chamber membership, however, such as access to monthly networking events attracting hundreds of other businesses and promotional opportunities in the Chamber’s widely circulated newspaper and print and online Member directories. Contact Theresa Reyes at email@example.com or 718-943-3884 for additional information about Chamber membership and to take advantage of this special offer.
Medical Plan Deductible / Health Savings Accounts (HSAs)
Do you have standard medical plan options (without a high deductible)?
No. As of January 2012 there are only high deductible plan options available for new enrolling groups. One plan has prescription drug coverage and the other one does not.
Why should I consider high deductible medical plans?
The monthly premiums on our high deductible plans are much cheaper than standard plan options available in Brooklyn--even when you add in the annual deductible to your monthly premium (averaging $100 per month for individual coverage and $200 per month for family coverage). If you stay below the annual deductible amounts, you are guaranteed to save money.
What happens when the deductible has been paid for the year? Does a subscriber have any additional out-of-pocket expenses?
Yes. A subscriber is responsible for applicable co-payments up to the annual maximum limit. After the annual maximum limit has been reached, GHI pays 100% of all covered claims until the deductible resets upon the group's annual enrollment anniversary with Brooklyn HealthWorks.
What is a health savings account (HSA)?
A HSA is an optional financing mechanism that may be established and funded when there is a qualified high deductible plan in place (such as Brooklyn HealthWorks). The money in a HSA may be used to pay for services when the deductible applies and for specialized services not covered under Brooklyn HealthWorks. You can even pay for qualified medical services for legal dependents--even if they do not have Brooklyn HealthWorks coverage. And unlike an FSA, unused funds at the end of the year can be rolled over indefinitely. For additional information about HSAs, click here.
Do employers have to contribute to HSAs?
No. Employers do not have to contribute to HSAs. If the goal, however, is to attract and retain key workers, then we encourage employers to contribute something to HSAs on a tax-preferred basis.
How much should an employer contribute to a HSA?
We leave this decision entirely up to the employer, and the amount may be zero. However, consider an amount below the individual deductible ($1,250) and family deductible ($2,500). By keeping the level below the deductible amount, employees have "skin in the game" and may be more thoughtful when making health care purchasing decisions.
Dental/Vision Plan Options
Do I have to offer dental/vision plan options to my employees? No. Our dental/vision plans are voluntary benefits, but we encourage employers to make both options available to employees as a way to attract and retain key workers.
Do I have to contribute to monthly premiums for dental/vision plans?
No. We leave this decision up to the employer. Consider the employer tax advantages when making this decision.
Do employees have to enroll in the same dental/vision plan?
No. Unlike our medical and life/disability plans, employees may enroll in either one of our dental/vision plan options?
What are the major differences between the two dental/vision plan options?
The DMO (preferred) plan requires care to be provided by or coordinated by a primary care dentist. In addition, the DMO plan is an in-network only plan, and the number of providers in this network is smaller than the PPO (premier) plan network. For the PPO plan you may have care provided by any dentist both inside and outside of the network. For additional plan differences, click here.
Why is the annual limit $1,000 for the PPO (premier) dental plan?
We have intentionally kept the annual limit modest to maintain affordable monthly premiums. In addition, very few subscribers ever reach this annual limit.
Is there a re-certification process?
Yes. On an annual basis, employers with Brooklyn HealthWorks coverage are required to submit a simple re-certification form that attests to their continued eligibility for the program. We will send you renewal paperwork approx. 90 days before your enrollment anniversary.
What changes can I make to my plan(s) during my annual re-certification period?
You may make the following changes during your annual enrollment anniversary with Brooklyn HealthWorks: 1) change medical plan, 2) add, change, or drop dental/vision plans, 3) add life/long-term disability plans, 4) change your new hire eligibility waiting period policy, 5) add existing employees to a plan, 6) add dependents of existing employees to a plan, and 7) change whether your company allows coverage for dependents and/or part-time workers.
What if my business/organization qualifies for Brooklyn HealthWorks and things change? For example, what if some of my employees drop coverage and my company no longer satisfies the 50% employee participation requirement? Would my coverage then be terminated?
Mid-year fluctuations in group size, wage levels and employee participation will not result in immediate termination of Brooklyn HealthWorks coverage. However, Brooklyn HealthWorks requires an annual re-certification process at which time your business’ eligibility will be reevaluated. If your business does not meet the eligibility criteria at the time of re-certification, you will be unable to continue to participate in the program.
Benefits And Provider Networks
What medical benefits are covered through Brooklyn HealthWorks?
Most medical and hospital services are included in Brooklyn HealthWorks coverage and prescription drugs may be added as an optional benefit. For a summary of benefits and associated co-payments and deductible, click here.
Are medical pre-existing conditions covered through Brooklyn HealthWorks?
There is a twelve-month waiting period for benefits for any condition, disease or symptom for which medical treatment or advice was recommended or received within the six-month period prior to the enrollment date. There will be no coverage for pre-existing conditions during this waiting period. This waiting period will be reduced to the extent that you are entitled to a credit for coverage under a previous health plan and did not have a lapse in coverage of 63 days or more. These pre-existing condition exclusions no longer apply to children.
Will my doctor accept Brooklyn HealthWorks coverage?
Most doctors in the New York City area accept Brooklyn HealthWorks coverage. To determine if your doctor will accept Brooklyn HealthWorks coverage, you can ask him or her directly if they accept GHI or go to GHI’s Website and enter “Healthy New York EPO” as the plan under "Find a Doctor". Existing subscribers may simply enter their GHI ID # found on their insurance card. For provider information on all Brooklyn HealthWorks plans, click here.
What happens if I go out of network to see a medical doctor or specialist?
With the exception of medical emergencies, all claims submitted from a provider not participating in GHI’s Tri-State network will not be covered, and the individual subscriber will be responsible to pay 100% of the claim.
Do I need a referral to see a medical specialist?
No. You do not need a referral to see a specialist as long as you see a GHI provider in the Tri-State network and the service provided is medically necessary. We do, however, strongly advise that you develop a relationship with a primary care physician who can help you maximize your medical benefits and reduce the chances of going out of network. Also, for any high dollar diagnostic test or other non-emergency service, we suggest your provider's office check with GHI beforehand to verify the medical claim will be covered.
Customer Service and Brokers
After I’m enrolled with Brooklyn HealthWorks, who do I contact to add or drop an employee from coverage?
All changes to your policy should be made through Brooklyn HealthWorks – not GHI or Guardian. We will work with these insurance carriers to make sure all changes are made in a timely manner.
Who do I contact about unpaid medical claims?
GHI processes all medical claims for Brooklyn HealthWorks. You should begin by calling GHI customer service (800-624-2414) to clarify any issues involving medical claims. If you still have questions about a specific unpaid claim for any Brooklyn HealthWorks plan, please contact our office at 718-596-4550.
Why does Brooklyn HealthWorks use insurance brokers?
We rely on brokers to personally help businesses with the enrollment process and assist them with other matters that may arise throughout the year.
Do I have to use a Brooklyn HealthWorks broker or may I continue to use my own broker?
You may use any licensed insurance broker with the New York State Department of Financial Services. Brokers selling Brooklyn HealthWorks must have a signed selling agent agreement and selling agent appointment through our insurance carrier, GHI.
How much does it cost to have a broker help me with the enrollment process?
A broker commission is built into many small group health insurance plans, including Brooklyn HealthWorks. You pay the same monthly premium regardless of whether a broker assists you or not. For information about Brooklyn HealthWorks broker compensation, including commissions paid on non-medical plan options, please contact our office at 718-596-4550.
Payment Due Date and Payment Methods
When are premium payments due?
To avoid disruption of individual employee coverage or mandatory termination of your group policy for non-payment of premium, all payments are due on the 1st of each coverage month.
May I pay with a credit card?
No. Credit card processing fees are not built into your monthly premium. You may pay online using our account management system (contact our office for your username and password), by phone (866-260-2015), or by mail to the address on your monthly invoice.
Terminating Employees From Coverage
Can I continue providing coverage to employees who are no longer on payroll?
Only business owners/partners and active employees on payroll may continue coverage with Brooklyn HealthWorks. Once an employee is terminated from employment or is no longer on payroll, they must be terminated immediately from coverage. We can only terminate an employee and dependents going back 30 days from a written request and only if covered individuals did not use benefits within the previous 30 days.
Do employers have to inform employees they may extend Brooklyn HealthWorks coverage (through COBRA) after they are terminated from the group plan?
Yes. Employers must inform employees in writing they are eligible to extend Brooklyn HealthWorks coverage for up to 36 months. Terminated employees have 60 days to elect COBRA coverage; the effective date of COBRA coverage is the day after they are terminated from the group plan--regardless of when we are notified during the 60 day window.
Will I be invoiced for employees on COBRA?
No. We directly invoice employees on COBRA.
Guardian Life/Long-term Disability Plans
Why should I make life/long-term disability plans available to my employees?
Most employees at small companies do not have access to life/long-term disability benefits, so making these plan options available to your employees may help you attract and retain key employees. Life/long-term disability benefits are the second most frequently requested employee ancillary benefits (dental/vision are the most popular non-medical benefits).
Do I have to contribute to monthly premiums for life/long-term disability plans?
No. You do not have to contribute to monthly premiums if you make life/disability plan options available to your employees.
To learn more about our life/long-term disability plan options, please click here.
Guardian State Mandatory Short-term Disability Plans
Do I get discounts if I enroll in your state mandatory disability plans?
Groups who pre-pay their annual premium and those who have enrolled in our dental/vision plans are eligible for significant discounts. For a free quote to see if you can save on your state mandatory disability benefits, please call our office at 718-596-4550.