Empire Healthy NY

Empire was founded in 1934 as a New York-based hospital insurance provider. They are a subsidiary of WellPoint, Inc., the largest publicly traded health benefits company in the country based on membership.  Empire has been providing health care benefits for 75 years.  They are covering more than 35 million members across 14 states together with their Blue Plan affiliates.  Aside from their long history of health insurance service, they boast of something that sets them apart – They own and directly manage their local networks. This makes it easier for them to provide customized health care plans to their members, maintain the quality of care provided, and keep the costs at the most cost-effective level.

Healthy NY is one of the  NY health insurance plans they offer.  It is a government-subsidized health insurance program that provides comprehensive health care benefits and services to employed and self-employed individuals with not more than fifty employees.

You need to meet some qualifications for the Healthy NY application. Eligibility requirements are as follows:
·         You should be a resident of the state of New York;
·         You must be ineligible to apply for Medicare;
·         Your total gross household income should be within the limit set by the Healthy New York program;
·         You must currently be a sole proprietor or an employee on a full-time, part-time, or periodic basis;
·         You must have been uninsured for the past 12 months except for some qualifying reasons (see below)
·         You must have no health insurance benefits from your employer

Qualifying Reasons /Exceptions:

• Loss of employment
• Change to a new employer
• Death of a family member
• Change of residence
• Discontinuation of a group health plan
• Termination or cancellation of COBRA coverage
• Change in marital status
• Loss of eligibility for group health insurance coverage
• Reaching the age limit for dependent coverage

Healthy NY Summary of Benefits:

·         Physician services including diagnostic, treatment, consultant, and referral services
·         Surgical services (including breast reconstruction surgery after a mastectomy) and anesthesia
·         Inpatient hospitalization including room and board, general nursing care, special diets,
·         and other hospital services and supplies

·         Outpatient hospitalization including diagnostic and treatment services and surgical facility charges
·          Pre-admission testing
·         Emergency services (ambulance not covered)
·         Second opinion for surgery and cancer treatment
·         Post-surgery or post-hospitalization home health care, up to 40 visits per calendar year
·         Post-surgery or post-hospitalization physical therapy, up to 30 visits per calendar year
·         Adult preventive services including mammogram, Pap test, prostate cancer screening,
physical examinations no more than once every three years, and adult immunizations
·         Prenatal care, well-child visits, and children’s immunizations
·         Diabetic supplies, equipment, and self-management education
·         Diagnostic, X-ray, and laboratory services
·         Radiation therapy, chemotherapy, and dialysis
·         Blood and blood products provided with surgery or inpatient hospitalization

Empire offers 4 Healthy New York plans –

• ·         Empire Healthy NY HMO 1 (without prescription coverage) – Premiums may range from  $251.60 – $290.40
• ·         Empire Healthy NY HMO 2 (with prescription coverage) – Premiums can be anywhere from  $298.92 – $346.59
• ·         Empire Healthy NY High Deductible Health Plan 1 (without prescription coverage) – Premiums may range from  $196.14 – $226.39
• Empire Healthy NY High Deductible Health Plan 2 (with prescription coverage) – Premiums can be anywhere from  $261.14 – $301.41

*Healthy NY rates vary depending on the region and they increase annually.

Certain services will not be included in the streamlined benefit package of the Healthy NY Health Insurance such as :

·         Mental health services and prescription drugs related to mental health conditions,
including treatment for depression, anxiety, and attention deficit hyperactivity
disorder (ADHD)
·         Alcohol and substance abuse treatment and prescription drugs related to alcohol
and substance abuse treatment
·         Chiropractic care
·         Physical therapy, unless post-surgery or post-hospitalization
·         Home health care, unless post-surgery or post-hospitalization
·         Hospice
·         Ambulance
·         Dental, vision, and hearing aids
·         Out-of-state treatment, unless in the case of an emergency

For queries and additional information regarding the Empire Healthy NY  just visit the Empire Blue Cross Blue Shield website.