What you need to know about
From: Assemblyman
Steven Cymbrowitz

Assemblyman Steven H. Cymbrowitz
Dear Neighbor,

It’s important that we ensure all New Yorkers receive the health care they need and deserve. The Healthy NY program helps provide comprehensive health insurance to those who need it most.

Healthy NY assists small-business owners in providing their employees and their employees’ families with quality, affordable health insurance. In addition, uninsured sole proprietors and workers whose employers do not provide health insurance may also purchase comprehensive coverage directly through the Healthy NY program.

This pamphlet provides guidelines about eligibility and contact information for the Healthy NY program.

If you have any questions or comments about this or any other subject, please don’t hesitate to contact my office.

Steven H. Cymbrowitz
Member of Assembly

1800 Sheepshead Bay Road • Brooklyn, NY 11235
718-743-4078 • cymbros@assembly.state.ny.us

What is Healthy NY?


Healthy NY is a program designed to make reduced-cost, comprehensive health insurance available to small employers that do not provide health insurance to their employees. Eligible individuals who work for employers that do not provide insurance coverage or who recently changed employers may purchase Healthy NY. Healthy NY is also available to sole proprietors.

All health maintenance organizations (HMOs) in New York State must offer Healthy NY, and other health plans can choose to offer it, as well. Rates vary by health plan and county, but the benefit package is the same regardless of the health plan selected. Benefits are comprehensive and include inpatient and outpatient hospital services; primary and specialist office visits; diagnostic, radiology, and laboratory services; pre-natal care; well-child care; and emergency services. Healthy NY also has an optional prescription drug benefit up to $3,000 per person annually. Healthy NY does not include mental health, vision, dental, and ambulance services.

Healthy NY also offers a high deductible health plan (HDHP) option. The 2009 deductible is $1,150 for individual coverage or $2,300 for family coverage. The benefit package for the HDHP is the same as with standard Healthy NY.

Who’s eligible?

Eligibility for individuals and sole proprietors:
  • the individual must be a New York State resident

  • the individual or the individual’s spouse must have worked at some point within the last 12 months

  • the individual’s employer must not arrange for and contribute to the cost of comprehensive insurance

  • the individual must not be eligible for Medicare

  • the individual must meet an income guideline, which is 250 percent of the Federal Poverty Level (sole proprietors may deduct business expenses to calculate income)

  • the individual must have been uninsured for the past 12 months or have lost coverage due to a specific event

Small employers must meet the following eligibility criteria:
  • the business must be located in New York State

  • the business must have 50 or fewer eligible employees

  • at least 30 percent of employees must make $36,500/year or less

  • the business must not have provided comprehensive insurance within the last 12 months

  • the business must contribute at least 50 percent of the employees’ Healthy NY premiums

  • at least 50 percent of the employees offered Healthy NY must accept coverage or have coverage through another source (e.g. a spouse, a public health program)

  • the business must offer Healthy NY to all employees who work 20 or more hours per week and earn $36,500 per year or less

Income amounts change annually. For current
income guidelines, visit www.healthyNY.com.

Please see the Healthy NY consumer
guides or visit www.healthyNY.com for a full description of eligibility requirements, benefits, co-payments, and other important information. You may obtain a consumer guide by calling 1-866-HEALTHY NY (1-866-432-5849).