Healthy New York
(Overseen by the New York State Insurance Department)
To provide reduced-cost, comprehensive health insurance to small employers, uninsured working individuals, and sole proprietors. (A sole proprietor is a person who owns a business in which he or she is the only employee).
Small employers must meet the following eligibility criteria:
- The business must be located in New York State;
- The business must have 50 or fewer eligible employees;
- At least 30% of employees must make $36,500/year* or less;
- The business must not have provided comprehensive insurance within the last 12 months;
- The business must contribute at least 50% of the employees' Healthy NY premiums;
- At least 50% of the employees offered Healthy NY must accept coverage or have coverage through another source (e.g. a spouse, a public health program);
- The business must offer Healthy NY to all employees who work 20 or more hours per week and earn $36,500* per year or less.
Eligibility for individuals and sole proprietors:
- The individual must be a resident of New York State;
- The individual or the individual's spouse must have worked at some point within the last 12 months;
- The individual's employer must not arrange for and contribute to the cost of comprehensive insurance;
- The individual must not be eligible for Medicare;
- The individual must meet income guidelines,which are 250% of the Federal Poverty Level (sole proprietors may deduct business expenses to calculate income).
- Income amounts change annually. For current income guidelines, visit http://www.dfs.ny.gov/website2/hny/english/hny.htm.
- The individual must have been uninsured for the past 12 months or have lost coverage due to a specific event. (A listing of all specific events is on the Healthy NY web site at www.HealthyNY.com.
Healthy NY is a program designed to make reduced-cost, comprehensive health insurance available to small employers that do not provide health insurance to their employees. Eligible individuals who work for employers that do not provide insurance coverage or who were recently employed may also purchase Healthy NY. Healthy NY is also available to sole proprietors.
All Health Maintenance Organizations (HMOs) in New York State must offer Healthy NY, and other health plans choose to offer it, as well. Rates vary by health plan and county, but the benefit package is the same regardless of the health plan selected.
Benefits are comprehensive and include inpatient and outpatient hospital services; primary and specialist office visits; diagnostic, radiology, and laboratory services; pre-natal care; well-child care; and emergency services. Healthy NY has an optional prescription drug benefit ($3,000 annual per person maximum). Healthy NY does not include mental health services, vision, dental, and ambulance. Benefits are on a network basis.
Healthy NY also offers a high deductible health plan (HDHP) option. The 2007 deductible is $1,150 for individual coverage or $2,300 for family coverage. Members may access preventive care for a co-payment prior to meeting the deductible. People electing the HDHP may open a health savings account to pay for qualified medical expenses, which provides tax benefits. The benefit package for the HDHP is the same as with standard Healthy NY.
For More Information
Please see the Healthy NY consumer guides or visit http://www.dfs.ny.gov/website2/hny/english/hny.htm for a full description of eligibility requirements, benefits, co-payments, and other important information. You may obtain a consumer guide by calling 1-866-HEALTHY NY (1-866-432-5849).