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New York Health Insurance
Health insurance is a fundamental necessity to ensure the safety of your financial future and your family’s overall health. Protecting your family against the occurrence of illness or injury is difficult; however a suitable health policy can relieve your financial burden caused by these events. When it comes to purchasing health coverage, your top priority should be a thorough assessment of all potential risks and its effect on your finances. In the U.S., approximately 47 million people are uninsured, majority of whom are working families. These families, especially children, end up suffering financially due to the lack of proper health insurance. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to these individuals.
Ranked at the 25th spot by the United Health Foundation, New York is gradually emerging to be one of the healthiest states to live in and obtain health coverage. The state has displayed a notable progress in its health score after staying at the 26th and 29th position in 2007 and 2006 respectively. Several factors have contributed to the state’s improving healthcare system including declining violent crime rate and low infant mortality rate. The state of New York, with more than nineteen million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced coverage to the uninsurable residents of New York who meet specific eligibility requirements of age and income.
The New York State Insurance Department manages and supervises all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, as the state continues its battle against the worst cases of infectious diseases, the population surviving without insurance is quite high i.e. approximately 13.6%. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 37.3% of New York’s uninsured residents come under the above 200% FPL category.
Buying health coverage can often be perplexing. Nevertheless, through a licensed health insurance agent/broker, you can choose a proper health insurance plan with benefits that are ideal for you and your family.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of New York. These regulations apply to all insurance companies offering individual or family health insurance in New York:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 12 months |
Look Back Period | 6 months |
Look Back Standard | Objective |
Mandatory Benefits | Cancer screening for women including breast cancer screening and cervical cancer screening, mastectomy stay as determined by the physician, reconstructive surgery after mastectomy, direct access to OB/GYNs, osteoporosis screening, eating disorder parity, infertility treatment coverage, maternity care |
Market Rate Restrictions | Yes |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of New York. These regulations apply to all insurance companies offering small group health insurance in New York:
| Small Group Size | 2-50 |
Employee Qualifications | Owner is counted as an employee |
Guaranteed Issue | Yes |
Premium Rating Factors | Pure Community Rating |
Rate Adjustment Factors | Community Rate |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as Individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of New York. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
| Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 18 months |
Extension of Benefits Period - Disabled | 29 months |
Maximum Premium Increase | 102% |
State Legislation Reference | Article 32 of the New York Insurance Regulation |
Additional Notes | Notice of continuation rights must be sent by employer with 5 days following the date of termination. |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of New York to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, New York does not have a high risk pool for residents who are unable to obtain private health insurance due to their pre-existing health conditions.
Children’s Health Insurance Program
Through shared funding from the federal government, the State of New York provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | Child Health Plus |
Website | |
Phone Number | 800-698-4543 |
Apply Online | Yes |
Age Limits | Under 19 |
Insurance Carrier | NA |
Length of Coverage | As long as eligibility requirements continue to be met |
Residency Requirements | New York resident |
Other Eligibility Requirements | To qualify: |
Pre-Existing Condition Exclusions | None |
Cost | $0 to $60 per child per month depending on the household income. No co-pays are required. |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of New York:
| Governing Agency | New York Department of Health |
Website | |
Phone Number | 877-472-8411 |
Residency Requirements | New York resident |
Federal Poverty Line Income Limits | Pregnant women and infants (ages 0-1): 200% FPL |
Additional Resources
New York Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines New York’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
New York: At-A-Glance
Provides exclusive health data of New York. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
