Health Insurance Resource Center
Health insurance is very important. It protects you and your family from a potentially catastrophic financial loss from a major illness. Even if you are healthy, you need health insurance. If you wait until you are sick and then try to obtain insurance, the insurance company may not pay for care relating to a pre-existing condition.
New York State of Health Marketplace
The New York State of Health Marketplace can help you shop for and enroll in health insurance. You can use the Exchange to compare insurance options and prices offered through the Exchange, calculate costs and enroll in coverage online, in person, over the phone or by mail. You may also qualify to receive federal tax credits to help pay for insurance offered through the Exchange. You can purchase insurance through the Health Benefit Exchange now for coverage starting January 1, 2014. You can also buy coverage directly from an insurance company, but tax credits will not be available.
Rights & Responsibilities
Health Insurance Premium Rate Increases and Prior Approval
Under Prior Approval law, enacted June 8, 2010, insurance companies are required to file an application with the DFS for prior approval to increase their health insurance premium rates. The Department has the authority to review the actuarial assumptions behind an insurer’s proposed rates and to review the financial condition of the insurer to make certain proposed rates are fair and appropriate. The Department may approve, reject or modify the insurer’s proposed rates.
In addition, insurance companies are required to send you a notice about a proposed premium rate increase when they file their application with DFS that states that an application has been filed and that you can review the application on this website and submit comments about the premium increase.
- Learn more about Health Insurance Premium Rate Increases and Prior approval
Health Insurance Complaints & External Appeals
Consumers have the right to an external appeal when health care services are denied by an HMO or insurer (health plan) as not medically necessary, experimental/investigational, a clinical trial, a rare disease treatment, or, in certain cases, as out-of-network. Providers have their own right to an external appeal when these health care services are denied concurrently or retrospectively. External appeal requests must be submitted to the DFS and the Department will assign independent medical experts to review the appeal.
Health Insurance Complaint Rankings
Each year, New York State (via the DFS and Department of Health) receives complaints about health insurance companies from consumers and health care providers. Complaints typically involve issues related to prompt payment, reimbursement, coverage, benefits, rates and premiums. The New York Consumer Guide to Health Insurers contains a ranking of HMOs and health insurance companies based on complaint statistics and enrollee satisfaction surveys and includes information on the number of successful appeals to independent external review agents. This Guide may help you when choosing a health insurance company. The Guide also contains telephone numbers for health insurance companies.
Insurance Help for the Seriously Ill and their Caregivers
Comprehensive insurance information for the seriously ill and their caregivers, detailing health insurance rights and how to exercise these rights to ensure proper access to health insurance coverage.
Information for Seniors
Long Term Care
The Long Term Cares section provides important information about long term care and the long term care insurance policies available in New York. This information is intended to help you make informed decisions about the need for financial protection and, should you choose to obtain long term care insurance, to help you choose a policy that will meet your individual needs.