Individuals and Sole Proprietors

Frequently Asked Questions

Listed below are some frequently asked questions by sole proprietors and individuals about the Healthy NY program.

Question: What if I already have other insurance, but it provides limited benefits?

Answer: If you have other insurance but it does not provide comprehensive coverage (for example, it includes only medical benefits or only hospital benefits, but not both) then you may still be eligible for Healthy NY. However, if you have other insurance that provides both medical and hospital coverage, then you would not be eligible for the Healthy NY program.

Question: One of the requirements is that my employer does not "provide" health insurance. When is an employer considered to be "providing" health insurance?

Answer: An employer provides health insurance if the employer arranges for comprehensive group health insurance and contributes towards the cost of the insurance. Also, if your employer provides only limited benefits you may still qualify for Healthy NY.

Question: What if my employer offers coverage to other employees and contributes to the premium, but I am not eligible for the coverage because of my hours or job duties? Would this prevent me from participating in Healthy NY?

Answer: No, you may still be eligible for the Healthy NY program if your employer provides coverage to other employees, but not to you.

Question: What if I had coverage through a public benefit program, like Medicaid, Family Health Plus, Child Health Plus or Healthy NY, within the last twelve months?

Answer: If you had coverage in one of those public programs, that would not prevent you from enrolling in Healthy NY.

Question: My child will no longer be eligible to remain on my policy. Would my child be eligible for Healthy NY?

Answer: Children who are aging off a parent’s policy may be eligible for Healthy NY if they meet the other eligibility guidelines of the program.

Question: Does my adult child have to count my income when listing household income?

Answer: Adult children who are 18 years of age or older do not have to include their parents’ income. They are only required to list their income and any income of a spouse with whom they reside, if applicable.

Question: What physicians participate in the Healthy NY program?

Answer: HMOs that offer coverage in your county contract with certain health care providers in your area. To obtain the most current information about which health care providers are participating providers with an HMO, you should contact the HMO directly. A list of the phone numbers for the HMOs in your county may be found by selecting "Insurers and Rates".

Question: Can my family be covered by Healthy NY?

Answer: Yes, you may elect to obtain coverage for certain dependents, including dependent children up to age 26 and, under certain circumstances, through age 29.

Question: What if my children are eligible for or currently covered under the Child Health Plus program?

Answer: Your children’s coverage under the Child Health Plus program will not affect your eligibility for Healthy NY. In fact, because the Child Health Plus program is a more highly subsidized program, it may be to your financial advantage to enroll your children in Child Health Plus while enrolling yourself and your spouse in Healthy NY. The income limits for the Healthy NY individual program were designed to be similar to the income limits for the Child Health Plus program. So, if you are eligible for Healthy NY, it is likely that your children will be eligible for Child Health Plus and vice-versa. To obtain more information about Child Health Plus, you may call New York’s toll free hotline at 1-800-698-4543.

Question: How does this program compare to Medicaid, Family Health Plus, and Child Health Plus?

Answer: Medicaid provides coverage to very low-income children and adults, regardless of employment status. Family Health Plus (FHP) provides insurance coverage for low-income adults who do not have health insurance but are making too much to qualify for Medicaid. Child Health Plus (CHP) offers coverage to children up to 19 at higher income levels than those required under Medicaid or Family Health Plus. Healthy NY builds on the CHP program to offer insurance to working uninsured adults at the same income levels.

Question: Is there a re-certification process?

Answer: Yes. On an annual basis, participants in the Healthy NY program will be asked to submit a re-certification that attests to their continued eligibility for the Healthy NY program. Your health plan will notify you when this re-certification is due and will provide you with all necessary forms.

Question: What if I receive an increase in wages during the year that would take me above the eligibility income levels? What if there is a change in my employment status? Would the coverage be terminated?

Answer: No, coverage will remain in effect. Mid-year fluctuations in household income and employment status do not serve as a basis for immediate termination. However, Healthy NY requires an annual re-certification process at which time your eligibility would be reevaluated. If you do not meet the eligibility criteria at the time of re-certification, you will be unable to continue to participate in the program. Please note that household income requirements for eligibility for the Healthy NY program will be adjusted on annual basis to account for inflation.

Question: What documentation is required for Healthy NY?

Answer: The insurer you apply to for coverage will ask you to complete a certification form at the time of application. You will also be asked to provide documentation of your employment status or status as a sole proprietor, proof of New York State residency and proof of income for the last 4-6 weeks. Examples of acceptable forms of documentation include:

Employment Status	New York State Residence	Current Income
Pay stubs Letter from employer Documentation sufficient to demonstrate self-employment	Utility bill Postmarked mail with address Letter/lease/rent receipt with home address from landlord	Pay stubs Letter from employer Business documents

Question: If I do not qualify for Healthy NY, are there other affordable health insurance products available?

Answer: Yes, there are several other affordable options available to individuals, sole proprietors and small businesses. For a list of other programs, contact information and general eligibility requirements, please visit this link.

Question: Do I have to enroll in Healthy NY for a whole year or can I enroll for a shorter duration.

Answer: Healthy NY enrollment is on an annual basis but can be terminated at any time with 30 days notice to your health plan.

If you did not see an answer to your question please feel free to email us at askhealthyny@dfs.ny.gov