New York offers many consumer protections through its health insurance laws.
Health insurance is not mandatory in the state of New York, and so the majority of New York's laws related to the health care industry involve regulating the practices of insurance companies, protecting consumers, and offering coverage to those who cannot afford it. Depending on what type of health plan a resident is interested in purchasing, the laws will be slightly different.
Individual Health Plans
There are many laws in place in New York to protect those applying for individual health insurance, including a ban on denying coverage to residents with pre-existing conditions, as well as a requirement that insurance companies offer a family coverage option to individual buyers. When an individual becomes sick, companies cannot cancel the insurance, and the maximum term for excluding a pre-existing condition is 12 months, with 10 months exclusionary for pregnancy.
Group Health Plans
As is the case for individual plans, group plans also cannot deny coverage because of a pre-existing condition. Changing circumstances such as marriage, the addition of a child, and job loss all allow residents to reevaluate their group insurance under New York law. Employers, however, may require a waiting period before adding an employee to group insurance, and HMOs may require a similar affiliation period.
Small-Business Health Plans
Insurers cannot deny small businesses with 2 to 50 employees a small group plan, and an illness in the group cannot lead to the cancellation of such a plan. New York even offers small businesses a special program called Healthy New York, which helps small companies with low-income employees to purchase group insurance. The same consumer protections that apply to large group plans also apply to the plans purchased by small businesses.
Controlling Premiums
On June 9, 2010, Governor Paterson signed into law a bill that requires insurance companies in New York to request approval from the state if they wish to raise premiums for customers in small-employer or individually-bought health plans. It also demands that 82 percent of the premiums collected from those plans cover medical costs; previously, only 75 percent of small-employer premiums and 80 percent of individual premiums had to be used for medical coverage.
State Aid for Health Care
In addition to Medicare and Medicaid, New York also has a program called Family Health Plus that offers coverage to residents without health insurance who have an income too high to qualify them for Medicaid. Interested residents should set up an appointment with an enrollment facilitator by calling 1-877-9FH-PLUS. Depending on a family's income, children may also be eligible for public care through the Child Health Plus program, which is reachable at 1-800-698-4KIDS.
