New York Health Insurance Policy & Program Information
Standardized Individual Direct Payment Policies
If you do not receive insurance through an employer, and are not eligible for Healthy NY or Family Health Plus, you may still purchase insurance regardless of your health status. You may also purchase coverage for your family. Some insurers may also offer husband-wife policies and parent-child(ren) policies. However, insurers may exclude treatment for certain pre-existing conditions if you have not had health insurance in the past 63 days.
Individual direct payment policies offer coverage through an HMO, which requires you to seek care from a network of providers. All HMOs in New York State must offer direct payment policies in the counties in which they operate.You may also purchase a point-of-service option for a higher price that would permit you to seek care from out of network providers.
Individual direct payment policies offer comprehensive benefits, including inpatient hospital care, outpatient services including laboratory tests and x-rays, care in a physicians office, maternity care, chemotherapy, prescription drug coverage, physical therapy, and inpatient and outpatient mental health care. See Premium Rates for HMO Standard Individual Health Plans by County.
If you do not have insurance and you or your spouse is currently working or has recently worked and your employer does not offer insurance or you are self-employed and meet certain criteria, you may be eligible for the Healthy New York program.
Child Health Plus
Every child in New York who is under age 19 who does not have health insurance is eligible for the Child Health Plus program. Child Health Plus offers comprehensive health coverage, including physician visits, hospital stays, outpatient care and prescription drugs. No copayments apply. Coverage may be free for certain income eligible families and others will pay a minimal premium for coverage. Some families may have to pay a full premium. Visit the Department of Health for more information on Child Health Plus or call 1-800-698-4543 or your local department of social services or department of health.
Family Health Plus
If your income falls below a certain level and you are between the ages of 19-64, you may be eligible for the Family Health Plus program. Family Health Plus is free and you do not need to be employed to qualify. Family Health Plus provides comprehensive health coverage, including hospital stays, physician visits and prescription drugs. Visit the Department of Health for more information Family Health or call 1-877-934-7587 or call your local department of social services or department of health.
NY Bridge Plan - A Pre-Existing Condition Insurance Plan (PCIP)
The federal Affordable Care Act contains a provision for the establishment of a temporary statewide insurance pool for high risk individuals. Coverage through this program will be available until January 2014 for the current enrollees in the program when more health insurance coverage options become available through a Health Insurance Exchange. New enrollment in this program is suspended by the federal government effective March 2, 2013. This new program is called the Pre-Existing Condition Insurance Plan (PCIP) and will be available throughout the country. In New York State, the PCIP plan is called the NY Bridge Plan.
"Age 29" Dependent Coverage Extension
Chapter 240 of the Laws of 2009 extended the availability of health insurance coverage to young adults through the age of 29. This law is sometimes referred to as the “Age 29” law, because it permits young adults to continue or obtain coverage under a parent’s policy through the age of 29. The law provides two distinct ways in which coverage may be extended. Learn more about the Age 29 law here.
COBRA Premium Assistance and the NYS Continuation Assistance
Continuation coverage gives workers who work for employers with fewer than 20 employees and their families the right to continue to purchase group health insurance for limited periods of time when they would otherwise lose coverage due to certain events. Qualifying events include voluntary or involuntary job loss, reduction in hours, transition between jobs, death, divorce and other life events. Qualified individuals may be required to pay up to 102% of the premium cost. People eligible for continuation coverage may have up to 36 months of coverage.
New York State’s continuation coverage law resembles the federal COBRA. It applies to employers with fewer than 20 employees. See COBRA and Premium Assistance for more information on COBRA in New York.
Prenatal Care Assistance Program (PCAP)
PCAP is a comprehensive prenatal care program that offers complete pregnancy care and other health services to women and teens who live in New York State and whose income does not exceed 200% of the federal poverty level. PCAP offers routine pregnancy check ups, hospital care during pregnancy and delivery, full health care for the woman until at least two months after delivery and full health care coverage for the baby up to one year of age. Visit the Department of Health for more information on PCAP or call 1-800-522-5006.
Group Health Incorporated (GHI)
Group Health Incorporated (GHI) offers the GHI Alliance Value plan in this market. GHI Alliance Value provides coverage for inpatient hospital care, prescription drug coverage, maternity and well child care and certain preventive care. The plan does not cover physician visits, other than for well-child or maternity. The plan is available statewide. Visit www.ghi.com or call 212-501-4444 in New York City, 315-432-0826 in Syracuse, or 1-800-624-2414 in other areas.
Empire Blue Cross Blue Shield
Empire Blue Cross Blue Shield also offers hospital only health insurance in the 28 counties in which it does business. These counties are in the metropolitan New York City region, the Mid-Hudson region and the Albany/Capital District region. Empires TraditionPLUS covers inpatient stays and limited outpatient services. Visit www.empireblue.com or call 1-800-662-5193.
Excellus Health Plan
Excellus Health Plan offers individual hospital and medical indemnity contracts. There are separate hospital and medical contracts available in the Central New York and Utica-Watertown regions. The hospital and medical benefits are provided under the same contract in the Rochester region. Visit www.excellusbcbs.com or call 1-800-633-6066 in Central New York, 1-800-847-1200 in Rochester, and 1-800-765-5226 in Utica.