Health Insurance FAQs
SELF-EMPLOYED HEALTH INSURANCE QUESTIONS
Q: What criteria must be met for an individual to be considered self-employed?
You are self-employed if you fall into any of the following categories:
- You work in a business or trade as an independent contractor or sole proprietor.
- You are part of a partnership that operates a business or trade.
- You run your own business, which includes any part-time ventures.
Q: I work as an independent contractor, is that the same as being self-employed?
Yes. Working as an independent contractor counts as being self-employed.
*Independent contractors are self-employed individuals hired to perform specific tasks or services. They operate their own businesses and are not employees of the companies they work for.
Q: I left my job a few months ago and have been working independently. Do I qualify as self-employed??
Yes, as long as you have legal documents proving your self-employment. Be aware that different insurance companies have different requirements.
Q: I recently started my business and don’t have any tax documentation yet. Can I still qualify?
Some insurance companies will qualify you since each company has varying requirements.
BUSINESS ASSOCIATION QUESTIONS
Q: Which insurance companies require membership in a business association to obtain health insurance?
HIP. Fortunately, they provide better health insurance deals since business associations pool their self-employed members. By joining a business association, you can access plans with lower rates.
Q: What business associations & what benefits do they offer besides health insurance?
These business associations are IRBA (Independent Retail Business Association), LIA (Long Island Alliance), NYSBG (New York State Business Group), and USFSB (United States Federation of Small Businesses). These associations also offer accidental and life insurance; vision and dental discounts; and shopping discounts.
Q: What are the business association dues?
Membership fees range from $35 to$60 per year depending on your chosen association.
Q: I have insurance through another business association but the rates are higher. Can I switch to one of your plans listed?
Yes, as long as you qualify to join our business association.
APPLICATION QUESTIONS
Q: If I have any questions completing an application, who do I call?
You can call us at (888)215-4045 from 8:30 AM-5:30 PM Monday to Friday.
Q: On your online form, you’re asking for my social security number and Date of Birth. I don’t feel comfortable providing that information online. Can I leave them blank?
Yes. You can leave that information out of the online form.
Q: Once I submit the online form what happens next?
After submission, you will receive an email with step-by-step instructions and a completed application form. You need to sign the form and send it back to us by fax, email, or snail mail. You also need to include your tax forms to verify your self-employed status along with the first month’s premium.
Q: How long does it take to process my application?
It depends on which insurance company and plan you applied for. Easy Choice, GHI, HIP, and Oxford plans are processed in less than two weeks. Healthy NY plans take at least three weeks to
process. The process takes much longer for applications with missing or improper documentation.
Q: I’m having trouble opening the application I received in your email can you fax it or snail mail it?
Yes, notify us by phone or email.
Q: How long will I have to wait to get my health insurance card?
Health insurance cards usually arrive 2 weeks after your plan’s effective date.
Q: When is the start date of my health insurance plan?
If you enrolled between the 1st and 15th of the month, your start date will be the 1st of the following month. If you enrolled after the 15th of the month, your start date will be the 1st of the month after the next. For example:
- If you enrolled on June 10th, your plan would start on July 1st.
- If you enrolled on June 20th, your plan would start on August 1st.
Q: What health insurance company should I enroll in?
New York State has a wide range of choices regarding health insurance companies. But the first thing to consider should be the network that your Primary Care Physician (PCP) belongs to. Ensuring your PCP is in-network can help you avoid higher out-of-pocket costs and ensure seamless care coordination.
To make an informed decision, you can give us a call so we can provide personalized recommendations based on your specific needs and circumstances.
Q: Why must I give my Social Security System (SSN) during the application process?
The New York State of Health requires Social Security numbers (SSNs) for all applicants who have them. SSNs are used to verify information with federal and state data sources, speeding the application process.
Q: Can I apply for health insurance coverage now in New York? I’m moving there next month.
You can only apply within 90 days after you have moved to New York State.
GENERAL QUESTIONS
Q: I’ve heard of a cheap plan called Essential Plan offered in NY. What is it and how do I qualify for that plan?
It is a state-sponsored health insurance program designed to provide affordable coverage to low-income individuals who do not qualify for Medicaid and cannot afford private health insurance. the program includes 10 minimum essential benefits mandated under the Affordable Care Act. You may qualify for this plan f you are between the ages of 19 and 64 and have an annual income between $20,121 and $37,650, or if your family meets the income eligibility criteria, refer to the Eligibility Chart to determine if you qualify.
Q: Can I purchase the health insurance plans at a lower rate by going direct?
No, self-employed health plans cannot be purchased directly from insurance companies and business
associations.
Q: As a young adult in New York City, what health coverage options do I have?
Depending on your eligibility, here are some health coverage options:
- Child Health Plus: A free or low-cost insurance plan for New Yorkers under 19, Child Health Plus is a stand-alone medical plan for children and young adults under 19
- Medicaid: Based on your income, you might qualify for Medicaid, a public health insurance program for low-income individuals.
- Essential Plan: A free or low-cost insurance plan for low-income adults who don’t qualify for Medicaid.
- Qualified Health Plans: Available on the NY State of Health Marketplace and directly from insurance companies. These private plans follow Affordable Care Act rules, covering essential health services and meeting cost-sharing standards. Financial assistance is available to make them more affordable.
- Your Parent’s Plan: Under the Affordable Care Act, you can stay on or join your parent’s health insurance plan until age 26. Some plans may extend coverage until you turn 30. Have your parent check with their HR department or insurance company for details.
Q: What happens if I decide to terminate my health plan, will I be penalized?
No, there won’t be any penalty. However, you are required to inform the business association two weeks before terminating your plan.
Q: I currently have an insurance plan that will expire in the middle of the MONTH; can I start a new plan in the middle of the month?
No, you will have to wait for the first of the month.
Q: I’m the only one in my family who needs health insurance; Do I have to cover my dependents?
No, you don’t have to. You can purchase a plan for yourself only.
Q: My current insurance is expiring and I have a pre-existing condition, will I be covered under the plans listed?
Pre-existing conditions will not be covered during the first 12 months of the plan’s effectiveness.
Q: I just learned I’m pregnant and don’t have insurance. Can I purchase an insurance policy and be covered?
Pregnancy, in the third trimester, is not considered a pre-existing condition.
Q: Can I search for doctors, hospitals, or facilities within the health plan’s network?
You can check if your current doctors or healthcare facilities are in a plan’s network. Since networks can change, it’s best to verify with your provider and the health plan first.
Q: One of my children is in college; will they be covered under my family plan?
Yes. Your child can be covered under your family plan if he or she is:
- at least 19 years old
- single
- supported by at least 50 percent of the member
- listed as a dependent at the time of the member’s application
- enrolled in an accredited educational institution which grants a degree or diploma
Q: I don’t understand some of the insurance terms that you have on your
web site.
Please refer to our Health Insurance Glossary for more information about health insurance terms.