Healthy NY

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Affordable health insurance for small businesses, uninsured individuals and sole proprietors

Healthy NY is a state-sponsored program offered through BlueCross BlueShield of Western New York. Healthy NY is designed to provide health insurance coverage to:

  • small businesses, their employees, dependents and other qualified individuals
  • sole proprietors
  • uninsured workers whose employers do not offer health insurance

Enrolling in the Healthy NY program through BlueCross BlueShield of Western New York gives you the same quality care and service that you get from any plan offered by BlueCross BlueShield. With many physicians and specialists to choose from, Healthy NY gives you access to the care you need when you need it.

Healthy NY Benefits

Healthy NY offers important medical services such as regular medical checkups, hospital care and, optionally, a benefit package with or without a limited prescription benefit. Covered services are subject to a copayment, and in the case of prescription drugs, a deductible and a benefit maximum.

The Healthy NY benefit package, which is streamlined, consists of health benefits that cover essential health needs including:

  • diagnostic and x-ray services
  • emergency services
  • inpatient and outpatient hospital services
  • maternity care
  • physician services
  • preventive health services

New York State has eliminated the Standard Healthy NY plan option for any new enrollments effective January 1, 2012.  The only option available is the High Deductible Health Plan option listed below.

Plan Information

High Deductible Health Plan Option

Healthy NY offers a high deductible health plan for those who meet eligibility requirements. Monthly premium costs for the high deductible health plan option are lower than the cost of standard Healthy NY. The plan also offers a benefit package with or without a limited prescription benefit.

A high deductible health plan (HDHP) is a health insurance policy that requires the enrollee to pay for most medical expenses up to a certain dollar amount before the insurance policy begins to cover them. The 2013 annual deductible amounts are $1,250 for single coverage and $2,500 for family coverage. Deductibles include both medical and pharmacy costs, minus any copays. Deductible amounts are adjusted annually for inflation.

Those insured by a high deductible health plan may establish a tax-deductible health savings account that can be used to pay for certain medical expenses. The maximum annual Health Savings Account (HSA) contribution is $3,250 for individual coverage and $6,450 for family coverage.

Also note the maximum out-of-pocket expenses are $6,250 for individuals and $12,500 for families.

Rates

The following monthly premium rates are for the High Deductible (HDHP) coverage plans.
Counties: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming (Effective January 1, 2013)

High Deductible

Single Employee (Children) Employee (Children w/dependent coverage thru age 29) Two-Person Fmaily Family w/dependent coverage thru age 29
$288.64 $688.37 $595.24 $591.27 $927.87 $938.66

High Deductible Without Rx

Single Employee (Children) Employee (Children w/dependent coverage thru age 29) Two-Person Fmaily Family w/dependent coverage thru age 29
$200.82 $409.31 $414.05 $411.68 $645.49 $652.96

Eligibility

Small Businesses

The Healthy NY Small Business Program is a health insurance program for small businesses that do not currently provide group health insurance coverage.

Your business is eligible to offer Healthy NY if the business:

  • employs 50 or fewer eligible employees
  • has a staff made up of at least 30% earning $41,250 or less in annual wages
  • did not provide health insurance coverage in the last 12 months (Providing health insurance is defined as arranging for coverage that includes BOTH hospital and medical coverage and contributing at least $50 per employee per month toward the premium)

In order to participate, your business must:

  • contribute at least 50 percent of the employee's Healthy NY premium
  • enroll at least half of your group of employees (at least one must earn $41,250 or less annually and work at least 20 hours a week)
  • be located within New York State

Uninsured Individuals and Sole Proprietors

The Healthy NY program for individuals is available to both eligible working individuals whose employers do not provide health insurance coverage and to eligible sole proprietors. Sole proprietor applicants must meet the same eligibility criteria that are applicable to working individual applicants.

Each of the following requirements must be satisfied in order to participate in the Healthy NY program for individuals and sole proprietors:

  • you must be a resident of New York State
  • you or your spouse must be employed full-time or part-time or be able to demonstrate that you have worked at some time in the past 12 months
  • your total gross household income must not exceed the household income limitations of the program (250 percent of the gross federal poverty level); to best reflect the applicant's current situation, income guidelines are based on current income
  • you must be uninsured for the 12 months prior to the application OR have lost your insurance due to a qualifying event
  • your employer does not provide group health insurance coverage
  • you must be ineligible for Medicare

Copayments and Deductibles

Covered services are subject to a copayment. A copayment is an amount enrollees must pay at the time they receive services.

If enrollees choose the benefit that includes prescription drug coverage, there is an annual deductible for prescription drugs. A deductible is a fixed amount during the annual benefit period that enrollees must pay before a plan starts to make payments for prescriptions.

Healthy NY Copayments and Deductibles

Service Copay
Inpatient hospital services $500 copay
Surgical services 20% or $200 copay
Outpatient surgical facility $75 copay
Emergency services $50 copay (waived if admitted to the hospital)
Prenatal services $10 copay
Well-child visits/Immunizations $0
All other services $20 copay
Optional prescription drug benefit Generic drugs have a $10 copay; brand name drugs have aGeneric drugs have a $10 copay; brand name drugs have a $20 copay plus the difference in cost between the brand name drug and generic equivalent

In the Healthy NY High Deductible Health Plan Option, any money that you spend on copayments for preventive services cannot be applied towards your plan deductible.

Services NOT Covered

Because Healthy NY has a streamlined benefit package, certain benefits are not covered. Examples of those services are:

  • alcohol and substance abuse treatment
  • ambulance
  • chiropractic
  • dental
  • home health care
  • hospice care
  • mental health

Pre-Existing Condition Limitation

Coverage under the Healthy NY program is subject to a pre-existing condition waiting period. This means that if the applicant has a medical condition that they have been either diagnosed with or treated for in the last six months, services for the treatment of that condition may be excluded from coverage for up to a year.

To Apply

In order to apply, you are required to provide a completed application with documentation verifying your current residence, current income and/or proof that you had worked within the past year. The links below take you to the appropriate application forms. All Healthy NY applications must be in our possession by the 20th of the month in order to be eligible for the following first of the month's coverage.

 Healthy NY Application for Small Businesses

 Healthy NY Application for Individuals and Sole Proprietors

Mail applications to:

Government Programs
PO Box 5204
Binghamton, NY 13902-9964

If you feel you qualify and you have questions or need other information, please call BlueCross BlueShield of Western New York at 716-887-7520 or 1-800-888-5407.

   

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