In a recent announcement on the Healthy NY website, major changes are coming for this New York State-subsidized health insurance program beginning January 1st 2014. This is due to the enactment of the Patient Protection and Affordable Care Act (AKA: “ACA” or “ObamaCare” – which sets new mandatory coverage requirements for all US citizens), as well as 2013-2014 budget legislation. The current Healthy NY medical plan structures do not meet these new requirements.

Below are the planned changes as per the latest insurance broker update from the NY Health Benefit Exchange published on 5/17/2013:

Individual & Sole Proprietor Plans

-All individual and sole proprietor Healthy NY plans will terminate effective January 1st 2014, regardless of the renewal date
-Health insurance carriers in NY that participate in the program (e.g. Empire, Oxford, Aetna, and Emblem) will send out termination letters to their insured’s next month (July)
-Individuals and sole proprietors may continue to enroll in the Healthy NY program through 2013. However, all in force coverage will terminate effective January 1st 2014
-Current Healthy NY benefit packages will be replaced with a new benefit package effective January 1, 2014 through the NY Health Benefit Exchange
-The replacement Healthy NY product will be the ACA’s Standard Plan at the gold level (80% AV). This will be the only benefit package available for Healthy NY coverage. The new coverage will comply with the essential health benefits and other federal requirements of the ACA
-Individuals and Sole Proprietors will be encouraged to seek health insurance through the Exchange (directly, or via your broker), where they may be eligible for premium assistance and cost-sharing subsidies

Small Employer Groups

-The Healthy NY program will continue to be available in 2014 for eligible small employers only
-Currently enrolled small employers will be notified that their coverage will be revised in 2014 to meet the new ACA requirements. The changes also apply to grandfathered plans (e.g. those with no annual medical deductible)
-The program’s eligibility criteria for small employer applicants will continue to apply
-The NYS DFS (Department of Financial Services) will be revising the Healthy NY small employer application to accommodate the program changes for 2014 (applies to new group enrollments in 2014)

Important Notes and Considerations

-Individual and sole proprietor Healthy NY termination letters will be going out next month (July 2013)
-Because the ACA mandates increased coverage requirements from insurance companies, premiums for the new individual and sole proprietor plans through the NY Health Benefit Exchange are expected to increase (meaning, possibly above and beyond the typical year-over-year Healthy NY annual renewal increase)
-Individuals and sole proprietors seeking replacement coverage through the Exchange may be eligible for tax payer subsidies. As this eligibility criteria becomes available, we will relay that information in a future article update
-Effective January 1st 2014, small employers enrolled in the current Healthy NY program will likely experience premium increases due to the new mandatory ACA increased coverage requirements
-Open enrollment through the NY Health Benefit Exchange begins on October 1st 2013
-Individuals, sole proprietors, and small employers may continue to use their brokers to assist them in securing coverage…whether it is through the NY Health Benefit Exchange, or continuing with the Healthy NY program
-Individuals, sole proprietors, and small businesses seeking to enroll in health insurance coverage through open enrollment on the Exchange, or through the Healthy NY program after January 1st 2014, may elect to use an insurance broker for application assistance. Like before, costs for these services are already factored into the premiums. Thus, it remains an advantage to have an insurance broker enroll and service your policy as opposed to dealing with the government directly

We will relay more information as it becomes available to us by the NYS Department of Financial Services, the NY Health Benefit Exchange, and Healthy NY.