Excellus Healthy NY

Excellus Blue Cross Blue Shield is a nonprofit holding company headquartered in Rochester New York providing health insurance coverage to 1.8 million individual members today with their 6,000 New York employees.

Their history goes back to 1932 when the Blue Cross organization was founded. They were previously known as BlueCross BlueShield of Central New York, BlueCross BlueShield of the Rochester Area, and BlueCross BlueShield of Utica-Watertown.  In 1996, BlueCross BlueShield Plans in Central New York and Rochester merged and Excellus was born.  Today they are part of a $5 billion company providing health care coverage to residents of upstate New York as well as long-term care insurance nationwide.  Their mission is to contribute to improving the quality of life in the communities they serve.

Healthy NY is among the health plans they offer.  It is a state-sponsored NY health insurance program that provides comprehensive coverage to individuals both self-employed and employed as well as sole-proprietors with not more than fifty employees.

There are certain qualifications for the Healthy NY application.

Here are the eligibility requirements:

·         You should be a New York state resident;

·         You must be ineligible 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

Excellus 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

Excellus Healthy New York plan options –

●     ·         Excellus Healthy NY HMO 1 (without prescription coverage) – Premiums may range from $186.26 – $221.94

●     ·         Excellus Healthy NY HMO 2 (with prescription coverage) – Premiums can be anywhere from $281.72 – $366.47

●     ·         Excellus Healthy NY High Deductible Health Plan 1 (without prescription coverage) – Premiums may range from $145.43 – $173.20

●     Excellus Healthy NY High Deductible Health Plan 2 (with prescription coverage) – Premiums can be anywhere from $227.93 – $296.48

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

There are certain services that 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 Excellus Healthy NY  just visit the Excellus BCBS website.