Empire Blue Cross Blue Shield of New York Healthy New York Plan Information
Eligibility
Are a New York State resident residing within our 28-county service area.
Your spouse is self-employed or employed on a full or part-time basis. If not employed at the time of the application, you or your spouse must have worked for some portion of the 52 weeks preceding the application.
Are not eligible for employer-provided comprehensive health insurance and have not had comprehensive health insurance (either individually or with a group) during the previous twelve months.
Medicaid, Family Health Plus, Healthy New York or Child Health Plus coverage with another health insurer is not considered comprehensive coverage for determining eligibility.
Qualifying exceptions to this requirement include:
Loss of employment
Change to a new employer
Loss of eligibility for group health insurance coverage
Change of residence
Discontinuation of a group health plan
Termination or cancellation of COBRA coverage
Legal separation, divorce or annulment
Death of a family member
Reaching the maximum age for dependent coverage
Have a total gross household income that meets the income guidelines for the program. The amount of the household income limit depends upon the number of household members you have.
Applicants may now choose the new High Deductible Health Plan option.
Are not eligible for Medicare
Benefits
Inpatient hospital services consisting of daily room and board, general nursing care and miscellaneous hospital services and supplies
Outpatient hospital services consisting of diagnostic and treatment services
Outpatient surgical facility charges related to a covered surgical procedure
Coverage for Home Health care for up to 40 post-hospital or post surgical visits in a calendar year
Coverage for 30 post-hospital or post-surgical visits per calendar year for physical therapy
Emergency services
Physician services
Maternity care
Preventive and primary healthcare services
Diagnostic X-ray and laboratory services
Diagnostic screening for prostate cancer for men
Pre-admission testing
Other Empire Blue Cross Blue Shield of New York health insurance plans:
