New York State Individual Health Insurance Regulations

Individual and family health insurance plans in New York are not allowed to be medically underwritten, so the ability to purchase individual New York health insurance plans is not based upon health status. New York law does not allow for applicants to be turned down for insurance coverage because of past or present medical conditions. This is because individual health insurance plans are sold on a guaranteed issue basis. Insurance regulations in New York do allow health insurance providers to perform a 6 month history check and a 12 month exclusionary period for all pre-existing conditions. The history check and exclusionary periods only apply to applicants who have not had prior creditable coverage. Also, state law forbids insurance companies from adding elimination riders while composing health insurance policies for individuals. Premium rates may vary due to geographic location and family status because the rates are community-based.

New York State Small Group Health Insurance Regulations

In New York, if a company has 2 to 50 employees then it is defined as a small employer group. Following the Health Insurance Portability and Accountability Act of 1996, all group health insurance in New York State is sold on a guaranteed issue basis. Coverage that is guaranteed issue prevents any group from being denied health insurance coverage due to the group's health status. Any group plan applicants that lack prior creditable coverage can have a 6 month history check and a 12 month exclusionary period on any pre-existing conditions. In order to join an employer-sponsored health insurance plan in New York, some employers may impose a waiting period to every employee before they become eligible to join the group health plan. The time span of the waiting period must be equal for all employees. For adult children who are full time students and covered under a group health plan, New York group plans allow for special protection. If the adult child becomes sick and needs to be out of school, New York law allows the child to remain on the group health insurance plan for up to one year. Group health plan premium rates are community-based.

New York COBRA and Continuation Coverage

The state of New York is a guaranteed issue state for health insurance and insurers must cover anyone who applies for individual health insurance. New York COBRA laws require employers with less than 20 employees to provide 18 months of continuation coverage.

Under both federal and state law, continuation of health insurance coverage in New York must be offered to individuals who have dropped their group health insurance coverage because of a qualifying event. Under COBRA, you must stay on the employer-sponsored health plan for a period of 18, 29 or 36 months while you receive the same level of coverage. You must pay the entire monthly premium, along with a 2% administration fee. Within 60 days of the qualifying event, individuals must give notice of the election of coverage. In addition, if any person has access to other group health insurance or Medicare benefits, mini-COBRA laws in New York permit insurance companies to reject that person from receiving continuation of coverage under the group plan.

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