New York Health Insurance Guide

Health Insurance Resources for NY State Residents

Major types of health insurance programs available in New York include:

Health Maintenance Organizations
This category, which can be offered by an employer or purchased by an individual, includes:

HMOs. In New York, HMOs are health care insurers that contract with or employ a network of health care providers and hospitals. HMOs require that you coordinate all care through a primary care physician (PCP), who is responsible for referring you to specialists. You make co-payments for in-network services. Typically, you are not reimbursed for out-of-network services.

HMOs/POS. This type of coverage combines the cost efficiencies of an HMO with the flexibility of an out-of-network option. You must use a PCP for referrals to in-network specialists, but can go out of network without a referral. You make a co-pay for in-network services and there is no deductible. You are reimbursed for out-of-network services, however such services are subject to deductibles and co-insurance, and will probably cost more than in-network services.

Fee-For-Services (FFS)

This type of health insurance is what is typically offered by an employer or an association as group insurance but may also be available for individuals. You can choose any health care provider or hospital. You need no primary care physician and or referrals to specialists. You pay the deductible specified in your plan. After that has been satisfied, you are responsible for a percentage of the cost for services of the reimbursement allowed, called co-insurance.

Preferred Provider Organizations (PPO)

Another type of group insurance typically offered by employers as group plans, a PPO is similar to a Fee-for-Service plan in that you don’t usually need a primary care physician or specialist referrals, although some services may require preauthorization. However there is a provider network, as the name implies. Your costs will be lower when you stay in network, and more services will be covered. If you stay in network, you make a co-payment for services. If you go out of network, you are reimbursed. Note that out-of-network services are usually subject to deductibles and co-insurance.

Pre-Existing Conditions
In New York State, all health plans must include a time limit for the exclusion of pre-existing conditions. Rules govern how a pre-existing condition is defined and how long you will have to wait before your new health insurance plan begins to cover treatment for it. As long as you don’t have a long break in your health insurance coverage, your new plan will typically credit your old coverage toward the waiting period. Note that insurers can’t apply the pre-existing exclusion period because of your genetic history. They aren’t even allowed to ask about genetic tests or family history when you apply.

Other Laws Protecting New York Health Care Insurance Consumers

Note that in New York, your options for health insurance coverage cannot be dependent on the status of your health, nor can an employer deny, limit or require you to pay more for a group plan because of your health status.
New York is a guaranteed issue state; you can’t be refused coverage because of your health, age or any other factor that might predict your use of health services.
Individuals buying coverage can’t be charged more because of community rating factors such as health status, age, gender or occupation.
Most health insurance in New York is guaranteed renewable. Neither individual or group health insurance can be canceled if you get sick, although different policies will have different definitions of guaranteed renewable.

New York State Reduced-Cost Health Care Programs
Eligible New York residents have access to these reduced-cost health care programs:

HealthyNY
A new program that provides affordable health insurance to sole proprietors, small employers (2 to 50 employees) and uninsured workers.
Child Health Plus
Health insurance for children under 19.
Family Health Plus
This program is for uninsured adults 19 to 54 whose incomes are too high to qualify for Medicaid.

The regulatory agencies for health care in New York include the New York State Insurance Department and the Department of Health: Managed Care.

Finding prices and health insurance plans in NY State is easy with free online New York health insurance quotes from E-Insure.

New York State Insurance Department
The Insurance Department is responsible for supervising and regulating all insurance business in New York State. The Department’s mission is to: Ensure the continued sound and prudent conduct of insurers’ financial operations; Provide fair, timely and equitable fulfillment of insurer obligations; Protect policyholders from financially impaired or insolvent insurers; Eliminate fraud, other criminal abuse and unethical conduct in the industry; and Foster growth of the insurance industry in the State. Visit the New York State Department of Insurance website or blog at:

Website: http://ww.ins.state.ny.us/nyins.htm
Twitter: NYSInsuranceDep

Important contact number for the New York State Insurance Department are:
For the Consumer Services Bureau, please call this toll-free number: 1-800-342-3736.
To reach the Licensing Bureau, call 518-474-6630.
You may also reach Consumer Services at: 518-474-6600 (Albany) or 212-480-6400 (New York City)

New York State Department of Health
The New York State Department of Health website provides comprehensive information on health insurance policy, programs and coverage in the state of new York.
http://www.health.state.ny.us/

A listing of New York State Deparment of Health Insurance Hotlines can be found here:
http://www.health.state.ny.us/contact/doh800.htm

Health Insurance Programs in the state of New York
http://www.health.state.ny.us/health_care/
New York State Department of Health
Corning Tower
Empire State Plaza,
Albany, NY 12237

(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.
http://www.naic.org/

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.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/