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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
Insurance Options 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 of age.

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.
Special Considerations 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.


State of New York
David A. Paterson
State of New York
Department of Insurance
Eric R. Dinallo
Superintendent of Insurance
State of New York
Department of Health
Richard F. Daines, M.D.
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