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New York Health Insurance
According to the Center for Disease Control, between 2001 and 2003 an average of 15.5% of New York residents went uninsured for New York health insurance each year.
New York Health Insurance Regulations
Individuals who have access to New York health insurance through an employer cannot be denied or limited coverage under that insurance plan. Persons looking to obtain individual New York health insurance are guaranteed the right to purchase. No New York insurance agency can deny an individual the option of purchasing an individual health insurance plan. New York is a guaranteed issue state for health insurance.
Individuals looking to renew an existing policy are guaranteed the right to renew that policy provided no false information has been provided and all premiums have been paid. This is a guaranteed renewability provision.
All New York HMOs are required to offer standard policies to all consumers who have the option of either an HMO or a point-of-service (POS) version of the policy. Both versions offer comprehensive coverage. They vary in deductibles and co-payments.
Individual New York health insurance policies can limit coverage for a pre-existing condition for up to 12 months. A pre-existing condition is one for which an individual was diagnosed or treated within the six months prior to the beginning of coverage under the new plan. Credit can be given to coverage prior to the plan provided that coverage was continuous. New York health insurers are prohibited from imposing elimination riders which would permanently exclude coverage for an existing medical condition or body part.
Pregnancy is considered a pre-existing condition for most individual health insurance companies in New York, but policies can only exclude coverage for the first 10 months of pregnancy. New York medical insurance companies offer coverage for families as well as individuals and can include husband-wife plans as well as dependent coverage. If an individual policy covers dependents, newborns and adopted children are automatically covered for the first 30 days after birth or adoption. Disabled children may remain under the policy past the age which dependent coverage usually stops. Full time students can also remain under a parent’s policy as adults. HIPAA eligible individuals have the same guaranteed access to health insurance but cannot be limited for pre-existing conditions.
New York health insurance rates do not vary based on age, gender, health or occupation. Premiums can, however, vary based on family size, location, and type of policy.
Alternative New York Health Insurance Options
Some New York health insurance companies sell temporary individual health insurance for individuals who are between plans or jobs. Temporary policies must be purchased within 45 days of the end of the previous individual health insurance plan.
New York state has programs available for individuals who have difficultly affording individual New York health insurance, and for small business and self-employed individuals who are looking for options in health insurance:
- New York Medicaid is available to qualified individuals who meet eligibility requirements.
- Healthy New York is a program designed to provide health insurance to eligible uninsured working individuals and self-employed individuals. Small businesses not currently offering health insurance can also apply.
- Child Health Plus (CHPlus) is New York’s Children’s Health Insurance Program that is designed to provide health insurance to children under 19 whose families do not qualify for Medicaid and who may not otherwise be able to afford New York health insurance.
- New York Family Health Plus is a program for uninsured adults between 19 and 64 who do not qualify for Medicaid. This program is available to couples without children, parents, and single adults. Eligibility requirements must be met.
New York Insurance Department
One Commerce Plaza
Albany, NY 12257
Consumer services: 518-474-6600 1-800-342-3736
For other New York Insurance Resources, See:
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