New York Health Insurance Guide
Health Insurance Resources for NY State Residents
Major types of health insurance programs available in New York include:
New York Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
- As a New York resident you can choose from health insurance plans provided to individuals and groups by private insurance carriers. Eligible individuals and families may also take advantage of low-cost and no-cost health insurance offered by New York State-funded programs, as well as government-sponsored programs such as Medicaid, COBRA and the Pre-Existing Conditions Insurance Plan (PCIP).
New York Guaranteed Issue Policy
- New York is a guaranteed issue state for individuals. That means that all insurers must offer a minimum of two comprehensive standardized plans to all individuals. You may not be turned down because of your current or past health (see New York and the Affordable Care Act below for other exceptions regarding pre-existing conditions). All small group policies are guarantee issue.
New York Guaranteed Renewal Policy
- New York is a guaranteed renewal state. New York insurers are prohibited from raising the premiums on individual plans at renewal to offset the cost of any claims or new risks you represent. Your insurer cannot cancel your policy as long as you pay your premiums, do not defraud the insurers, and in the case of some managed health programs, do not move out of the coverage area. If your New York health insurance is provided through an employer’s group plan, your coverage cannot be canceled or subject to higher premiums because of your health.
New York and the Affordable Care Act of 2010
The Affordable Care Act (ACA) has no direct impact on individual state mandates, however it may have
significant impact on some aspects of your health care. As of September 23, 2010:
- Insurers can no longer impose pre-existing condition exclusions on children under age 19. The ban includes both benefit limitations and outright denial of coverage. These protections apply to all types of insurance except individual policies that are grandfathered. Beginning in 2014, these protections will be extended to all ages.
- ACA eliminates the use of lifetime benefit caps on such essential services as ambulatory patient care, hospitalization, emergency services, chronic disease management, lab services, maternity and newborn care, preventive and wellness care, and prescription drugs.
- Health insurance providers must provide full coverage for preventive health care recommended by the Centers for Disease control including immunizations.
- New ACA rules make emergency services more accessible by prohibiting health plans and insurers from charging higher copayments or coinsurance for emergency services obtained out of a plan network.
- ACA allows children under age 26 to stay on their parents’ family policy or be added to it. Grandfathered group plans can limit this benefit to adult children who do not have any other offer of employment-based coverage.
A number of additional ACA mandates are scheduled to go into effect in 2014. New York has adopted broad implementation of ACA insurance provisions.
New York State Mandated Health Benefits
New York currently has a number of state-mandated benefits that exceed ACA requirements and that private providers must provide or offer in health insurance policies, depending on plan. They currently include
- Alcoholism and chemical abuse treatment
- Ambulance services
- Autism spectrum
- Breast reconstruction
- Cancer drugs
- Cervical cancer screening
- Chiropractic care
- Diabetes supplies and self management
- Eating disorders
- Emergency services
- End of life care
- Enteral formulas
- Home health care
- Infertility treatment
- Maternity and maternity stays
- Mastectomy and mastectomy stays
- Mental health
- Prescription drugs
- Preventive and primary care
- Prostate cancer screening
- Prosthetics and orthotics
- Second medical opinion for cancer diagnosis
- Second surgical opinion
Private Health Care Options in New York
Individuals and small businesses in New York may chose from a variety of Health Maintenance
Organizations (HMO); Preferred Provider Organizations (PPO) and Point-of-Service (POS) plans.
- For Individuals and Families –There is a 6-month look-back period and a 12-month exclusionary period for pre-existing conditions for applicants without proof of prior creditable coverage. Medical underwriting and elimination riders are not permitted. All insurers must offer a minimum of 2 standardized plans. Plan costs including premiums, copayments and coinsurance will vary. There is no rate cap, however you cannot be charged more because of community rating factors such as age, health status, gender or occupation.
- For Small Businesses (2 – 50 employees) – There is a maximum 6-month look-back period and a maximum 12-month exclusionary period for pre-existing conditions for enrollees without prior creditable coverage. Pre-existing conditions are covered. Employees must work a minimum of 20 hours to be eligible for enrollment. Owner can count as an employee. Costs to employer depend on level of contribution and are based on a pure community rate. Another option for small businesses with 1 to 50 employees and sole proprietors include Healthy NY.
Public Health Care Programs in New York
Regulating Agencies and Insurance Information ResourcesNew York State Insurance Department
25 Beaver StreetNew York, NY 10004
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
Insurance Information Institute (I.I.I.)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
110 William Street
New York, NY 10038