How It Works

• You can take an eligibility test to determine if you qualify for the program. Next, you must fill out an application and choose an HMO. The HMO rates vary by company and by county. If you are approved, health care services are provided for a copayment.
  
  

Will I Qualify?

• To qualify for coverage as an individual or sole proprietor, you must be a New York resident who is not eligible for Medicare. You or your spouse must have worked in the past 12 months and meet income requirements. For a small business, you have to be located in New York state and have fewer than 50 employees.
  
  

What is Covered?

• Coverage includes maternity care, preventive screenings, inpatient hospital care and well-child visits and immunizations. Prescription drugs are covered at an additional premium.
  
  

What is Not Covered?

• Mental health services, including treatment for depression and anxiety, are not covered with this plan. Substance abuse, hospice care and dental and vision care are also not covered.
  
  

Pre-existing Conditions

• Pre-existing conditions may not be covered for the first year. A pre-existing condition is a medical condition that has been diagnosed or treated in the 6 months prior to application. Pregnancy is considered a pre-existing condition in individual applicants.