New York Reinsurance

The Healthy New York Program is a state-subsidized reinsurance mechanism that reimburses health plans for 90 percent of claims paid between $5,000 and $75,000 on behalf of a member in a calendar year.  All Health Maintenance Organizations (HMOs) are required to write HealthyNY.  Since its inception in 2001, HealthyNY has enrolled more than 300,000 workers and their families.  As of December 1, 2006, the program had approximately 131,000 enrollees.  Approximately 55 percent of enrollees are working individuals, 17 percent are sole proprietors, and 28 percent are enrolled through small-groups.

Qualifying small employers, sole proprietors, and individuals are eligible for the program provided they have not been insured in the past 12 months or lost their insurance due to a qualifying event.  Small employers may buy into the program if they have less than 50 employees, 30 percent of whom earn less than $35,500 annually (adjusted annually for inflation).  Employers must contribute at least half of the premium, and at least 50 percent of employees must participate in the program or have coverage through other sources.

Starting in January 2007, HealthyNY began offering a high deductible health plan option that is designed to be compatible with health savings accounts.

To learn more about the Healthy New York program, read SCI’s Profile in Coverage.