Healthy NY

Healthy NY was authorized by the New York State Health Care Reform Act of 2000. It was designed to encourage small businesses to offer health insurance coverage to their employees as well as to make coverage available to uninsured workers, their dependents and other qualified individuals whose employers do not provide group health insurance.

Currently over 160,000 New Yorkers receive health insurance from health plans participating in Healthy NY.

The State of New York Insurance Department administers Healthy NY. Health care is provided through Health Maintenance Organizations (HMO’s) or health plans that operate throughout NYS.

Individuals and sole proprietors pay the entire premium amount. The cost of health insurance for small businesses is shared by the employer and employee. New York State regulation and sponsorship insures that premiums remain affordable. To help lower premiums New York State makes “stop-loss” reimbursement payments to health plans covering 90% of all annual claims totaling between $5,000 and $75,000 per member.

Healthy NY offers comprehensive health insurance through HMOs to qualified working, uninsured individuals and their families, sole proprietors and small businesses.

The Healthy NY benefit package consists of health benefits covering essential health needs. Although it is considered a streamlined benefit because services such as mental health, substance abuse treatment, dental, vision and hearing aids are not included.

Uninsured individuals and sole proprietors must have gross household incomes below 250% of the Federal Poverty level; they must not have health insurance, and must either be currently employed or must have been employed within the past 12 months. Applications for individuals and sole proprietors are made directly to the participating health plan of the applicant’s choice. If the application is received by the health plan by the 20th of the month with the first month premium payment, coverage will start by the 1st of the following month.

To participate in Healthy NY, small businesses must be located within NYS, have 50 or fewer employees, at least 30% of the small business’s workforce must be receiving annual wages at or below $40,000, and have not provided group health insurance during the 12 month period preceding application. Small businesses can find the application on the Healthy NY website.