Health Insurance Resource Center
New York Health Insurance Policies & Delivery Programs
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. To follow are some of the health insurance policies and programs available in New York:
- New York Health Insurance Policies & Programs
- New York State Health Benefit Exchange (external site)
Rights & Responsibilities
New York Consumer Guide to Health Insurer Data
Each year, New York State (via the DFS or 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 insurers 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
- Senior Citizens Resource Center
- Long Term Care
- Insurance Help for the Seriously ill and Their Caregivers
- New York Medicare Information (Including Supplement Premiums & Medigap Info)
Prior Approval
In 2010 New York State enacted a new law known as the Prior Approval Law that gives the Department of Financial Services the authority to review and approve health insurance premium rate increases before any changes take effect.
The Prior Approval law will not completely solve the problems of costly health care expenses and high premiums, but it will allow the Department to make sure rate increases are justified and supported by actuarial data. And the Department is working to increase transparency as to what goes into a premium rate increase to allow consumers to better understand their health insurance and its costs.
Health Insurance Complaints & 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.
If you have an issue concerning a health insurer and/or payment, reimbursement, coverage, benefits, rates and premiums, contact us or file a complaint:
Federal Health Coverage Tax Credit HCTC.
The HCTC is a tax credit administered by the Internal Revenue Service (IRS) affecting Trade Impacted Workers and Pension Benefit Guaranty Corporation (PBGC) Recipients. Several health insurance products in New York qualify for the tax credit and the DFS publishes rate information for the HCTC program in New York.
Outside Resources
Learn more about New York State’s efforts in health care reform at www.HealthCareReform.ny.gov and efforts toward the expansion of health insurance coverage at www.partnership4coverage.ny.gov.
Updated 02/25/2013
