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New York insurance law and regulation
The state insurance department can be reached by telephone at (212) 480-6400 or by mail at 25 Beaver Street New York, NY 10004. The state children’s health insurance plan (CHIP) Web site is NYstateofhealth.
For issues concerning payment, reimbursement, coverage, network adequacy, benefits and premiums, contact:
New York State Department of Financial Services
Consumer Assistance Unit
Phone: 800-342-3736
Email: consumers@dfs.ny.gov
Online: www.dfs.ny.gov/complaint
For denials of coverage of health care services because a health insurance company considers them experimental, investigational, not medically necessary, a clinical trial, a rare disease treatment, an out-of-network service or, an out-of-network referral, contact:
New York State Department of Financial Services
New York State External Appeal Division
Phone: 800-400-8882
Email: externalappealquestions@dfs.ny.gov
Online: www.dfs.ny.gov/complaints/file_external_appeal
For issues concerning HMO quality of care, contact:
New York State Department of Health
Managed Care Complaint Unit
Phone: 800-206-8125
Online: www.health.ny.gov/health_care/managed_care/complaints/index.htm
For issues concerning insurance fraud, contact:
New York State Department of Financial Services
Insurance Frauds Bureau
Phone: 888-FRAUDNY | 888-372-8369
Online: www.dfs.ny.gov/complaints/report_fraud
Under federal law, if you receive health coverage through a self-insured plan covered by ERISA, New York consumer protections and insurance laws do not apply. If you have a complaint regarding a self-insured plan, contact:
United States Department of Labor
Employee Benefits Security Administration
200 Constitution Avenue, NW
Washington, DC 20210
Phone: 202-693-8700 | 866-444-EBSA
Online: www.dol.gov/agencies/ebsa
A copy of the 2019 Consumer Guide to Health Insurers :https://www.dfs.ny.gov/consumers/health_insurance/guide_2019
News that affects your health insurance and planning
March 12, 2023 – New Yorkers have lots of questions about legalization of marijuana, especially as it relates to medical treatment. Jeffrey Hoffman’s show covered on Syracuse.com is a great resource for evolving news: Home grows, insured cannabis, and ongoing cannabis legislation in NYS – syracuse.com
June 1, 2022 – Today the New York Senate passed Bill S8837 that would require its state public health plans to cover medical marijuana. If passed by the State Assembly, New York would be the first state to cover the high cost of prescription marijuana. The bill only applies to public health plans (Medicaid, Child Health Plus, Elderly Pharmaceutical Insurance Coverage (EPIC), Essential Plan programs and workers compensation). Private health insurance plans could make their own choice and most supplemental plans like those listed here on Freedom Benefits do not contain prescription coverage.
December 27, 2020 – ParCare Community Health Network is under scrutiny this week after posting about the availability of COVID vaccine to the general public. The State of New York’s department of health intends to enforce that all available doses are used for first responders and other priority recipients now.
August 13, 2020 – Mental health has become more important in this post-pandemic environment. Congratulations to New York Psychotherapy and Counseling Center, based in Jamaica, New York, that operates outpatient mental health clinics in under-served communities in New York City. It has converted almost all of its patients to an online telemedicine service.
July 18, 2020 – AM Best categorizes the subsidiaries of EmblemHealth, Inc. as very weak, as well as its marginal operating performance, neutral business profile and marginal enterprise risk management. That includes Health Insurance Plan of Greater New York, HIP Company of New York, Group Health Incorporated, and ConnectiCare.
July 18, 2019 – Soon a new will amend New York’s Mental Health Parity Law to expand coverage by extending the definition of what is considered an eating disorder by law. Under the new law the definition of a disorder is expanded to include: Anorexia nervosa, Avoidant/restrictive food intake disorder, Binge eating disorder. Bulimia nervosa, Pica Rumination disorder,
other specified feeding or eating disorders and any disorder contained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
June 16, 2019 – Status of alternative non-ACA health plans: New York does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, does not permit insurers to sell non-compliant transitional policies in the individual market. New York does not allow the sale of medically underwritten short-term coverage.
May 23, 2019 – Between now and the end of 2020, all New York City residents without health insurance will be eligible for a NYC CareCard that will provide each member with a dedicated doctor, access to a 24/7 customer service line to make appointments, and clear copays that are affordable to each individual member.
March 30, 2019 – Crystal Run Healthcare will withdraw from offering its health plans that serve members in Orange and Sullivan counties. The officers of this well-managed innovative health plan object to a provision of the Affordable Care Act (ACA) that is designed to prevent “cherry picking” of healthy members from other health plans. The ACA imposed administrative burdens and additional costs on this health plan. It is not clear whether the company will continue in business by offering plans outside of the ACA. In the event that health plan members are threatened with a loss of coverage, the state insurance exchange and resources like Freedom Benefits OnlineNavigator are available help assess the remaining options.
March 29, 2019 – Small business health plans – Yesterday a federal court in the District of Columbia ruled in favor of states in striking down U.S. Treasury regulations that permitted the expansion of small business association health plans. Even before the court ruling, association health plans were not showing promise as cost-saving measures as was hoped. What this means to small businesses is that if they want a lower cost health plan then they must design it themselves independently from an insurance company. The problem is that most firms providing benefits services are primarily in the business of selling insurance rather than lowering costs. Freedom Benefits offers an affordable consultation to help small business owners design and document an alternate small business health plan without necessarily requiring the purchase of insurance.
January 20, 2019 – This week the New York legislature will likely pass the Reproductive Health Act that protect a woman’s right to choose abortion and expands the availability of the procedure. Since other states are passing laws to restrict abortion rights, New York is expected to become a more common provider of the procedure for women across the nation.
The history of health care planning in New York (Information is outdated and links may be expired)
New York state law does not allow short term medical insurance. The low cost defined benefit insurance options used elsewhere are also not available within New York. Although some states allow residents to purchase health insurance that is legally available in other states, New York does not permit this option while you are physically within New York state.
The only solution, it appears, is to purchase insurance while temporarily residing outside of the state. Insurance legally issued while you are at another temporary address is legally valid within New York state and you may use it for New York doctors and hospitals. A temporary address may be a vacation residence, school, relatives, etc. where you need insurance and it is offered. There is no requirement that it be a permanent address or your legal address. If you return to an address in New York it is possible to notify the short term insurance carrier for administrative purposes (if you pay by mail) but this does not affect the rates or validity of the already in-force policy.