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Health Insurance Information For New York Consumers

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Health insurance is very important. It protects you and your family from a potentially catastrophic financial loss from a major illness. Studies have shown that one of the leading causes of personal bankruptcy is medical costs.

Even if you are healthy, health insurance may be a wise purchase. Many health insurance policies cover you for preventive care to detect illnesses before they become serious. Even if you are healthy, you need health insurance. If you wait until you are sick and then try to obtain insurance, the insurance company may not pay for your care relating to a "pre-existing condition."

Most people obtain insurance through an employer or a spouse’s employer. Some employers offer insurance to part-time employees.

Healthy NY

If you do not have insurance and you or your spouse is currently working or has recently worked and your employer does not offer insurance or you are self-employed and meet certain critieria, you may be eligible for the Healthy New York program. For more information on Healthy New York, select this link.

Child Health Plus

Every child in New York who is under age 19 who does not have health insurance is eligible for the Child Health Plus program. Child Health Plus offers comprehensive health coverage, including physician visits, hospital stays, outpatient care and prescription drugs. No copayments apply. Coverage may be free for certain income eligible families and others will pay a minimal premium for coverage. Some families may have to pay a full premium. For more information on Child Health Plus, go to http://www.health.state.ny.us or call 1-800-698-4543 or your local department of social services or department of health.

Family Health Plus

If your income falls below a certain level and you are between the ages of 19-64, you may be eligible for the Family Health Plus program. Family Health Plus is free and you do not need to be employed to qualify. Family Health Plus provides comprehensive health coverage, including hospital stays, physician visits and prescription drugs. For more information about Family Health Plus go to http://www.health.state.ny.us, or call 1-877-934-7587 or call your local department of social services or department of health.

Prenatal Care Assistance Program (PCAP)

PCAP is a comprehensive prenatal care program that offers complete pregnancy care and other health services to women and teens who live in New York State and whose income does not exceed 200% of the federal poverty level. PCAP offers routine pregnancy check ups, hospital care during pregnancy and delivery, full health care for the woman until at least two months after delivery and full health care coverage for the baby up to one year of age. For more information on this program, go to http://www.health.state.ny.us or call 1-800-522-5006.

Standardized Individual Direct Payment Policies

If you do not receive insurance through an employer, and are not eligible for Healthy NY or Family Health Plus, you may still purchase insurance regardless of your health status. You may also purchase coverage for your family. Some insurers may also offer husband-wife policies and parent-child(ren) policies. However, insurers may exclude treatment for certain pre-existing conditions if you have not had health insurance in the past 63 days.

Individual direct payment policies offer coverage through an HMO, which requires you to seek care from a network of providers. All HMOs in New York State must offer direct payment policies in the counties in which they operate.You may also purchase a point-of-service option for a higher price that would permit you to seek care from out of network providers.

Individual direct payment policies offer comprehensive benefits, including inpatient hospital care, outpatient services including laboratory tests and x-rays, care in a physician’s office, maternity care, chemotherapy, prescription drug coverage, physical therapy, and inpatient and outpatient mental health care. To learn more about the companies that offer direct payment policies, as well as the cost in the county which you reside, please select this link.

Other Individual Policy Options

Several New York insurers offer health insurance options to individuals in addition to the direct payment products discussed above.

Group Health Incorporated (GHI) offers two products, GHI Alliance Value and GHI Alliance 365, in this market.
GHI Alliance Value provides coverage for inpatient hospital care, prescription drug coverage, maternity and well child care and certain preventive care. The plan does not cover physician visits, other than for well-child or maternity.
The GHI Alliance 365 hospital plan covers inpatient stays, including mental health and certain types of outpatient care such as mammography and cervical cytology. Physician office visits and prescription drugs are not covered.
Both plans are available statewide.
To contact GHI, go to http://www.ghi.com or call 212-501-444 in New York City, 315-432-0826 in Syracuse, or 1-800-624-2414 in other areas.
Empire Blue Cross Blue Shield also offers hospital only health insurance in the 28 counties in which it does business. These counties are in the metropolitan New York City region, the Mid-Hudson region and the Albany/Capital District region. Empire’s TraditionPLUS covers inpatient stays and limited outpatient services. To contact Empire, go to http://www.empireblue.com or call 1-800-662-5193.
Excellus Health Plan offers individual hospital and medical indemnity contracts. There are separate hospital and medical contracts available in the Central New York and Utica-Watertown regions. The hospital and medical benefits are provided under the same contract in the Rochester region. To contact Excellus, visit http://www.excellusbcbs.com or call 1-800-633-6066 in Central New York, 1-800-847-1200 in Rochester, and 1-800-765-5226 in Utica.