Health Care Benefits: New York

Federal law and guidance on this subject should be reviewed together with this section.

Author: Jayne Zanglein, Western Carolina University

Summary

• New York chose to establish a state-based Marketplace under the Affordable Care Act. See Health Insurance Marketplaces Under the ACA.
• New York health coverage mandates apply to certain fully insured group health benefit plans, policies and subscriber contracts and certificates of insurance. See Scope of Mandates.
• Group health insurers are subject to certain policy availability requirements. See Policy Availability.
• Insurers cannot impose preexisting condition exclusions to group insurance policies. See Preexisting Conditions.
• Group health policies that provide coverage to spouses and dependents are also required to cover newborn and adopted children, grandchildren, disabled children and same-sex spouses. See Dependent Coverage.
• Group health plans must provide basic health care for children up to age 19. See Basic Health Care Services - Children.
• Group health plans must provide basic preventive health care and screenings for adults. See Basic Health Care Services - Adults.
• Group health plans that provide hospitalization coverage must also make available and provide, at the employer's request, coverage for nursing homes and hospice care services. See Home Health, Nursing, and Hospice Care.
• Group health plans must cover certain women's health benefits. See Women's Health Care Benefits.
• Group health plans must cover prostate cancer screening for men. See Prostate Cancer Screening.
• Group health plans must provide mental health benefits and parity. See Mental Health Benefits and Parity.
• Group health plans must provide coverage for certain services and supplies. See Ambulance/Emergency Services; Coverage for Specified Providers; Diabetes; Medical Foods and Formulas.
• Group health plans must provide coverage for certain illnesses, diseases and medical and surgical procedures. See Clinical, Experimental, and Investigational Trials; Cancer Treatment.
• Group health plans are prohibited from discriminating based on sex or marital status and from engaging in sexual stereotyping. See Discrimination Based on Sex or Marital Status.