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Oxford Healthy NY

Mar 23rd, 2011

oxford healthy nyOxford Health Plans Inc. was founded in 1984 and they became a United Health Care Company through a merger in 2004. Being part of the country’s largest single health insurer, empowered Oxford to give better health care services to their members. Today, they are providing health insurance to over 1,300,000 employees, employers and individuals in New York, New Jersey, and Connecticut. As a large health care company, their members have access to over 73,000 physicians and providers with 104,000 office locations in the tri-state areas. Oxford offers a wide selection of health care products such as traditional HMO’s (Health Managed organization), PPO’s (Preferred Provider Organization), EPO’s (Exclusive Provider Organizations), POS plans (Point-of-Service), consumer directed health policies and Medicare 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 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 be 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 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

Oxford offers 4 Healthy New York plans –

●     ·         Oxford Healthy NY HMO 1 (without prescription coverage) -Current premium rate is  $293.02

●     ·         Oxford Healthy NY HMO 2 (with prescription coverage) – Current premium  rate is $357.17

●     ·         Oxford Healthy NY High Deductible Health Plan 1 (without prescription coverage) – Current premium  rate is  $228.13

●      Oxford Healthy NY High Deductible Health Plan 2 (with prescription coverage) – Current premium  rate is  $271.65

*Oxford Healthy NY rates 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 Oxford Healthy NY just visit the Oxford Health Plans website.

"Vista Health Solutions" Tel (888)215-4045 Email [email protected]