Univera Healthy NY

Univera Healthcare is a non-profit organization providing health care coverage in Western New York.  Their mission is to improve the health of their members and communities they serve by providing access to affordable, effective health care services, including long-term care services and seeking ways to continually improve the health and health care of the communities they serve. Today they have more than 200,000 members. Univera has over 5,700 health care providers in their network. Members have access to all major pharmacy chains, most independent drugstores, and more than 61,000 pharmacies across the United States.

Univera Healthcare is member of The Lifetime Healthcare Companies.

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

Univera offers 4 Healthy New York plans –

• ·        Univera Healthy NY HMO 1 (without prescription coverage) -Current premium rate is $185.53
• ·         Univera Healthy NY HMO 2 (with prescription coverage) – Current premium  rate is $277.26
• ·         Univera Healthy NY High Deductible Health Plan 1 (without prescription coverage) – Current premium  rate is  $144.85
• Univera Healthy NY High Deductible Health Plan 2 (with prescription coverage) – Current premium  rate is  $224.31

*Univera 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  Univera Healthy NY  just visit the Univera website.