Healthy NY Benefit Package

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Healthy NY was developed as a program to help promote comprehensive and quality health care for small business owners and their employee’s. It was created after the passage of the Health Care Reform Act of 2000 which was developed to provide a greater number of people access to health care insurance in the state of New York.

The Healthy NY program also helps sole proprietors and those whose employers do not provide health insurance for them.

Included benefits cover essential health needs and include: inpatient and outpatient hospital services, physician services, maternity care, preventative health services, diagnostic and x-ray services, and emergency services. Applicants may now choose a benefit package with a limited prescription drug benefit or a benefit package without a prescription drug benefit in order to lower premiums in cases where they are not needed.

The chart below shows the maximum annual income levels for households in order to qualify for Healthy NY benefits.

Individuals to be InsuredAnnual Income
Applicantbelow $27,084
Applicant and Spousebelow $36,432
Applicant and Childbelow $36,432
Applicant and 2 Childrenbelow $45,780
Family (Applicant, Spouse and 1 Child)below $45,780
Applicant and 3 Childrenbelow $55,128
Family (Applicant, Spouse and 2 Children)below $55,128
Family (Applicant, Spouse and 3 Children)below $64,476
Applicant and 4 Childrenbelow $64,476
Family (Applicant, Spouse and 4 Children)below $73,836
*add $9,360 per year for each additional individual

Services Covered by Healthy NY

  • Adult preventive services consisting of mammogram, Pap test, prostate cancer screening, physical examinations every three years and adult immunizations
  • Preventive and primary health care services for dependent children including routine well-child visits and immunizations
  • Inpatient hospital services consisting of daily room and board, general nursing care, special diets and miscellaneous hospital services and supplies
  • Outpatient hospital services consisting of diagnostic and treatment services
  • Physician services consisting of diagnostic and treatment services, consultant and referral services, surgical services (including breast reconstruction surgery after a mastectomy),anesthesia services, second surgical opinion and a second opinion for cancer treatment
  • Emergency services
  • Outpatient surgical facility charges related to a covered surgical procedure
  • Diagnostic, x-ray, and laboratory services
  • Pre-admission testing
  • Maternity care
  • Home health care (up to 40 post-hospital or post-surgical visits per calendar year)
  • Physical therapy (up to 30 post-hospital or post-surgical visits per calendar)
  • Diabetes equipment, supplies and self-management education
  • Therapeutic services including radiological services, chemotherapy and hemodialysis
  • Blood and blood products furnished in connection with surgery or inpatient hospital services
  • If the prescription drug benefit is selected, prescription drugs obtained at a participating pharmacy ($3,000 annual maximum per person)
Co-Payments
Inpatient hospital$500
Surgical Services20{20db973e782fb65bfdf97144db4f650632052350b0f72632898b4b56b6799be5} or $200, whichever is smaller
Outpatient surgical facility$75
Emergency services (waived if admitted to hospital)$50
Prenatal services$10
Well-child visits including immunizationsNo charge
All other services$20
Optional prescription drug benefit
  • $3000 annual benefit maximum per person
  • $100 deductible per calendar year
  • $10 generic
  • $20 brand plus the difference in cost between brand and generic, if generic exists

Services Not Covered by Healthy NY

  • Mental health services, including but not limited to treatment and medication for ADHD, depression and anxiety
  • Alcohol and substance abuse treatment
  • Chiropractic coverage
  • Hospice care
  • Ambulance
  • Dental care and vision care
  • Durable medical equipment

Download Healthy NY Benefit Package pdf
Windows: Right Click / Save As • Mac: Right Click (option + click) / Save Link As