If you want to learn more about specific health insurance providers in New York, click on any of the providers from the list below. Read on to learn about New York health insurance regulations.

UnitedHealthcare

Oxford Health Plans
HIP Health Plan of New York
Health Net
Guardian
Group Health Incorporated (GHI)
Empire Blue Cross Blue Shield
Aetna

Unlike many other states, New York insurers are not allowed to turn you away because of a health problem. They also must offer family coverage is requested. Eligible individuals for HIPAA (Health Insurance Portability and Accountablily Act which protects health insurance coverage for workers and their familes when they change or lose their jobs) have the same rights to individual insurance. Additionally, there are stringent rules governing Health Maintenance Organizations (HMOs) and Point of Service (POS) health plans in New York State. Your insurance can't be cancelled due to illness, for example. When purchasing an individual policy with a pre-existing condition, the company can check the individual's medical history up to six months prior to coverage; the maximum exclusion period is 12 months. Elimination riders are not allowed. Although pregnancy can be deemed a pre-existing condition, it can only be excluded for 10 months. If there hasn't been a prior break in coverage of more than sixty three days, individual insurance allows for credit to be given for an exclusion period of a pre-existing condition. The cost of premiums is determined by community rating. The most important fact, though, is that individual insurance cannot be cancelled if the individual gets sick.


If you're self-employed or thinking about it and you live in the NY, one of your biggest concerns is likely to be health insurance. Most people in the U.S. - about 60% according to the National Coalition on Health Care - get health coverage through their employers.
But the health insurance outlook for the self-employed is not as bad as you might think. If you are reasonably healthy, you might be surprised how cheaply you can arrange coverage, especially if you choose a high-deductible health plan. And now that health insurers are looking for growth beyond their bread-and-butter large group policies, you could see even better rates as those insurers compete for health coverage dollars.


Many of the rules for Individual health coverage are also included for group health insurance. New York regulations concerning group health insurance provide that because of a health condition , a qualified person cannot be refused or charged more. When a policy holder's life changes either positively with a marriage or children or negatively with family problems, or a job loss, there may be additional opportunities for group insurance Whether a child is a newborn, adopted, disabled, or a full-time student, there are special considerations for group policy holders in the State of New York. It should be noted, however, that a new employer may require a waiting period before offering group insurance, and a new HMO may also require an affiliation period. When applying for new insurance, insurance companies can look back for pre-existing conditions up to six months prior to new coverage. If you have a pre-existing condition, the insurance company can require an exclusion period of no more than six months under normal conditions. If you have maintained continuous coverage, with no breaks of more than 63 days, you are entitled to creditable coverage.

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Small Business owners who have from two to 50 employees cannot be refused small group health insurance, nor can insurance be cancelled due to illness in the employee group. To understand small business health insurance fully, the best idea is to contact the New York Department of Insurance (address below). Basically, New York offers a program whereby small businesses with low income employees are able to buy group insurance. Community rating determines the premiums of small businesses. There is a program for certain areas of New York: Long Island, Nassau and Suffolk Counties, and the Five Boroughs of New York City- which are allowed to join a purchasing pool for the purpose of group health insurance coverage. Again, it is best to contact the New York Department of Insurance for regulations governing associations that have group health coverage availability.


Empire State Plaza, Building No. 1
Albany, NY 12257
(518) 474-6600
www.ins.state.ny.us/nyins.htm

• Child Health Plus
• Medicaid
  • Medicaid Buy-in Program for Working People with Disabilities
  • Medicaid Obstetrical & Maternal Services (MOMS) Program
• Family Health Plus
• Elderly Pharmaceutical Insurance Coverage (EPIC)
• AIDS Drug Assistance Program (ADAP)
• HIV Uninsured Care Programs (ADAP)
• HIV Special Needs Plans (HIV SNPS)
• Managed Care
• Prenatal Care Assistance Program (PCAP)
• Medicaid Cancer Treatment Program: Breast, Cervical, Colorectal and Prostate Cancer
• Child and Adult Care Food Program (CACFP)
• Health Insurance Portability and Accountability Act (HIPAA)
• Long Term Care
• Early Intervention Program
• WIC (Special Supplemental Nutrition Program for Women, Infants & Children)
• Commodity Supplemental Food Program
• Farmers Market Nutrition Program
• Healthy New York Program
• Medicare
• Veterans Health Information Clearing House
• Workers' Compensation Preferred Provider Organizations (PPO)
  (source: Department of Health, New York)

More New York history...

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