New York State Department of Financial Services
How to Apply
You may print out the application, complete it and mail it, or complete the application online and then print it out and mail it. Applications cannot be submitted online or via e-mail.
How to Submit Your Application
- Complete and sign the application.
- Enclose a check for the first month’s premium, made payable to the insurer to which you are applying. Mail your completed application directly to the insurance company through which you want Healthy NY coverage. Please do not mail your application to the Department of Financial Services. This will delay the application process.
For a list of insurance companies, their addresses, and premium rates, visit the Insurers and Rates page.
When Coverage will Start
If the insurance company receives your completed application and first month’s premium payment by the 20th of the month, coverage will start the first of the following month.
DFS does not process Healthy NY applications. Please direct all questions regarding application status to the insurance company to which you applied. For your insurance company’s contact information, visit the Insurers and Rates page.
If you are unable to print the application, please contact DFS at (800) 342-3736 (Monday through Friday, 8:30 AM to 4:30 PM) or email firstname.lastname@example.org to request an application.