Overview

As a result of the Health Care Reform Act of 2000, the state of New York established Healthy NY. Healthy NY supports comprehensive and quality health care and insurance for employees and owners of small businesses (50 or fewer employees) in New York, their dependents and other qualified family members. Healthy NY also aids sole proprietors and those whose employers do not offer health insurance as part of an employment package in New York.

Download our Healthy New York Insurance Informational Guide.May require PDF Reader.

Healthy New York Coverage

All HMOs (health maintenance organizations) in New York State offer Healthy NY insurance coverage. Each group covered by Healthy NY (small employers, sole proprietors, and uninsured workers) has its own set of rules and eligibility criteria, much of which includes things like a maximum household income threshold and past employment history. The program includes standard insurance benefits like:

Inpatient hospital coverage
Outpatient hospital coverage
Physician services
Consultant and referral services
Surgical services
Maternity care
Adult preventive services
Preventive and primary health care services for children
Diabetes equipment, supplies, and self-management education
Diagnostic x-ray and laboratory services
Radiological, chemotherapy, and hemodialysis services

Several packages are available through the program, some with limited and some with no prescription coverage. There is a pre-existing condition limitation wherein if an applicant has been either treated for or diagnosed with in the previous six months, that condition may be excluded from coverage for up to a year. This period will be reduced or waived if the individual had prior insurance coverage and did not break that coverage for longer than 63 days.

Healthy New York does not cover:

Mental health services and medication
Chiropractic services
Physical therapy
Alcohol and substance abuse treatment or medication
Hospice care
Home health care

In order to determine which packages you’re eligible for and what documentation you may/will need to submit, talk to a HMO provider in the state of New York.

Here are a few resources related to the Healthy NY Program:

Healthy NY For New York State

Health Care Reform Act of 2000

Small business owners who provide their employees with Healthy NY health insurance coverage were sent a survey to find out how satisfied they are with the Healthy NY program. Burns & Associates, Inc. (B&A) mailed the survey in August and September 2010 to 30% of small business owners who were enrolled as of March 2010. Surveys were sent taking into consideration the following variables:

• Health plan enrolled with
• County where the business is located
• Year enrollment began in Healthy NY
• The number of employees enrolled in Healthy NY
• Healthy NY product selection

B&A also asked health insurance companies providing Healthy NY coverage whose enrollment is more than 1% of the total Healthy NY membership. B&A had a total of 1,839 respondents.
Most of the respondents had been in business for at least 6 years and most of them have less than 5 employees with mostly half of their employees enrolled under a Healthy NY plan.

The survey asked the employers why they chose to provide their employees with Healthy NY plans. 73% said they weren’t offering health benefits to their employees before and found Healthy NY to be an affordable means to do so. 23% said they prefer Healthy NY since it’s more cost-effective compared to the ones they were previously paying for.

Employers were asked to rate how satisfied they were with Healthy NY based on three features: the application process, customer service and cost. Employers gave a high rating for the application process. 80% said they were somewhat satisfied or very satisfied. Satisfaction ratings for customer service also improved compared to the 2009 survey.

Overall, small business were happier with Healthy NY in 2010 compared to the previous year.