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Healthcare in New York

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Pharmacy Benefit Managers and Drug Prices

Pharmacy benefit managers (PBM) are companies that manage prescription drug benefits. PBMs must be licensed to operate in New York and their activities are carefully monitored to address problematic practices in the industry, help lower prescription drug and health insurance costs, and protect New Yorkers who need access to medications. 

DFS also investigates significant price increases for certain drugs sold or advertised in New York State, and requires companies to show reasonable justification for sudden increases.

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.

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.

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.

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.

Mental Health and Substance Use

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.