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You may print out the application and complete it, or you may complete the application online and then print it out. Applications cannot be submitted online or via e-mail.
Make sure you:
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.
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.
The Department of Financial Services 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 our toll-free hotline at 1-866-HEALTHY NY (1-866-432-5849) or e-mail us to request an application.