HIP Healthy New York — High Deductible HMO Plan

What Is Healthy New York?

Healthy New York is a state-sponsored health maintenance organization (HMO) plan that covers "basic" health care services, such as regular medical checkups, inpatient and outpatient hospital care, diagnostic X-ray and laboratory services and limited prescription drug coverage (optional).

Who Is Eligible?

Healthy New York is available to:

Eligible small businesses with 50 or fewer employees;
Eligible working individuals who do not have health insurance.

HIP Healthy New York High Deductible HMO Plan

Under HIP’s Healthy New York HMO Plan, members receive care for covered services from providers who have agreed to our standards. Members will be asked to select a primary care physician (PCP) from our wide provider network. Their PCP provides care, including preventive care, and arranges referrals when they need to see a specialist. In most cases, members will not be covered for specialist care without a referral from their PCP.

This plan requires members to pay for most medical expenses up to a certain dollar amount out of pocket before the plan provides coverage. Members should establish a tax-deductible health savings account (HSA) to pay for certain medical expenses.

When members receive care from their PCP or receive a referral for specialty care, the following will occur:

100% coverage after copayment once deductible is met for PCP or specialist visits.
Coverage for preventive care (certain preventive services are not subject to the deductible and are covered at 100%).
There will be no out-of-pocket costs for selected preventive care services obtained in network. There are separate guidelines for infants, children and adults.
Optional: Prescription drug coverage unlimited per person per year (also subject to the combined medical and pharmacy deductible).
Benefits include physical therapy*, home health care** and prostate cancer diagnostic screening.

Frequently Asked Questions about the HIP Healthy New York High Deductible Option

Do I need a PCP or a referral to specialists? Yes.

How is preventive care covered? There will be no out-of-pocket costs for selected preventive care services obtained in network. There are separate guidelines for infants, children and adults.

Is there out-of-network coverage? No.

What is the annual deductible? $1,250 for Individuals; $2,500 for Families (combined hospital/medical/pharmacy).

Where can I find information about a Health Savings Account? Upon enrollment, members must indicate the intent to open an HSA. Visit www.hsafinder.com for information and participating banks or www.treas.gov.

Are the plan benefits the same as the Healthy New York Standard HMO Plan? Yes.

If I select pharmacy coverage, is there a limit to benefits? No, members have unlimited pharmacy coverage per member, per calendar year.

How to Enroll

Here's what you need to do to enroll in HIP’s Healthy New York High Deductible HMO plan:

If you are an eligible small business:

Fill out the Healthy New York Small Employer Application and have each of your eligible employees who would like to enroll in Healthy New York fill out an enrollment form. Return the completed application with enrollment forms and a company check for the first month's premium to: Health Insurance Plan of Greater New York, Attn: Healthy New York, PO Box 2806, New York, NY 10016-2806. If your group meets Healthy New York's eligibility requirements, we will send you a letter of confirmation.

If you are an eligible individual:

Fill out the Healthy New York Application for Individuals, including selecting a PCP, and return the application with required documentation and a check for the first month's premium.

If you meet Healthy New York's eligibility requirements, we will send you an ID card.

When Will Coverage Begin?

All required paperwork must be received by the 20th of the month in order for your coverage to go into effect on the first of the following month. If paperwork is received after the 20th, your coverage will go into effect on the first of the month following the next month.

If you need more information about HIP Healthy New York, please call our Healthy New York Hotline at 1-888-215-8306, Monday through Friday, 8 am to 7 pm (EST).

2013 Cost Summary

Effective January 1, 2013 — December 31, 2013

	Individual	Individual & Chid(ren)	Individual & Spouse	Family
With Drugs	$414.32	$770.11	$828.03	$1,266.56
Without Drugs	$337.95	$628.58	$675.91	$1,034.14

The Healthy NY rate is inclusive of all benefit variable and rider rates.

Rates and benefits are underwritten by HIP. Refer to policy form 155-23HNYGRPHMO (1/07) and 155-23-HNYDIRCONT (1/07).

* Physical Therapy: Up to 30 post-hospital or post-surgical visits per calendar year.

** Home Health Care: Up to 40 post-hospital or post-surgical visits per calendar year.

This information is not intended to provide you with complete information on the specific benefits of Healthy NY. Please refer to the Healthy NY contract for specific details. In the event of a conflict, the contract provisions will prevail. The federal health reform law contains specific benefit change requirements, which for non-Medicare and non-Medicaid plans are effective the date of the policyholder's renewal. The renewal date is typically the first of the month, and is based upon the original policy implementation date.

	Plan Options
	SMALL BUSINESS
	MEDIUM & LARGE BUSINESS
	INDIVIDUALS
	CITY, STATE AND FEDERAL MEMBERS
	MEDICARE
	MEDICARE SUPPLEMENT INSURANCE
	STATE SPONSORED PROGRAMS - Medicaid - Family Health Plus - Child Health Plus
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