Healthy NY Changes

Credit: Glyn Lowe Photoworks, via Flickr under Creative Commons

Healthy NY is a New York healthcare program designed to provide coverage to financially challenged individuals, sole proprietors, and small business owners. This allows qualified NY residents to be covered under a comprehensive NY health insurance program at affordable rates.

Through the Healthy NY program, individuals can provide adequate coverage for themselves and their families; sole proprietors can acquire coverage even as they are just starting with their endeavor; small business owners can afford to keep their employees happy by offering health care benefits.

Healthy NY’s benefits package is streamlined regardless of the health plan provider you choose. There are 14 health insurance carriers offering the Healthy NY plans. The benefits are the same for all of these carriers but the premium rates differ.  Member benefits include emergency care, inpatient care, outpatient services, doctor visits, x-rays, laboratory tests, preventive care, and prescription drugs (if enrolled in a plan with prescription coverage). Services not covered include eye care, dental care, chiropractic care, and treatment for drug or alcohol abuse.

There are 4 Healthy NY plans available: an HMO (Health Maintenance Organization) plan with prescription coverage, an HMO plan without prescription coverage, a High Deductible Health Plan (HDHP) with drug coverage, and HDHP without drug coverage. Being a New York state resident is not enough to qualify you to enroll. There are eligibility requirements to apply for this program. One of them is that your income should be within the Healthy NY limit. You or your spouse should be working currently or not more than 12 months ago. The applicant should have no health insurance coverage for at least a year before applying for Healthy NY except if your reason for applying is among the qualifying reasons that can be found on the Healthy NY website or brokers’ websites offering the program.

In place of the health care reform, changes are and will continue to be implemented on Healthy NY health insurance plans.  Changes are as follows:

• No more pre-existing exclusion for children below age 19
• Children below the age of 26 can stay on their parent’s policy as dependents
• Preventive services will be free from copays, co-insurance, or deductibles.
• The annual medical limit is increased to $750,000 annually

Healthy NY’s limit for prescription drugs was $3,000 annually but now it falls under the $750,000 yearly limit.

Those who have grandfathered health plans (plans that were purchased before March 30th, 2010) may choose to keep their plans without allowing the changes to be implemented.