Information for Health Insurance Companies
General Information and Guidance
- Health Care Claims Reports
- Mental Health and Substance Use Disorder Parity Compliance Program Certification
- Mental Health and Substance Use Disorder Parity Reporting
- Substance Use Disorder Treatment Guidance
- QHP 2026 Filing Instructions in SERFF (PDF)
- Contraceptive Exception Request Form (Word)
- Definition of Sepsis for Purposes of Health Insurance Coverage
- Guidance Regarding Rate Guarantees and New Business Discounts (PDF)
- Guidance for Individual and Small Group Comprehensive Health Insurance Policy Forms Offered Inside and Outside the NY State of Health (PDF)
- Guidance for Large Group Comprehensive Medical Policy Form Filings (PDF)
- Court Ordered Treatment Certification (Word)
- Decision: Implementation of the Market Stabilization Pool for 2017 Pursuant to 11 NYCRR ยง 361.9 (PDF)
- Mandated & Make Available Benefit Listing (Commercial, HMO & Article 43 Insurance Contracts)
- Market Rules Guidance (on Guaranteed Availability and Renewability)
- Special Enrollment Period for Victims of Domestic Abuse or Spousal Abandonment
- Uniform Modification Policy Changes Guidance
New York State of Health (NYSOH) Coverage
Unless otherwise noted, the items below are in PDF format.
Forms, Maps, Charts and Notices
- NY Standardized Rating Regions for Individual and Small Group Health Insurance (including Exchange-certified Stand-Alone Dental Plans)
- NY Standardized Rating Regions Map
- Grace Period Guidance (html)
For APTC insureds in 3 month grace period for NYSOH
Frequently Asked Questions
- Information for Insurers and Providers on Coverage for Telehealth Services
- FAQs About Network Adequacy and Access Standards for Behavioral Health Services (11 NYCRR 38)
- Health Equity FAQs
- FAQs about laws passed in 2021-2023 related to opioid treatment, PrEP, colorectal cancer screening, rabies, prescription drug coverage, and Donate Life Registry
- FAQs about Coverage of Early Intervention Services Questions and Answers (2022)
- FAQ about Insulin Cost-Sharing Limit
- Association Health Plans (AHPs) FAQs
- Circular Letter No. 20 (2017) FAQs and FAQs About Supplement No. 1 to Circular Letter No. 20 (2017)
- Court Ordered Treatment FAQs
- IVF and Fertility Preservation Law FAQs (updated 9/4/2020)
- Mental Health and Substance Use Disorder (MHSUD) FAQs
- Step Therapy Legislation FAQs
- Small Group Expansion to 1-100 Employees FAQs
SERFF Public Access to Accident & Health Insurance Form Filings
The Department makes certain accident & health insurance policy form filings and Plan Management binder filings available for public viewing online, via the NAIC SERFF State Filing Access website. Filings disposed of on and after February 27, 2018 are available through SERFF Public Access. The public may also obtain access to filings by submitting a Freedom of Information Law (FOIL) request to the Department. Note that filings may be updated or changed by a subsequent filing. You should search for the most recent version of the filing. The Department is not responsible for any errors in or omissions from the filings. Filings may contain or incorporate material that is protected by U.S. or foreign copyright laws, and no person may reproduce, redistribute, or make commercial use of any such material in violation of those laws.