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Numerous state and federal laws make it easier for people with pre-existing conditions to get or keep health insurance, or to change from one health plan to another. A federal law, known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans. In addition, states can pass different reforms for the health plans they regulate (fully insured group health plans and individual health policies), so your protections may vary if you leave New York. New York has enacted comprehensive reforms to expand your access to health insurance and to guarantee fair pricing of policies. Neither federal nor state laws protect your access to health insurance in all circumstances. So please read this guide carefully.

The following information summarizes how federal and state laws do – or do not – protect you as a New York resident.

How am I protected?
In New York, your health insurance options do not depend on your health status.

• Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.

• All health plans in New York must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new health plan will begin to pay for care for that condition. Generally, if you join a new plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.

• Your individual or group health insurance cannot be canceled because you get sick. Most health insurance is guaranteed renewable. Note, however, that the precise definition of guaranteed renewable may vary based on what type of insurance you have.

• If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA continuation coverage or state continuation coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition. There are limits on what you can be charged for this coverage.

• If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. All health plans for small employers must be sold on a guaranteed issue basis.

• If you are a small employer buying a group health plan, you cannot be charged more due to the health status, age, gender, or occupation of those in your group. This is called community rating.

• You cannot be turned down for an individual health plan because of your health status, age, or any other factor that might predict your use of health services. This is called guaranteed issue.

• If you are buying an individual health plan, you cannot be charged more for your health insurance due to health status, age, gender, or occupation. This is called community rating.

• If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The New York Medicaid program offers free health coverage for pregnant women, families with children, elderly and disabled individuals with very low-incomes. The Child Health Plus Program offers free or subsidized health coverage for uninsured children. In addition, the Family Health Plus Program offers free health coverage for eligible uninsured families and individuals.

• If you have low or modest household income and your employer does not provide health insurance, you may be eligible for subsidized health coverage for yourself or members of your family. The Healthy New York program offers low-cost health coverage to uninsured working individuals, small employers and sole-proprietors.

• If you have lost you health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program then you may be eligible for a federal income tax credit to help pay for new health coverage. This credit is called the Health Coverage tax Credit (HCTC), and it is equal to 65% of the cost of qualified health coverage.

• If you are a retiree aged 55-65 and receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), then you may also be eligible for the HCTC.