Introduction: The health insurance situation in New York does not differ significantly, from the health insurance situation of the entire United States. According to a survey conducted by The Center for Disease Control, an average of 16% of the total New York population was uninsured for New York medical insurance for each year, between 2001 and 2003.
In the below mentioned abstract, we have discussed some important New York medical insurance regulations, elaborately. A brief discussion on New York state-aided medical insurance alternative programs is also included in this article. Being a New York dweller, you can read this abstract to know the health insurance status of your state.
Important Regulations for New York Medical Insurance
To supervise the overall New York health insurance market and regulate the activities of different New York medical insurance companies, the state government has introduced some rules and regulations. The regulations are discussed below:
- As per state laws, New York medical insurance companies should provide coverage to the New York residents, having access to medical insurance through an employer. They are qualified to get coverage under employer medical insurance policy. New York insurers should offer unlimited coverage to those individual.
- New York is a state where medical insurance is sold on guaranteed issue basis. New York medical insurance companies can not refuse or restrict an individual to get health insurance coverage under individual New York medical insurance plans.
- Moreover, the insurers can not limit access to New York medical insurance, on the basis of age, health condition and other risk factors.
- All New York health insurance policies should have a guaranteed provision for renewal.
- As per state regulations, a guaranteed renewability provision lets a New York individual renew his or her existing health insurance plan.
- Renewal provision is guaranteed, only when the policy holder has disbursed all the premiums, on time and provided to fake information during the term of that insurance policy.
- New York medical insurance companies can inflict a waiting period for any pre-existing health condition.
- A pre-existing health condition may be defined as an illness for which an individual has been treated or otherwise diagnosed previously, within 6 months before starting of new health insurance plan.
- New York medical insurance companies can impose a waiting period for a pre-existing health condition for not more than one year.
- During tenure of a pre existing waiting period, an individual is not entitled to get any coverage for the said health condition.
- Continual coverage can be credited towards new New York medical insurance plan; provided there was no breakage in coverage during the term of that plan.
- New York medical insurance policies can not carry elimination riders that cease coverage for any particular pre existing medical condition or body system or body part, even permanently.
- According to New York state health insurance laws, Pregnancy may be considered as a pre-existing health condition. However, the New York medical insurance companies can refuse coverage for pregnancy for the initial 10 months of pregnancy, only.
- New York health insurance organizations provide coverage to family unit, dependants and individuals, as well. The list also includes husband-wife policies.
- Individual New York health insurance plans that offer dependant coverage should cover newborns and adopted children under parent's insurance policy, for initial 30 days from the day of birth or adoption.
- Disable and handicapped dependants should get coverage under their parent's health insurance plan that offers dependant coverage. They can always get coverage, even if the decided upper age limit is over.
- New York residents, who are between medical insurance policies or jobs, can take advantage of temporary New York health insurance policies offered by different New York medical insurance companies. However, the temporary medical insurance plans should be bought within 45 days from the end of last individual New York medical insurance policy.
Standard New York Policies
Every New York Health Maintenance Organizations or HMOs should compulsorily offer some standard policies to the New York residents. They can opt for any of the point-of-service (POS) and the HMO versions of the standard policy. Coverage offered by both the versions differs in co-payments and deductibles. However, both of them offer complete health coverage.
New York Health Insurance Costs
Unlike other American states, New York medical insurance premium rates vary, on the basis of type of plan, demographics and size of the family. Rates do not differ, according to gender, age and occupation of the policy holder.
New York Medical Insurance Alternative Options
There are some state-aided health insurance alternative programs are active within the state of New York. New York individuals, who are otherwise considered as “uninsurable” by most of the health insurance companies or are not able to afford the cost of New York medical insurance, can opt for such state-aided health insurance alternative programs. The programs are as follows:
- New York Medicaid: This program is accessible to New York individuals who meet all the income as well as other health-related qualifying criteria.
- Child Health Plus or CHPlus: This is New York's Children's Health Insurance Program or NYCHIP, which is created to provide the benefits of New York medical insurance to the children and teens. Nevertheless, children from the families that are ineligible for New York Medicaid or unable to pay for New York medical insurance are only qualified to access this program.
- Healthy New York: This state-aided program is designed to provide insurance coverage to the uninsured working New York residents as well as self-employed people. Small employers that are not offering medical insurance, presently, can also opt for this program.
- New York Family Health Plus: This state-aided medical insurance alternative program lets the uninsured New York individuals, between age group of 19 and 64, to get coverage; provided, they should be ineligible for New York Medicaid. Couples without kids, parents and single adults can avail this program. However, they should meet all the eligibility criteria.
New York Insurance Department
For more information on New York medical insurance, you can contact at the following address:
New York Insurance Department
One Commerce Plaza
Albany, NY 12257
For telephonic assistance, you can call at any of the telephone numbers:
Consumer services: 518-474-6600