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Health Insurance FAQs

Self-Employed Health Insurance Questions:

Q: Who are the self-employed?

You are self employed if you fall into any of the following categories:

  • You are in a business or trade as an independent contractor or a sole proprietor.
  • You belong to a partnership that carries a business or trade.
  • You operate your own business which includes part-time business.

Q: I’m an independent contractor, is that the same as being self employed?

Yes. You are self-employed if you are an independent contractor.

These are individuals who are in an independent business, trade, or profession who offer services to the general public.

Q: I just left my job a few months earlier and have been working on my own, can I still qualify as self employed?

Yes, provided you have legal documents that show you are self-employed. You should note that different insurance companies have different requirements.

  • Easy Choice requires a business certificate, W-4 and three months of documented income.
  • GHI requires a Letter of Certification.
  • HIP requires a business certificate and CPA letter (confirming you are self-employed working at least 20 hours a week, and your expected date of tax form availability)

Q: I recently started my business and don’t have any tax documentation,
can I still qualify?

Yes, although different insurance companies have different requirements.

  • Easy Choice requires a business certificate, W-4 and three months of documented income.
  • GHI requires a Letter of Certification.
  • HIP requires a business certificate and CPA letter (confirming you are self-employed working at least 20 hours a week, and your expected date of tax form availability)

 

Business Association Questions:

Q: Which insurance companies require that I become a member of a business association to purchase health insurance?

HIP. Fortunately, they offer better health insurance deals as business associations pool their self-employed members together. You can access lower rates by becoming a member of a business association.

Q: Which business associations & what benefits do they offer
besides health insurance?

These business associations are IRBA (Independent Retail Business Association), LIA (Long Island Alliance), NYSBG (New York State Business Group), USFSB (United States Federation of Small
Businesses). These associations also offer accidental and life insurance; vision and dental discounts; and shopping discounts.

Q: What are the business association dues?

Membership fees range from $35 to$60 per year depending on the association you choose.

Q: I have insurance through another business association but the rates
are higher. Can I switch to one of your plans listed?

Yes.

Healthy NY Insurance Questions

Q: What is Healthy NY?

Healthy NY is a state-subsidized program created to provide small business owners and their employees with comprehensive and quality healthcare. The program is also available for sole
proprietors and workers who cannot get employer-sponsored health insurance.

Q: Healthy NY rates are very competitive, how can I qualify for healthy
NY?

  • You must be resident of New York State
  • You or your spouse must currently be self-employed
  • You must not have health insurance coverage for
    the past 12 months, or must have lost health coverage due to any of the
    following:

    • change of residence
    • loss of employment
    • change of employer
    • loss of eligibility for group health insurance coverage
    • discontinuation of a group health plan
    • termination or cancellation of COBRA coverage
    • reached maximum age for dependent coverage
    • death of a family member
    • annulment, divorce, or legal separation
    • ineligible for Medicare

Your gross household income must meet the program’s income requirements.

Q: Will my current health insurance coverage make me ineligible for
Healthy NY?

Yes. But coverage is still possible under certain conditions.

Q: I’m on COBRA now, but it’s expensive. If I qualify for Healthy NY based on income can I sign on?

Yes. Healthy NY waives the 12-month rule if you have lost health insurance due to any of the following:

  • change of residence
  • loss of employment
  • change of employer
  • loss of eligibility for group health insurance coverage
  • discontinuation of a group health plan
  • termination or cancellation of COBRA coverage
  • reached maximum age for dependent coverage
  • death of a family member
  • annulment, divorce, or legal separation

Q: I would like to get Healthy NY just for myself but there are 4 people in my family. On your Healthy NY income guidelines am I considered a single or a family 4?

You will be considered as a family of 4 even though you are the only applicant.

Q: I currently have Healthy NY but I’m not happy with the insurance company. Can I switch to another company?

Yes.

Q: How many plans does Healthy NY offer?

There are four (4) plans available under Healthy NY; two (2) HMO plans (one with prescriptions) and two (2) high deductible health plans (one with prescriptions).

Q: I see that every company offers Healthy NY but what are the differences between the companies?

The main differences between these companies are the size and participation of the network providers (hospitals, physicians, and labs)

APPLICATION QUESTIONS

Q: If I have any questions completing an application, who do I call?

You can call us at (888) 215-4045 from 8:30AM-5:30PM Monday to Friday.

Q: On your online form I see that you’re asking for my social security number and Date of Birth. I don’t feel comfortable providing that information online. Can I leave them blank?

Yes. You can leave that information out of the online form.

Q: Once I submit the online form what happens next?

After submission, you will receive an email with step-by-step instructions and a completed application form. You need to sign the form and send it back to us by fax, email, or snail mail. You also need to include your tax forms to verify your self-employed status along with the first month’s premium.

Q: How long does it take to process my application?

It depends on which insurance company and plan you applied for. Easy Choice, GHI, HIP, and Oxford plans are processed in less than two weeks. Healthy NY plans take at least three weeks to
process. The process takes much longer applications with missing or improper documentation.

Q: I’m having trouble opening the application that I received in your eail can you fax it or snail mail it?

Yes, just notify us by phone or email.

GENERAL QUESTIONS

Q: Can I purchase the health insurance plans at a lower rate by going direct?

No, self-employed health plans cannot be purchased directly from insurance companies and business
associations.

Q: What happens if I decide to terminate my health plan, will I be penalized?

No, there won’t be any penalty. However, you are required to inform the business association two weeks prior to terminating your plan.

Q: I currently have an insurance plan that will expire in the middle of the MONTH; can I start a new plan in the middle of the month?

It depends on the insurance carrier you want to apply for. Easy Choice and GHI health coverage can begin in the middle of the month. However, Healthy NY, HIP, and Oxford plans can only begin at the first of every month.

Q: I’m the only one in my family that needs health insurance; do I have to cover my dependents?

No.

Q: My current insurance is expiring and I have a pre-existing condition, will I be covered under the plans listed?

Pre-existing conditions will not be covered during the first 12 months of the plan’s effectivity.

Q: I just found out that I’m pregnant and don’t have insurance. Can I purchase an insurance policy and be covered?

Pregnancy, on the third trimester, is not considered as a pre-existing condition.

Q: One of my children is in college; will they be covered under my family plan?

Yes. Your child can be covered under your family plan if he or she is:

  • at least 19 years old
  • single
  • supported by at least 50 percent by the member
  • listed as a dependent at the time of the member’s application
  • enrolled in an accredited educational institution which grants a degree or diploma

Q: I don’t understand some of the insurance terms that you have on your
web site.

Please refer to our Health Insurance Glossary for more information about health insurance terms.

"Vista Health Solutions" www.nyhealthinsurer.com Tel (888)215-4045 Email info@nyhealthinsurer.com