New York Health Insurance - Health Plan One

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Health Insurance for the Well Informed

In New York, medical underwriting is not allowed. This means that insurance companies are not permitted to review the medical history of prospective members. As a result, they are required to charge the same rate (or premium) to members regardless of their health status. This leads to extremely high premiums.

In New York, all health insurance companies must offer insurance coverage to all individuals, even those with serious medical conditions. Health Plan One offers individual health insurance through GHI in all areas of New York and health insurance plans through Atlantis in the five Burroughs. Health Plan One also offers several health insurance plan options to sole proprietors through GHI, Oxford, HIP, and Atlantis. More Info

4% of New Yorkers have individual health insurance according to Kaiser's StateHealthFacts.org website. In 2006, the average monthly premium for an individual with a traditional low deductible policy was $302, while it cost $734 to cover a family. (www.tnhis.com/ny.htm )

According to www.familiesusa.org, health insurance premiums in New York for a family with private, employer-sponsored coverage increased by $640 in 2005 and are expected to increase by $1024 by 2010. Premiums for individual health insurance coverage in New York were $233 higher in 2005 and will increase by $343 in 2010. These additional costs are directly related to the unpaid cost of health care for the uninsured. The percentage of New Yorkers who do not have health insurance affects the price of insurance for everyone, and therefore it is important that we work to provide everyone with affordable health insurance.

Empire Blue Cross Blue Shield - Prism Plans

Empire's latest plan offers premium access to the nation's largest and most respected provider network. The new Empire Prism Plan offers some of the best options with competitive rates in New York. Here are some of the benefits:

The nation's largest provider network. As a member, you will have access to 668,000 in-network providers. The BlueCard PPO network will cover you at 90% of all hospitals and 80% of all doctors in the US.
Empire's provider network has the very best doctors and hospitals in the country.
The Prism Plan covers members across the globe, regardless of where the incident occurs.
Most Prism Plans do not require a referral or deductible to receive care.
To prevent members from becoming ill, the Empire Prism Plan covers 100% of costs on annual preventive care screenings.

13% of New Yorkers lack health insurance even though medical underwriting is not allowed. For this 13%, trying to find affordable health insurance can be very difficult. Health Plan One can help New Yorkers find affordable health insurance plans that meets their specific needs.

In New York, health insurance policies offered to small businesses (small groups) are often less than half the cost of comparable individual policies. Generally, a “small group” is defined as at least one or more eligible individuals that are employed as associates, partners or owners of a small business, and 75% of those employees must be covered under the company sponsored plan. Insurance premiums are based on community rating in New York. There is a 6 month look back and 12 month exclusionary period limit for preexisting conditions for those without prior healthcare.

According to www.ahipresearch.org , the average monthly premium in 2006 for an individual in New York under a small group plan was $419, while family coverage cost $1,097 per month under the small group plan.

You must reside in New York state

Healthy NY

“Healthy NY” began in 2000 to help small business owners and uninsured workers obtain health insurance. All HMOs in New York State offer the Healthy NY health insurance benefit packages which cover essential health needs. Healthy NY is available to small business (group) employers, sole proprietors, and uninsured workers, but each group has different participation rules and criteria.

You or your spouse must either be currently employed or must have been employed within the past 12 months

Your employer does not currently provide you with health insurance.

You must be ineligible for Medicare

You have not had health insurance in effect for the 12-month period preceding application or have lost that coverage due to a qualifying event such as loss of job, death of a family member, change to a new employer, change of residence, discontinuation of a group health plan, termination or cancellation of COBRA coverage, legal separation, divorce, or annulment, loss of eligibility for group health insurance coverage, or reaching the maximum age for dependent coverage.

For more information on Healthy NY visit: http://www.ins.state.ny.us/downpdf.htm#sbg

If you are eligible for coverage through this program, you can review the application process and access an application form at www.healthyNY.com.

Medicaid is a joint state and federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income, resource, age, or disability requirements.

Income requirements

Ages 1-5: 133% of the Federal Poverty Level

Ages 6-19: 100% of the Federal Poverty Level

Pregnant Women and Infants

Pregnant Women: 200% of the Federal Poverty Level

Infants- Ages 0-1: 200% of the Federal Poverty Level

Non-Working: 150% of the Federal Poverty Level

Working: 150% of the Federal Poverty Level

Medically Needy Individuals: 87% of the Federal Poverty Level

Medically Needy Couples: 93% of the Federal Poverty Level

Supplemental Security Income Recipients: 74% of the Federal Poverty Level

Covered Services
Smoking cessation agents, treatment and preventive health and dental care (doctors and dentists), hospital inpatient and outpatient services, laboratory and X-ray services, care in a nursing home, care through home health agencies and personal care, treatment in psychiatric hospitals (for persons under 21 or those 65 and older), mental health facilities, and facilities for the mentally retarded or the developmentally disabled, family planning services, early periodic screening, diagnosis, and treatment for children under 21 years of age under the Child/Teen Health Program, medicine, supplies, medical equipment, and appliances (wheelchairs, etc.), clinic services, transportation to medical appointments, including public transportation and car mileage, emergency ambulance transportation to a hospital, prenatal care, and some insurance and Medicare premiums.

Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

New York offers the Child Health Plus program to children under the age of 19, who are residents of New York, and whose family income is up to 250% of the Federal Poverty Level. Please visit the Child Health Plus website for more detailed information at http://www.health.state.ny.us/nysdoh/chplus/index.htm.