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Listed below are some frequently asked questions by sole proprietors and individuals about the Healthy NY program.
Answer: If you have other insurance but it does not provide comprehensive coverage (for example, it includes only medical benefits or only hospital benefits, but not both) then you may still be eligible for Healthy NY. However, if you have other insurance that provides both medical and hospital coverage, then you would not be eligible for the Healthy NY program.
Answer: An employer provides health insurance if the employer arranges for comprehensive group health insurance and contributes towards the cost of the insurance. Also, if your employer provides only limited benefits you may still qualify for Healthy NY.
Answer: No, you may still be eligible for the Healthy NY program if your employer provides coverage to other employees, but not to you.
Answer: If you had coverage in one of those public programs, that would not prevent you from enrolling in Healthy NY.
Answer: Children who are aging off a parent’s policy may be eligible for Healthy NY if they meet the other eligibility guidelines of the program.
Answer: Adult children who are 18 years of age or older do not have to include their parents’ income. They are only required to list their income and any income of a spouse with whom they reside, if applicable.
Answer: HMOs that offer coverage in your county contract with certain health care providers in your area. To obtain the most current information about which health care providers are participating providers with an HMO, you should contact the HMO directly. A list of the phone numbers for the HMOs in your county may be found by selecting "Insurers and Rates".
Answer: Yes, you may elect to obtain coverage for certain dependents, including dependent children up to age 26 and, under certain circumstances, through age 29.
Answer: Your children’s coverage under the Child Health Plus program will not affect your eligibility for Healthy NY. In fact, because the Child Health Plus program is a more highly subsidized program, it may be to your financial advantage to enroll your children in Child Health Plus while enrolling yourself and your spouse in Healthy NY. The income limits for the Healthy NY individual program were designed to be similar to the income limits for the Child Health Plus program. So, if you are eligible for Healthy NY, it is likely that your children will be eligible for Child Health Plus and vice-versa. To obtain more information about Child Health Plus, you may call New York’s toll free hotline at 1-800-698-4543.
Answer: Medicaid provides coverage to very low-income children and adults, regardless of employment status. Family Health Plus (FHP) provides insurance coverage for low-income adults who do not have health insurance but are making too much to qualify for Medicaid. Child Health Plus (CHP) offers coverage to children up to 19 at higher income levels than those required under Medicaid or Family Health Plus. Healthy NY builds on the CHP program to offer insurance to working uninsured adults at the same income levels.
Answer: Yes. On an annual basis, participants in the Healthy NY program will be asked to submit a re-certification that attests to their continued eligibility for the Healthy NY program. Your health plan will notify you when this re-certification is due and will provide you with all necessary forms.
Answer: No, coverage will remain in effect. Mid-year fluctuations in household income and employment status do not serve as a basis for immediate termination. However, Healthy NY requires an annual re-certification process at which time your eligibility would be reevaluated. If you do not meet the eligibility criteria at the time of re-certification, you will be unable to continue to participate in the program. Please note that household income requirements for eligibility for the Healthy NY program will be adjusted on annual basis to account for inflation.
Answer: The insurer you apply to for coverage will ask you to complete a certification form at the time of application. You will also be asked to provide documentation of your employment status or status as a sole proprietor, proof of New York State residency and proof of income for the last 4-6 weeks. Examples of acceptable forms of documentation include:
New York State Residence
Letter from employer
Postmarked mail with address
Letter/lease/rent receipt with home address from landlord
Letter from employer
Answer: Yes, there are several other affordable options available to individuals, sole proprietors and small businesses. For a list of other programs, contact information and general eligibility requirements, please visit this link.
Answer: Healthy NY enrollment is on an annual basis but can be terminated at any time with 30 days notice to your health plan.
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