New York Health Insurance Protection Laws

New York health insurance companies must adhere to many different regulations in order to do insurance business in the state. New York has more insurance laws than most, as the state has recently made an effort to help its citizens obtain New York health insurance coverage regardless of whether or not they have access through their employers. Because of these rules, New York health insurance companies are not allowed to deny applicants policies based on their health, age or other risk factors. New York health insurance companies are required to offer family policy plans when applicants apply.

New York health insurance companies are also not allowed to increase New York health insurance policyholders’ premiums based on their ages or health conditions. This community rating system keeps New York health insurance premium rates somewhat affordable, though they can still fluctuate depending on where the policyholder lives and the type of New York health insurance policy the individual has.

New York health insurance companies are required to provide coverage to newborns, adopted children and children placed for adoption under the parent’s New York health insurance policy for thirty-one days. During this time, the parent must take needed steps to register the dependent as an official member of his or her New York health insurance policy. In cases where disabled children are involved, New York health insurance companies are required to extend dependent coverage age limits if the dependent is incapable of having a job due to physical or mental handicap. Exceptions to the dependent age limit in a New York health insurance policy can also be made for adult children who are full time students.

In New York health insurance law, all HMOs must offer the same standard comprehensive coverage policy. These New York health insurance HMO policies by law must include coverage for hospital stays, immunizations, maternity and pre-natal care and various other services and treatments. Within this, the New York health insurance policyholder can chose between a standard HMO or a point-of-service version. HMO’s require that you select physicians and hospitals that are in the HMO network, while point-of-service policies allow you to see doctors and to obtain treatment outside of the network. These more flexible New York health insurance policies have higher premiums than HMOs.

Elimination riders are not legal in the New York health insurance system, but New York health insurance companies can still impose exclusion periods during which they will not pay for treatments relating to pre-existing conditions. New York health insurance law limits exclusion periods to twelve months. Pre-existing conditions are defined as any illness or diagnosis for which the New York health insurance policyholder obtained treatment during the six months that immediately preceded his or her acquisition of the new New York health insurance policy. New York health insurance companies can consider pregnancy a pre-existing condition, but there are more strict limitations on the exclusion periods that can be imposed.

New York Health Insurance Protection Laws

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