Healthy NY Health Insurance Coverage and Benefits

Healthy NY coverage includes important services such as hospital care and regular medical checkups. You also have a choice of coverage with or without a prescription drug benefit.

Benefit Packages

Healthy NY offers four benefit packages:

Healthy NY
Healthy NY with a prescription drug benefit
Healthy NY high deductible health plan
Healthy NY high deductible health plan with a prescription drug benefit

Network-Based Coverage

Benefits are provided through each HMO's network of medical providers. This means that you must use doctors and health care providers who participate in your HMO's network, except in an emergency or when care is not available through a participating provider. To find out if a health care provider is in your HMO's network, contact the HMO, visit the HMO's Web site, or contact your health care provider. You can also go to the Healthy NY Web site at www.HealthyNY.com to view provider directories.

Each HMO has a different provider network, so it is important to make sure that the doctors and health care providers you like are in your HMO's network.

Coverage for Family Members

You can cover yourself, your spouse, dependent children to age 19, and dependent children who are full-time students to age 23. Sole proprietors may also cover domestic partners. For more information on adding your spouse, domestic partner, or children to your policy, contact your HMO.

Covered Health Care Services

Healthy NY benefits include:

Physician services including diagnostic, treatment, consultant, and referral services
Surgical services (including breast reconstruction surgery after a mastectomy) and anesthesia
Inpatient hospitalization including room and board, general nursing care, special diets, and other hospital services and supplies
Outpatient hospitalization including diagnostic and treatment services and surgical facility charges
Pre-admission testing
Emergency services (ambulance not covered)
Second opinion for surgery and cancer treatment
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 including mammogram, Pap test, prostate cancer screening, physical examinations no more than once every three years, and adult immunizations
Prenatal care, well-child visits, and children's immunizations
Diabetic supplies, equipment, and self-management education
Diagnostic, X-ray, and laboratory services
Radiation therapy, chemotherapy, and dialysis
Blood and blood products provided with surgery or inpatient hospitalization

Coverage by Region:

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New York Health Guide Pages:

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