New York (NY)
Individual Health Insurance Regulations

Learn more about New York Individual Health Insurance

Health insurance is mandatory when it comes to your family’s physical well-being. In the event of medical catastrophes, suitable health coverage can save a great deal of money and protect your health. Getting a health insurance policy can be quite confusing. You should evaluate your family’s medical needs and finances, before selecting a policy. If you are resident of New York, you can choose from wide range of health insurance alternatives. The New York State Insurance Department supervises the regulations under which the New York health insurers can sell private health insurance to individuals and families.

The ability to purchase individual health insurance plans in New York is not based upon your health status, as individual and family health insurance policies are not permitted to be medically underwritten in the state. New York law requires individual health insurance to be sold on a guaranteed issue basis, meaning that an applicant cannot be turned down for coverage due to past or present medical conditions. New York insurance regulations do permit health insurance carriers to have a 6 month look back period and a 12 month exclusionary period limit on all pre-existing conditions. The look back and exclusionary periods apply only to those applicants without prior creditable coverage. The law does not permit insurance carriers to use elimination riders when writing individual health insurance policies. Premium rates are community-based and may vary due to geographic location and family status.

New York (NY)
Small Group Health Insurance Regulations

In New York, a small group is defined as a company with 2-50 employees. Pursuant to the Health Insurance Portability and Accountability Act of 1996, all group health insurance is required to be guaranteed issue. Guaranteed issue coverage prevents any group from being declined for health insurance coverage based upon its collective health status, past or present. All group plan applicants lacking prior creditable coverage are subject to a 6 month look back and a 12 month exclusionary period limit on pre-existing conditions. In addition, employers may impose a waiting period before allowing an employee to join the group health plan, but the length of the waiting period must be the same for all employees. Under a group plan, New York affords special protection to adult children who are covered under a group health plan and who are full time students. If the adult child should become sick and need to take a leave of absence from school, New York law provides that the child may remain on the group health plan for up to one year. Premium rates for group health plans are community-based.

New York COBRA and Continuation Coverage

This is a guaranteed issue state for health insurance and insurers are required to cover anyone who applies for individual health insurance. In spite of this, New York COBRA laws require employers with less than 20 employees to offer 18 months of continuation coverage.

Under both federal and state law, continuation of health insurance coverage must be provided to those individuals who have lost their group health insurance coverage due to a qualifying event. Under COBRA you may remain on the employer-sponsored health plan, receiving the same level of coverage, for a period of 18, 29 or 36 months. Notice of continuation rights must be sent by employer within 5 days following the date of termination. You will be responsible for paying 100% of the monthly premium, plus a 2% administration fee. Individuals must give notice of the election of coverage within 60 days of the qualifying event. New York mini-COBRA laws allow any person to be rejected continuation of coverage under the group plan if they have access to other group health insurance or Medicare benefits.