Healthy NY
Please contact Cliff Grekin for more information or to enroll: Phone direct 631-963-6020 or email cgrekin91@aol.com
Healthy NY is a New york State program designed to reduce the cost of health insurance for small businesses. Here are the current Healthy NY rates for small businesses in NY. Compare New York small business health insurance plans for businesses that don't qualify for Healthy NY.
To qualify for a Healthy NY plan your business must meet five qualifiers for a small business.
1. Your small business has to be uninsured for at least one year or it has to be a new business never insured before.
2. At least 30% of your employees must be earning less than $40,000 per year.
3. Your business must contribute at least 50% of the premium cost.
4. At least 50% of your employees must enroll.
5. At least one employee who earns less than $40,000 per year must enroll.
The Healthy NY program is available in every county in New York State. The program uses the local insurance companies to administer the health insurance benefits. The benefits are all standardized, the only exceptions are you can purchase the plans with or without drug benefit and in a few rare cases you can purchase the programs without the need for referalls to see specialists.
Please contact me to determine if your small business qualifies for the Healthy NY program. The Healthy NY program benefits are as follows:
Benefit Package
The Healthy NY benefit package includes important services such as hospital care and doctors' office visits. The business may also choose an optional prescription drug benefit. Although many different insurance companies offer Healthy NY, each insurance company offers the same standardized benefit package. Insurance companies have different premiums and provider networks. The business can change benefit packages at the time of annual recertification or if there is a change in the premium rate. The benefit package that the business chooses will apply to all covered employees.
Network-Based Coverage
Most of the insurance companies that offer Healthy NY are HMOs. This means that benefits are provided through each insurance company’s network of medical providers. You must use the doctors and health care providers who participate in your insurance company’s network, except in an emergency. To find out of a health care provider is in your insurance company’s network, contact the insurance company or visit the Provider Directories page.
Covered Benefits
- Adult preventive services including annual mammogram, annual Pap test, annual prostate cancer screening, adult immunizations and routine physical examinations once every three years
- Preventive services for children including routine well-child visits and immunizations
- Inpatient hospital services including daily room and board, general nursing care, special diets and miscellaneous hospital services and supplies
- Outpatient hospital services including diagnostic and treatment services and surgical facility charges
- Physician services including diagnostic, treatment, consultant and referral services
- Surgical services including anesthesia, pre-admission testing and breast reconstruction surgery after a mastectomy
- Emergency services (ambulance not covered)
- Second opinion for surgical and cancer treatment
- Diagnostic, X-ray and laboratory services
- Radiation, chemotherapy and hemodialysis
- Maternity and prenatal care
- Home health care (up to 40 post-hospital or post-surgical visits per calendar year)
- Physical therapy (up to 30 post-hospital or post-surgical visits per calendar year)
- Diabetes equipment, supplies and self-management education
- Therapeutic services including radiological services, chemotherapy and hemodialysis
- Blood and blood products furnished in connection with surgery or inpatient hospital services
- Optional prescription drug benefit
Copayments and Deductibles
Except for preventive services, most services have a copayment. The copayment is an amount that you must pay at the time you receive services. Copayment amounts are the same for each insurance company. A deductible is the amount you must pay before your insurance company will pay for services. All Healthy NY coverage with an effective date of January 1, 2012 or later is subject to an annual deductible of $1,250 for an individual and $2,500 for a family. For more information on deductibles, please visit our page on High Deductible Health Plans (HDHPs). Some services (such as preventive services) are not subject to the deductible.
Copayments
| Covered Service |
Copayment |
|
Inpatient hospitalization
|
$500
|
|
Surgical services
|
Lesser of 20% or $200
|
|
Outpatient/ambulatory surgery center
|
$75
|
|
Emergency services
|
$50 (waived if admitted to the hospital)
|
|
Prenatal care
|
$10
|
|
well-child visits, including immunizations
|
No charge
|
|
Preventive care
|
No charge
|
|
All other services including specialist visits, diagnostic testing and lab work
|
$20
|
|
Optional prescription drug benefit
|
$10 for generic drugs
$20 for brand drugs plus the difference in cost between brand and generic (if a generic exists)
|
Services Not Covered by Healthy NY
Because Healthy NY has a streamlined benefit package, certain services are not covered. Examples of these services include:
- Mental health services and prescription drugs relating to mental health conditions, including but not limited to treatment and medication for ADHD, depression and anxiety
- Alcohol and substance abuse treatment
- Chiropractic coverage
- Hospice care
- Ambulance
- Dental, vision and hearing aids
- Durable medical equipment, prosthetics, orthotics and supplies
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