Marketplace SHOP 2018/2019

MetroPlus Health Plan offers four Small Business (SHOP) health plans through the NY State of Health, The Official Health Plan Marketplace. These plans are available to businesses with 100 or fewer employees. Some businesses with 25 or fewer employees may qualify for a federal tax credit of as much as 50% of employer's contribution. 

OUR 2019 MARKETPLACE SHOP PLANS ARE HERE! SEE DETAILS BELOW.

Learn if you qualify

Our cost treatment calculator is intended for individuals who are uninsured or covered by private insurance. Cost estimates reflect health care professional fees and are not the negotiated rates which may be available through insurance plan networks. 

Calculate Costs 

 

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2018 Small Business (SHOP)*
Product  BronzePlus B4 SilverPlus S4 GoldPlus G4 PlatinumPlus P4
Product Type Small Business (SHOP) Small Business (SHOP) Small Business (SHOP) Small Business (SHOP)
Premium (1st Quarter) $453.94 $516.80 $604.54 $709.07
Premium (2nd Quarter) $462.27 $526.28 $615.64 $722.09
Premium (3rd Quarter) $470.76 $535.95 $626.94 $735.35
Premium (4th Quarter) $479.40 $545.79 $638.46 $748.85
Deductible (Individual) $4,000 $2,000 $600 $0
Deductible (Family) $8,000 $4,000 $1,200 $0
Max out of Pocket (Individual) $7,150 $6,750 $4,000 $2,000
Max out of Pocket (Family) $14,300 $13,500 $8,000 $4,000
PCP 50% $30 $25 $15
Specialist 50% $50 $40 $35
Prescription Drug** $10/$35/$70 $10/$35/$70 $10/$35/$70 $10/$30/$60
Adult Dental/Vision No No No No
Pediatric Dental / Vision Yes Yes Yes Yes
Mail Order RX Yes Yes Yes Yes
Exercise Facility Reimbursement Yes Yes Yes Yes

* This chart is a brief description of benefits for plan. 
** Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand
 Deductible must be met first before cost sharing begins. Family cost is multiplied by (2).

Premiums listed are example base rates for individuals. Rates may differ based according to family size, income level, and eligibility for tax credits.

Our 2018 Premium Rates Sheet, listing quarterly premium rates by plan, can be found here.

2018 Employee Enrollment Form (editable) Español   中文 
2018 Employer Enrollment Form (editable)  Español  中文
 
2018 Enrollment Waiver Form (editable)       Español   中文 



2019 Small Business (SHOP)*
Product  BronzePlus B4 SilverPlus S4 GoldPlus G4 PlatinumPlus P4
Product Type Small Business (SHOP) Small Business (SHOP) Small Business (SHOP) Small Business (SHOP)
Premium (1st Quarter) $521.34 $579.02 $692.73 $805.92
Premium (2nd Quarter) $529.15 $587.69 $703.09 $817.98
Premium (3rd Quarter) $537.07 $596.48 $713.61 $830.22
Premium (4th Quarter) $545.10 $605.41 $724.29 $842.65
Deductible (Individual) $4,000 $1,700 $600 $0
Deductible (Family) $8,000 $3,400 $1,200 $0
Max out of Pocket (Individual) $7,600 $7,500 $4,000 $2,000
Max out of Pocket (Family) $15,200 $15,000 $8,000 $4,000
PCP 50% $30 $25 $15
Specialist 50% $50 $40 $35
Prescription Drug** $10/$35/$70 $10/$35/$70 $10/$35/$70 $10/$30/$60
Adult Dental/Vision No No No No
Pediatric Dental / Vision Yes Yes Yes Yes
Mail Order RX Yes Yes Yes Yes
Exercise Facility Reimbursement Yes Yes Yes Yes

* This chart is a brief description of benefits for plan. 
** Prescription Drug: Generic / Formulary Brand / Non-Formulary Brand
 Deductible must be met first before cost sharing begins. Family cost is multiplied by (2).

Premiums listed are example base rates for individuals. Rates may differ based according to family size, income level, and eligibility for tax credits.

Our 2019 Premium Rates Sheet, listing quarterly premium rates by plan, can be found here.

2019 Employee Enrollment Form (editable)  Español   中文 
2019 Employer Enrollment Form (editable)   Español  中文 
2019 Enrollment Waiver Form (editable)        
Español   中文 

All MetroPlus SHOP members have access to a mail order option for their medications. Access the mail order form here: https://www.caremark.com/portal/asset/mof_unauth.pdf

Tax Credits

Small Businesses can qualify for tax credits of up to 50% of the employer cost of premiums.

To be eligible, your business must:
  • Have fewer than 25 full-time equivalent employees (FTEs), who have average wages of $50,000 or less per year.
  • Cover at least 50% of the cost of single (not family) health care coverage for each of your employees.
  • Purchase insurance through the Small Business Marketplace to be eligible for the credit for tax years 2017 and beyond. If your business did not owe tax during the year, the credit can be carried forward or applied back to other tax years.

If your business is tax-exempt, the credit is refundable. You may be eligible to receive the credit as a refund, if it does not exceed your income tax withholding and Medicare tax liability.

  

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 Certificate of Coverage 
Small Business (SHOP) 2018 English Español 2019 English  Español
BronzePlus B4 Download Download Download Download
SilverPlus S4 Download Download Download Download 
GoldPlus G4 Download Download Download Download 
PlatinumPlus P4 Download Download Download Download 

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Additional Member Resources
Marketplace Small Business (SHOP) 2018 English Español 2019 English Español
Young Adult Rider Download Download Download Download
Women’s Health and Cancer Rights Act Download Download Download Download