Broker Message From EmblemHealth

JUNE 2013

Healthy NY Benefit Coverage

We are writing to let you know about important changes to Healthy NY benefit coverage that will take effect on January 1, 2014. These changes are required by the Affordable Care Act (ACA) and New York State Law.

Beginning January 1, 2014, Healthy NY will no longer provide coverage for direct pay individuals, sole proprietors and spouse/employees groups. The Healthy NY program will be limited to small employers only.

Transition to Replacement Coverage — Direct Pay Individuals, Sole Proprietors and Spouse/Employee Groups

Starting on January 1, 2014, direct pay individuals, sole proprietors and spouse/employee groups will no longer be eligible for the Healthy NY program. Under the ACA, sole proprietors with no employees or whose only employee is a spouse are considered to be part of the individual market.

Due to these changes, individuals, sole proprietors and spouse/employee groups currently covered by Healthy NY will need to purchase replacement coverage in the individual market.

New York's new Health Benefit Exchange will help these individuals shop for and enroll in health insurance. They may also go directly to health insurance carriers or purchase a conversion policy from their current health insurers.

Transition to Replacement Coverage — Small Employers

To make sure the new Healthy NY small employer plan includes all the benefits required by the ACA, the existing Healthy NY small employer plans will be discontinued effective December 31, 2013. These plans will be replaced with a new Healthy NY small employer plan that will go into effect January 1, 2014.

The new Healthy NY small employer plan will be sold outside the SHOP Exchange. The additional benefits of the new Healthy NY plan will result in new premiums for employers. We have filed our new policy and premium rates with the New York Department of Financial Services. More details of the new Healthy NY benefit plan (including the premium rates, once they are approved) will be available soon. You can also visit for program updates.

Notifying Healthy NY Members and Employers

We are mailing letters announcing the discontinuance to affected direct pay individuals, sole proprietors, small employers and group subscribers about 180 days before the effective date of the discontinuance. This will provide ample time for your clients to consider their replacement coverage options in the marketplace.

For your reference, we've attached samples of the sole proprietor/direct pay individual, employer and group subscriber communications.

In the near future, we will be sending a second letter to affected groups and individuals regarding replacement plan options.

If you have any questions about the Healthy NY plan discontinuance, please contact your EmblemHealth representative.


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Group Health Incorporated (GHI), GHI HMO Select, Inc. (GHI HMO), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies.

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