Health Coverage Tax Credit (HCTC)

What is it?

The Health Coverage Tax Credit or HCTC is a tax credit administered by the Internal Revenue Service (IRS).

Who is eligible for the HCTC?

Eligible individuals should receive notice and an enrollment kit from the HCTC program. That enrollment kit will include more information about the federal tax credit and instructions as to how to pay for your share of the coverage. Eligible groups include:

Trade Impacted Workers - Trade Impacted Workers are individuals certified to receive certain Trade Adjustment Assistance (TAA) and Alternative TAA benefits because they have lost their jobs due to the effects of international trade. For general information about eligibility for TAA/ATAA benefits call the New York State Department of Labor, Special Programs Unit at 518-402-0189.
Pension Benefit Guaranty Corporation (PBGC) Recipients - PBGC Recipients are individuals receiving PBGC pension benefit payments who are 55 years of age or older. This includes individuals receiving benefits from the PBGC as a survivor or beneficiary of a PBGC recipient. Those receiving portion of an ex-spouse’s benefit from the PBGC can also qualify for the HCTC. For questions about pension benefits through PBGC, call them at 1-800-400-7242.

Highlights of the Program

HCTC pays certain health insurance premiums.
If you receive TAA or ATAA benefits or PBGC pension benefits , you may be eligible for the HCTC.
Eligible individuals must enroll in a qualified health plan to claim the HCTC.
The tax credit may cover your spouse and dependents in addition to you.
You may claim the credit even if you do not owe federal income tax.

Ways the Credit Can Be Applied

Pay health insurance premiums directly to your health plan and claim your tax credit when you file your federal tax return; or
Register with the HCTC program to access your tax credit in advance. To find out more about registering for this prepayment feature call 1-866-628-HCTC (1-866-628-4282).

Qualifying Products in New York

New York State has several health insurance products that qualify for the tax credit. These include:

Pre-Existing Condition Insurance Plan (PCIP) - NY Bridge Plan

Federal health care reform law contains a provision for the establishment of a temporary statewide insurance pool for high risk individuals. Coverage through this program will be available until January 2014 when more health insurance coverage options become available through a Health Insurance Exchange. In New York State, the PCIP plan is called the NY Bridge Plan, and is administered by Group Health Incorporated (GHI), an EmblemHealth company.

The NY Bridge Plan provides health coverage to individuals who have a pre-existing medical condition, have not had insurance for six months, and who are legal residents and covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. Eligibility is not based on income and the Plan does not charge a higher premium because of a pre-existing condition. Coverage for a pre-existing condition begins right away, with no waiting period.

Non-Group/Individual HMO and POS Plans

All Health Maintenance Organizations (HMOs) are required to offer two direct payment State-Qualified Health Plans: a) a non-group/individual HMO plan, and b) a non-group/individual Point of Service (POS) plan. For the non-group/individual HMO plan option you must use doctors and hospitals that participate with the HMO. The Point of Service (POS) plan allows you to access providers which do not participate with your HMO. Each plan is only offered in a limited geographic area of New York State.

HCTC Healthy NY

HCTC Healthy NY HCTC Healthy NY is available for purchase by all individuals eligible for the HCTC. HCTC Healthy NY offers the streamlined comprehensive health insurance benefit package which was developed for the public Healthy NY program.

GHI and Excellus

GHI and Excellus Insurance companies sell HCTC Healthy NY that do not have income eligibility limits. GHI offers HCTC Healthy NY statewide in addition to their other State-Qualified Health Plans. Excellus offers HCTC Healthy NY in western and central NY State and also sells other State-Qualified Health Plans.

GHI Customer Service: 1-800-444-2333 ,
Website: GHI

Excellus Customer Service: 1-800-462-0108 ,
Univera Customer Service: 1-800-337-3338
Website: Excellus or Univera

Healthy NY

Healthy NY All HMOs in New York State offer the Healthy NY health insurance benefit package to eligible individuals. Individuals must be income qualified for this product.

Healthy New York Customer Service: 1-866-432-5849
Website: Healthy New York

Other Qualifying Coverage

You can also apply for the HCTC and apply the federal premium assistance to the following automatically eligible types of coverage:

COBRA or New York State continuation coverage.
Employer plans or spousal employer plans where the employer pays for less than 50% of the premium.
Any individual health insurance policy that you purchased directly as long as that coverage was in effect 30 days prior to your separation from your employment.

Rates

Resources and Contact Information

To obtain information about enrollment in the federal tax credit call the HCTC program at 1-866-628-HCTC (1-866-628-4282) or visit www.irs.gov (IRS keyword HCTC).

Updated 01/17/2013