How to Get Health Insurance
||Directly purchase health insurance (individual plan)
||Qualify for reduced-cost health insurance through New York State programs
||Get health insurance coverage through an employer or association
||HMO: A health insurer that directly contracts with or employs a network of doctors, hospitals and
other types of providers.
HMO/POS: A health insurer that combines a HMO with the flexibility of being
able to see out-of-network doctors.
Healthy NYis a program that offers health insurance to small employers, sole
proprietors and uninsured working individuals.
Child Health Plus is a health insurance plan for children who are under 19 years
Family Health Plus is a health insurance program for adults between 19 and 64 years
of age who are uninsured and have incomes too high to qualify for Medicaid.
Insured Plan: An employer contracts with a licensed health insurer or HMO to provide
coverage for its employees.
Self-Insured Plan: An employer creates a fund to cover medical expenses
and typically contracts with an outside party to administer the health benefits.
Professional Association: An association may offer its members group rates on
insurance plans that are generally less expensive than individual plans.
||For a pre-existing medical condition, a member may have to wait up to a year for
coverage of the condition if treatment was recommended or received within the 6 months prior
to the date of enrollment. The waiting period may be reduced if the individual was
previously covered and applied within 63 days of expiration of coverage. It is important that
insurance coverage does not lapse beyond this point. Contact NYSID or the individual health insurer
for details about the pre-existing condition waiting period
||Individuals must meet eligibility criteria, which are different for each program. Eligibility
for these reduced-cost health plans is based on a person's income. See
Health Insurance Options for Uninsured New Yorkers for
information about cost and enrollment.
||Employers and associations can offer different types of plans and different cost-sharing options.
New York consumer protections and insurance laws do not apply to selfinsured
plans. These plans are regulated by the U.S. Department of Labor under a federal statute known
as ERISA. Ask your employer's benefit manager if the health coverage provided is self- insured.
Copyright © 2006 New York State Insurance Department