Health Equity
Learn more about how New York State is working to build a more equitable and accessible health care system.
Drug Prices
The Department has the authority to investigate significant price increases for prescriptions drugs sold, offered for sale, purchased, or advertised within New York. DFS requires drug manufacturers to show a reasonable justification for sudden prescription drug price increases. As of June 19, 2024, DFS also requires drug manufacturers to report prescription drug price increases 60 days in advance of the effective date of the increase.
- Learn more about drug prices and what to do if you experience a significant increase or “spike” in the price of a prescription drug.
- Drug manufacturers needing to report a drug price increase, should visit the Prescription Drug Manufacturer Filings page.
Pharmacy Benefit Managers
Pharmacy benefit managers (PBMs) are companies that manage prescription drug benefits on behalf of health plans. PBMs must be licensed to operate in New York. DFS monitors PBM activities to address problematic practices in the industry, help lower prescription drug and health insurance costs, and protect New Yorkers who need access to medications.
- Learn more about Pharmacy Benefit Managers.
Confidentiality for Victims of Domestic Violence
You have the right to request that claim-related communications from your health insurer be sent to you in alternative ways if disclosing the information could endanger you. “Claim-related information” means claim or billing information relating specifically to you, including your name, address, any services you received, and the name and address of your provider or doctor. Your request will remain in effect until you revoke it.
- Learn more about health insurance confidentiality requirements for victims of domestic violence.
- See a sample confidential communication request form that a health insurer may ask you to submit.
- Visit the OPDV website to download and print a Reference Guide for Health Insurance Rights for Victims and Survivors of Domestic Violence.
Appealing a Denial of a Health Care Service
If your insurer or HMO denies health care services as not medically necessary, experimental/investigational or out-of-network, you have the right to appeal to the Department of Financial Services. This appeal is known as an External Appeal. Health care providers also have the right to appeal when health care services are denied.
- Learn how to file an External Appeal.
- Search prior appeal decisions using our External Appeals Database.
New York State Paid Family Leave
Under the New York State Paid Family Leave Benefits Law, all eligible employees are entitled to job-protected, paid time off to bond with a newly born, adopted, or fostered child, to care for a family member with a serious health condition, to assist loved ones when a spouse, domestic partner, child or parent is deployed abroad on active military service, or when an employee or their minor dependent child are subject to a mandatory or precautionary order of quarantine or isolation due to COVID-19.
- Learn more about Paid Family Leave in New York State
Designating a Representative to Help with Health Insurance
If you need assistance with a preauthorization request, complaint, grievance, or appeal with your health insurer, you can designate a person or persons or organization to assist you by completing the New York Standard Health Insurance Designee Form and submitting it to the address or fax number on your member identification card or by the method specified by your insurer.
- This form is available in other languages on the File a Complaint page.
Health Insurance Premiums and Rate Increases
Health insurers must submit proposed rate changes to DFS. DFS then reviews the application and the insurer’s calculations to make sure that a rate increase is justified and not excessive. During review, DFS may consider comments from policyholders or the public.
- Learn more about Health Insurance Premiums and Applications for Rate Increases.
Mental Health and Substance Use
- Learn more about Mental Health and Substance Use Disorder coverage in New York
Child Health Plus
Every child in New York under the age of 19 who does not have health insurance is eligible for the Child Health Plus program. Visit the Department of Health for more information on Child Health Plus or call (800) 698-4543 or your local department of social services.
Healthy NY
DFS oversees the Healthy NY program, in partnership with HMOs and other insurance companies in New York State, to offer comprehensive health insurance to small businesses.
Accident & Health Insurance Filings
Certain accident & health insurance policy filings are available to the public on the SERFF State Filing Access website. These filings may be updated or changed by a subsequent filing, so you may want to search for the most recent version of a filing. DFS is not responsible for any errors in or omissions from the SERFF website. You may also request filings by submitting a Freedom of Information Law (FOIL) request to this Department.