New York health insurance tips

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New York insurance law and regulation

The New York Department of Insurance Web site contains consumer help sections for each type of insurance including a section on financially assisted health plans and Medicaid.  The Web site has not yet developed resources to help individuals find commercial low cost health plans like mini-med or core coverage, specific illness policies, Supplemental Accident Insurance and basic health insurance.

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

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.