PartnerIndustry.com

Understanding Empire Healthy NY

Empire, a health insurance carrier in New York was established in 1934. Empire is a subsidiary of WellPoint, Inc. WellPoint is the largest publicly-traded health insurance company in the United states based on their number of members. It has been 75 years since Empire started health care to New York’s residents. 35 million residents in 14 states trust Empire and their affiliate Blue Cross and Blue Shield for their health coverage needs. They don’t only have a long history to be proud of. There is another thing that is unique about this company – They own and directly manage their own local networks. Because of this, they are able to provide their members with a high level of quality health care and lower costs.

Among the plans they have available is Healthy NY. It is a government-sponsored health insurance program established to provide health care to New Yorkers who are having a hard time applying for coverage.

In order to apply, you must meet Healthy NY’s eligibility requirements.Eligibility requirements are as follows:

· You should be a resident of New York;

· You must be ineligible to apply for Medicare;

· Your total gross household income should be within the limit set by the Healthy New York program;

· You should either be an employee or a sole-proprietor;

· You must be uninsured for the past 12 months except for some qualifying reasons (see below)

· You must have no health insurance benefits from your employer

Qualifying Reasons /Exceptions:

· Losing your job with health benefits

· Change to a new employer

· Death of a member in the family

· Change to a new address

· Discontinuing group health plan· Cancellation of COBRA

· Changing marital status

· Losing eligibility to a group coverage

· Reaching age limit for dependent coverage

Healthy NY Summary of Benefits:

· Physician services and treatment

· Surgical services and anesthesia

· Inpatient hospitalization

· Outpatient hospitalization including diagnostic and treatment services and surgical facility charges

· Pre-admission testing

· Emergency services except for ambulance

· Surgery and Cancer treatment second opinion

· Post-surgery or post-hospitalization home health care, up to 40 visits per calendar year

· Post-surgery or post-hospitalization physical therapy, up to 30 visits per calendar year

· Adult preventive services;

Physical examination – once every year

· Prenatal care, well-child visits, and children’s immunizations

· Diabetic supplies, equipment and information

· Diagnostic, X-ray, and laboratory services

· Radiation therapy, chemotherapy, and dialysis

· Blood and blood products provided with surgery or inpatient hospitalization

Empire offers 4 Healthy New York plans -

· · Empire Healthy NY HMO 1 (without prescription coverage) – Premiums may range from $251.60 – $290.40

· · Empire Healthy NY HMO 2 (with prescription coverage) – Premiums can be anywhere from $298.92 – $346.59

· · Empire Healthy NY High Deductible Health Plan 1 (without prescription coverage) – Premiums may range from $196.14 – $226.39

· Empire Healthy NY High Deductible Health Plan 2 (with prescription coverage) – Premiums can be anywhere from $261.14 – $301.41

*Expect Healthy NY rates to change every year.

There are certain services that will not be included in the streamlined benefit package of the Healthy NY Health Insurance such as :

· Mental health services and prescription drugs related to mental health conditions including treatment for depression, anxiety, and attention deficit hyperactivity

disorder (ADHD),

· Alcohol and substance abuse treatment and prescription drugs related to alcohol and substance abuse treatment

· Chiropractic care

· Physical therapy, unless post-surgery or post-hospitalization

· Home health care, unless post-surgery or post-hospitalization

· Hospice

· Ambulance

· Dental, vision, and hearing aids

· Out-of-state treatment, unless in the case of an emergency

About the Author

I love to read and write

AGMG – COLONOSCOPY + EGD (Dual Procedure)