Marketplace SHOP Plans 2018

MetroPlus Health Plan offers Small Business (SHOP) health plans certified by and promoted by the NY State of Health (NYSOH), The Official Health Plan Marketplace (https://nystateofhealth.ny.gov/).  Currently, we offer the lowest-priced health insurance plans available in New York City. 

SHOP is open to businesses that have a main office in New York and have 100 or fewer full-time-equivalent employees. 

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 

← scroll →

Small Business (SHOP)* Plans - At-a-Glance
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.

FOR INDIVIDUAL PLAN INFORMATION, SEE BELOW:

BronzePlus B4    SilverPlus S4    GoldPlus G4    Platinum P4


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.
  • Pay 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 2018 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.

 


← scroll →

Certificate of Coverage - For members who joined before
April 1, 2018
Small Business (SHOP) English Español
BronzePlus B4 Download Download
SilverPlus S4 Download Download
GoldPlus G4 Download Download
PlatinumPlus P4 Download Download
 

To learn more about the drugs covered by our Marketplace SHOP Plans, please visit the MetroPlus Formulary Page 

To search our provider network for our Marketplace SHOP Plans, please visit the MetroPlus Provider Directory Page.


← scroll →

Additional Member Resources
  English Español
Marketplace Small Business (SHOP)
Young Adult Rider
Download Download