Healthy NY Health Insurance Plan

Health insurance is one of the best investments your money can buy. An ideal health insurance can offer you and your family protection from very expensive costs of medical care and guaranty that a serious illness will not lead to certain financial distress. Some states offer their residents other options aside from the federal government-sponsored Medicare and Medicaid programs. For example, New York offers Healthy NY, a state-sponsored program which offers health insurance to qualified individuals who may have limited options.

Healthy NY Program

This program offers affordable health insurance to eligible employers and in turn offer them to their workers as employee benefit. The employers can also avail of the coverage plan for themselves. Co-payments are required from Healthy NY policyholders every time they receive treatment. The plan may charge as little as $100 deductible annually, the rest of the cost is covered by employers and paycheck deductions. Healthy NY is administered by the New York State Insurance Department and is promoted by the state’s Health Department.

Program Eligibility

The Healthy NY program is made available to two groups: employers with fewer than fifty employees and sole proprietors with businesses that listed themselves as the only employees.

Small businesses are required to have at least 30 percent of their employees earn less than $36,500 a year. Small business employers also must not have provided comprehensive medical insurance in the previous 12 months and are required to share at least fifty percent of the Healthy NY cost with their employees.

Sole proprietors must be residents of New York state who have worked at some time for the past 12 months and must earn less than 250% the federal poverty level.

Plan Coverage

Healthy NY plan offers coverage for most common medical treatments and services. These may include screening for diseases, X-rays, inpatient and outpatient hospital services. surgery, physical therapy, blood testing and home health care. In addition, some health plans offer prescription drug coverage, including generic and brand name prescriptions with an annual limit of up to $3,000.

Costs and Sources

The state of New York requires all health maintenance organizations (HMOs) that operate in the state to offer Healthy NY to qualified residents. HMOs have their own set of rates and can place policyholders under their own network of doctors and hospitals. The Healthy NY co-payments however are still the same for each plan.

These include a co-pay of $500 for hospital stays, 20% co-pay with $200 limit for surgeries, a co-pay of $50 for emergency room visits and $20 co-pay for the majority of other services.

Other HMOs offer high-deductible plans which substitute the $100 annual deductible with a much higher one with lower annual premium payments.