Healthy New York

(Overseen by the New York State Department of Financial Services)

Program Goal

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).

Eligibility

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 $40,000/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 $40,000* 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), and
  • 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)

*Income amounts change annually. For current income guidelines, visit www.healthyNY.com.

Description

Healthy NY is a program designed to make reduced-cost, comprehensive health insurance available to working uninsured individuals, sole proprietors, and small employers that do not provide health insurance to their employees.

All Health Maintenance Organizations (HMOs) in New York State must offer Healthy NY. Rates vary by HMO and county, but the benefit package is the same regardless of the HMO selected.

Healthy NY also offers a high deductible health plan (HDHP) option. The 2013 deductible is $1,250 for individual coverage or $2,500 for family coverage. Members may access preventive care for a co-payment prior to meeting the deductible. Enrollees may open a health savings account to pay for qualified medical expenses, which provides tax benefits.

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. Healthy NY does not cover certain benefits including mental health services, vision, dental, and ambulance. Benefits are on a network basis.

For More Information

Please visit www.HealthyNY.com for a full description of eligibility requirements, benefits, co-payments, and other important information. You may also call the Healthy NY hotline at 1-866-HEALTHY NY (1-866-432-5849) for more information.

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Publication 0548
Revised 10/2013