New York Individual Health Insurance

Health insurance is an indispensable solution for individuals and families wishing to enjoy a secure financial and physical health. If you are currently uninsured, looking into a New York individual health insurance is a smart choice. If you are considering this route, you may have a lot of questions about the laws in New York regarding private policies. The information below will seek to help you learn more about individual health insurance policies, the New York laws surrounding them, and any rights that you may have.

Eligibility: How Am I Evaluated?

New York individual health insurance applications are reviewed based on residency requirements. Insurers are not allowed to use criteria such as age, past medical history, and lifestyle habits to determine whether or not to approve or deny an applicant. New York law requires private insurers to accept all residents who meet certain residency standards and provide a certain number of standardized policies for them to choose from. However, the state does not limit the monthly premium you can be charged for your insurance policy.

In accordance with HIPPA Group-to-Individual Portability Coverage regulations, New York guarantees issuance of health insurance through any private health insurance provider to all HIPPA eligible consumers.

New York Guaranteed Benefits & Pre-Existing Conditions

The state of New York does require insurers to carry two standardized policies that are guaranteed issue. These policies include:

• A comprehensive HMO policy which requires that you seek care from in-network providers, has a limited co-pay for most services (or none at all), and requires a deductible of no more than $500 for hospital stays and a few other select services only.
• A comprehensive POS policy which allows you to seek care from any provider, but imposes a $1,000 deductible and 20% co-pay for services rendered by out-of-network providers. Costs for in-network providers are the same as with the HMO plan.

HIPPA eligible consumers cannot have exclusion periods imposed on their policy. Pre-existing conditions can be included in an exclusionary period of up to 12 months for up non-HIPPA customers. To determine what is a pre-existing condition, insurers can look back in your medical files up to 6 months prior to your application. Any condition that you did or should have sought medical advice or treatment for can be considered a pre-existing condition. Elimination riders cannot be imposed on policies in the state.

New York Individual Health Insurance Premiums

Lastly, unlike in many other states, premiums cannot vary due to factors such as age, gender, health, or your occupation. They can vary depending on how many people are applying under the policy, the policy type, and what part of New York you reside in. Your policy also cannot be cancelled because of a change in your health status, even when it is time to renew, and you will not be charged with an increased premium in order to keep your policy.

With the hundreds of different individual policy options out there from multiple private insurers, you are bound to find a plan that meets the needs of your family and your budget. Make sure to contact your local licensed health insurance agent/broker to help you find the right health insurance policy for you.

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