GHI Healthy NY

Group Health Incorporated (GHI) was founded in 1937 as a non-profit healthcare provider in New York. They started as the Group Health Association of New York which was a small cooperative. As time passed and more subscribers joined them, they became the Cooperative Health Association of New York then Group Health Insurance. It was in 1971 when they started to be the Group Health Incorporated we know of today.

They are currently the largest NY not-for-profit carrier providing NY health insurance coverage to 2.1 million members. GHI members are provided with care by 15,000 primary care physicians and over 31,000 specialists. They provide a wide range of hospital, medical, health, dental, mental, vision, and prescription drug plans.

Healthy NY is among the health plans they offer.  It is a state-sponsored 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

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

GHI offers 4 Healthy New York plans –

• ·         GHI Healthy NY HMO 1 (without prescription coverage) -Current premium rate is  $288.29 – $353.94
• ·         GHI Healthy NY HMO 2 (with prescription coverage) – Current premium  rate is $330.82 –  $406.15
• ·         GHI Healthy NY High Deductible Health Plan 1 (without prescription coverage) – Current premium  rate is  $215.38 – $264.42
• GHI Healthy NY High Deductible Health Plan 2 (with prescription coverage) – Current premium  rate is  $249.3 – $306.08

*GHI Healthy NY rates vary depending on location 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  GHI Healthy NY  just visit the GHI website.