Skip to Content

NY.gov Portal State Agency Listing

Healthy New York logo

Small Business Eligibility

Benefit Package

Insurers and Rates

How to Apply

Who Can be Covered

Provider Networks

Recertification

Changing Insurers

Frequently Asked Questions

Glossary

Other Resources

Employers and Employees

Benefit Package

Network-Based Coverage

Most of the insurance companies that offer Healthy NY are HMOs. This means that benefits are provided through each insurance company’s network of medical providers. You must use the doctors and health care providers who participate in your insurance company’s network, except in an emergency. To find out of a health care provider is in your insurance company’s network, contact the insurance company or visit the Provider Directories page.

Covered Benefits 2014

This is not intended to be a complete list of covered benefits.  Please refer to your health plan coverage documents for a full description of covered benefits.

Cost Sharing 2014

Please consult your health plan coverage documents for a more extensive description of your cost sharing responsibility.  Some examples of copayments and coinsurance are included below.

Deductible

$600 individual / $1,200 family

Maximum out of pocket costs

$4,000 individual / $8,000 family

Primary Care Physician (PCP) visit

$25

Specialist visit

$40

Preventive Care

No cost sharing

Ambulance

$150

Emergency Room visit

$150 (waived if admitted)

Urgent Care

$60

Chemotherapy, radiation therapy

$25 per visit

Chiropractic care

$40

Physical therapy, occupational therapy, speech therapy

$30

Diagnostic and routine laboratory and pathology

$40

Diagnostic and routine imaging

$40

Surgical Services – inpatient, outpatient and surgicenters

$100

DME / Medical supplies

20%  coinsurance

Hearing aids

20%  coinsurance

Inpatient Facility / Skilled Nursing / Hospice

$1,000 per admission

Mental Health & Substance Use Disorder Services

$1,000 per admission (inpatient)
$25 (outpatient)

Prescription drugs
     Ask your health plan about mail order.     

$10 generic
$35 formulary brand
$70 non-formulary brand

Pediatric dental - office visit

$25

Pediatric vision – eye exam visit
    Prescribed lenses and frames or contact lenses

$25
20%  coinsurance

Contact Us | Accessibility | Disclaimer | NYS Department of Financial Services | Site Map | Top of Page

© 2014