Frequently Asked Questions

The Amherst Chamber of Commerce has created the Frequently Asked Questions portion of Health Care Corner to answer questions that may arise when thinking about health care coverage. Below is a compilation of questions created by the Chamber's Insurance Benefits Manager Christian Solecki. If you have any questions or want more information on Chamber health insurance, please feel free to contact Christian at csolecki@amherst.org or 716.632.6905.

What is a deductible?

A specific dollar amount your health insurance provider may require you to pay out-of-pocket each year before they begin to make payments for claims. The deductible amount varies based on the plan you choose.

What is coinsurance?

Coinsurance is the shared risk between you and your insurer. It is usually expressed as a percentage and indicates how you and the insurer will share the costs of a bill that exceeds your plan's deductible.

What is a copay?

A copay is the amount you pay out of pocket for a medical service.

An HSA can fund up to $3,050 single and $6,150 family annually and there is a  20% penalty for payment to non-qualified medical services

My wife and I do not have any children.  Can we both enroll in a single policy and save money? Is there a 2 tier rate available?

We only offer single and family policies.  In order to qualify to enroll in two single plans, both spouses will have to work at the same company and income must be reported on a NYS-45.  If only one spouse works for the company, your only option is to enroll in a family policy.

What does "2.5 copays per 90 day supply of prescription drugs" mean?

Mail Order is an option you can use to save money on prescription drugs.  When you buy a 90 day  supply of a maintenance medication, you are presented with a cost savings opportunity.  Instead of paying 3 full copays for the 90 day supply, you save half a copay on the purchase. 

What does Out of Network mean?

Out of Network does not necessarily mean that you are receiving services outside of Western New York.  The term refers to the provider's contract with the insurance carrier.  When a provider is contracted, they agree to accept assigned reimbursements from the insurance carrier.  It is a protection to you in terms that a provider cannot overcharge you for a service.

I am a contracted employee and cannot get access to health insurance.  Can the Amherst Chamber help me?

Yes we can.  If you file a Schedule C on your taxes and have a Business Certificate, you can enroll in one of our plans.  A Business Certificate can be acquired at the County Clerk's Office and is similar to a Doing Business As Certificate, but can also be used when contracting for work.

Are there additional plans available?

If you are a Sole Proprietor, you are limited to the Amherst Chamber's Association plans.  If your company has 2 or more employees, you have access to additional plans. Please call for more information and to check if your eligibility meetings the underwriting guidelines of the insurance carriers.

I travel quite often for business and sometimes am out of the country.  Do I still have coverage?

You are covered for Emergency treatments while traveling, but not for routine medical services.  Your annual physical and follow up visits must be received while at home in the Western New York area from your Primary Care Physician.

How can I check to see if my doctor is participating with the medical plan I am enrolled in?

The insurance carriers continuously update their provider lists on their websites.  They no longer print Provider Directories as it is costly and the copies can be outdated soon after mailing when doctors join and leave their agreements.  A good rule of thumb is also to ask any provider you make an appointment with if they participate or not. You can avoid potential additional costs with asking in advance.

What is the difference between Chamber and Small Group medical plans?

Chamber Group:

The local insurance carriers provide us with medical plans to offer our members.  Current members can then chose a plan that will fit their personal needs and enroll.  The benefits are straightforward and are set by the insurance carrier. These plans are available for groups of all sizes but especially sole proprietors and we coordinate the billing to all employees.  We will review the plans and options with your employees and free up valuable time in your day. The premiums renew each January and new members can enroll as they join the Amherst Chamber.

Benefit Solutions:

Small Groups are made up of 2 or more employees. This option offers the most flexibility and a NYS 45 or 1099 is required to be submitted to the insurance carrier.  Benefits such as prescription drugs, office copays, and hospitalization copays can be adjusted per the insurance underwriter's guidelines so that you can tailor the plan according to your needs.  As a small group in Benefit Solutions, you are billed directly by the insurance carrier monthly and renew the following year on the anniversary that you started your enrollment. 

Do I need to wait until my renewal to change my plan? 

There is some truth to that, in regards to Sole Proprietors enrolled in Chamber medical and dental plans.  For anyone with a small group, you can review your coverage at any time and move to a new insurance carrier if the rates and benefits fit your needs. 

Should I wait until I receive my renewal to begin preparing for the next plan year?

No. You can start looking at plans any time throughout the year and do not need to wait for the renewal period to make decisions.  We advise not to rush your decision and take time to weigh any changes to your benefits that might affect the premiums.

What options do I have to enroll in a health insurance policy?

Chamber Group:

As a Sole Proprietor, your options may be limited.  You can enroll in a policy directly with an insurance carrier, but you risk potentially paying more for the coverage. You could also opt for enrollment in the Amherst Chamber's group plans.  There is strength in numbers and joining with a group of business owners under the Amherst Chamber's group policy offers you convenience in the enrollment process and lower medical premiums. 

Benefit Solutions:

Small groups (2 or more employees) may also take advantage of the Amherst Chamber Benefit Solution's medical plans. We can offer direct billing of your employees, COBRA coverage if you elect to offer the coverage, and your choice of insurance carriers.  Your employees can chose different plans under the Amherst Chamber Benefit Solution's plans, but must opt for the same coverage if enrolling as a small group under Benefit Solutions and tailoring the plans to your needs.