2015 News & Updates - OCHIA

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Bronx Partners for Healthy Communities

Find In-Person Help

Download Health Insurance Fact Sheets

Get News and Updates

Find Information for Partners and Assistors

Download Reports

Find Other Public Benefits

Visit Helpful Links


2015 News & Updates

Children's Health Coverage from Birth

Starting January 2017, children will be able to get Child Health Plus health insurance from the day they are born, thanks to a new bill signed into law by Governor Cuomo.

The law says Child Health Plus coverage will start the day of a baby's birth, so long as their parents enrolled them before birth or within 60 days of birth. Today, parents may have to wait weeks after applying for Child Health Plus coverage to begin for their child. During that gap in coverage, families might be concerned about medical costs or even hold off on getting checkups and care for their newborns. Starting in 2017, new parents will no longer have to worry about waiting for coverage.

Child Health Plus is New York's insurance program built for kids. The program is free or has a sliding scale fee depending on a family's income. All New York children under 19 are eligible regardless of income or immigration status.

You can enroll your child in health coverage any time of the year online, over the phone, or in-person. Help is available in many languages.

Visit NY State of Health

Call: 855-355-5777 or 311 for help to enroll.

Wishing you a happy, healthy, and fun New Year!

View the video

All Pregnant Women Can Now Enroll in Health Insurance Coverage Any Time through the State's Health Insurance Exchange

Last Updated: December 23, 2015

On December 23rd, Governor Andrew Cuomo signed legislation making New York the first state in the country to add pregnancy to the list of "qualifying life events" that allow individuals to enroll in health insurance outside of the normal open enrollment period through the state's health insurance exchange, the New York State of Health. Prior to this legislation, only pregnant women with incomes up to 223% of the federal poverty level could enroll in Medicaid year round. Now, all pregnant women can enroll in coverage regardless of income or plan type. Learn more about the legislation.

If you are pregnant and in need of coverage, apply online, over the phone, or in-person. Help is available in various languages.

Visit NY State of Health.

Call: 855-355-5777 or 311 for help to enroll.

LGBTQI Get Covered

Last Updated: December 11, 2015

LGBTQI Week of Action for Health Insurance Enrollment is December 7-11. It's time to get covered!

Learn more about your health insurance options and health care if you are uninsured from our LGBTQI fact sheet.

More LGBTQI New Yorkers are getting covered thanks to the Affordable Care Act. In fact, a recent national survey found that the uninsurance rate among LGB individuals was almost cut in half over the past two years.

Under the Affordable Care Act, plans can't discriminate based on your gender identity or who you love. You can't be denied based on a preexisting condition like HIV or cancer. And now, transgender individuals have better access to care because of New York State rules for private insurance plans and Medicaid to cover transition-related care and services.

If you are uninsured, you can visit the NY State of Health Marketplace to find a plan that's right for you. You can get free help to enroll from someone in your community. There are new plans and new prices this year, including a new affordable option called the Essential Plan. Financial assistance is available.

Visit NY State of Health to explore your options and apply. Open enrollment for health insurance lasts until January 31, 2016. Medicaid and Essential Plan are open for enrollment year-round for those who qualify.

Special note for assistors: Health Care For All New York's LGBT Task Force presented a webinar last year called Best Practices for Enrolling LGBT New Yorkers in NY State of Health Coverage. Learn more and view the webinar slides.

Your Rights to Preventive Care

Last Updated: November 6, 2015

Under the Affordable Care Act, health plans must cover all recommended preventive services, like cancer screenings, without cost-sharing (e.g. copays, coinsurance, deductibles). A new federal FAQ helps explain your rights to some of these preventive services.

Breastfeeding Moms

Health plans must cover services during pregnancy and after birth that promote breastfeeding. These include prenatal and postnatal lactation support, counseling, and equipment rental or purchase. Your plan must:

Cover lactation counseling and the rental or purchase of breastfeeding equipment for the duration of breastfeeding. For example, plans can't cover lactation counseling only in an in-patient setting (hospital).

Provide you with a list of lactation counselors that are "in-network" (this will usually be found with your plan's online list of in-network providers)

Cover an out-of-network lactation counselor without cost-sharing, if there is no lactation counselor in-network.

Cover lactation counseling by any provider working within the scope of their practice (for example, a registered nurse can provide lactation counseling).

Adult Obesity

Health plans must cover preventive and weight management services related to adult obesity. Your plan can't cover only pediatric obesity prevention and weight management.

Colon Cancer Screenings

In addition to colonoscopies, plans must cover related services that are considered integral parts of colonoscopies. For example, plans must cover specialist consultations prior to colonoscopies, pathology exams and polyp biopsies.

Read more FAQs.

New York State's New Essential Plan Offers Free or Low Cost Health Insurance. You Could pay less than $1 a day or nothing at all, if you qualify

Last Updated: October 30, 2015

You can enroll in the Essential Plan through the NY State of Health Marketplace starting November 1 for a plan that starts January 1, 2016. After that, you can enroll in the Essential Plan any time of year, just like Medicaid and Child Health Plus.

You will have a choice of plans, but every plan will cover the same essential benefits, like doctor's visits, hospital visits, and prescription drugs. You can even get vision and dental for free, or pay a little for these benefits, depending on your income!

How can I qualify?
You may qualify if you:

Are an adult 19-64 years old (children under 19 can get Child Health Plus).

Are a NYS resident.

Have lower-income (up to $23,540 for single adults; up to $48,500 for family of four).

Meet immigration status requirements (most immigrants qualify).

Apply online, over the phone, or in-person. Help is available in many languages.
Visit NY State of Health
Call: 855-355-5777 or 311 for help to enroll.

Resources for Health Republic Customers

UPDATE: October 30, 2015

On October 30, the DFS and the NY Department of Health announced that all Health Republic health insurance policies would end November 30.

Individuals/Families

Current customers with individual and family plans will need to pick a new insurance plan on the NY State of Health Marketplace by November 15 to have coverage for December 2015.

To get help:

Call the special NY State of Health helpline to get help enrolling: 855-329-8899 (Hours: 8am-8pm M-F; 9am-1pm Saturday).

Read the NY State of Health FAQ.

Consumers can also enroll for 2016 coverage on the NY State of Health Marketplace during the Open Enrollment Period which starts on November 1, 2015. Ten insurance companies will offer 2016 individual/family coverage in New York City through the NY State of Health Marketplace. Individuals can preview 2016 plans in their zip code.

Small Businesses

Health Republic Small Business customers will need to choose new insurance plans as soon as possible to have coverage after November 30, 2015. Employers can sign up for a new plan through the NY State of Health Small Business Marketplace or through a broker. Businesses that sign up for a plan through the NY State of Health may be eligible for a small business health care tax credit.

General Questions

If you have a Health Republic plan and you questions not related to enrollment through the NY State of Health special consumer helpline, you can call the NY Department of Financial Services consumer help line: 800-342-3736 (Hours: Hours: 8am-8pm M-F; 9am-1pm Saturday).

Protecting People from Health Care Discrimination

Last updated: October 8, 2015

An individual shouldn't be denied health care services because she is in a wheelchair. A person who speaks very little English shouldn't be required to have their child interpret sensitive and complex medical information. A transgender person shouldn't be denied care simply because of his or her preferred gender. These are all forms of discrimination in health care.

An important part of the Affordable Care Act called Section 1557 prohibits discrimination on the basis of race, color, national original (including English language proficiency), sex, age, and disability. All health programs that get federal money from the Department of Health and Human Services have to obey Section 1557. This includes doctor's offices that accept Medicare payments, health insurance companies that get federal health insurance subsidies, State health insurance marketplaces, and others.

Now, the federal government is proposing to make nondiscrimination requirements even clearer and stronger, and to add new protections for transgender people. The proposed rule includes protections like:

Health programs must post notices, in multiple languages, about consumer rights and language and auxiliary assistance.

Insurance companies can't categorically deny all health services for gender transition services.

Individuals must be treated consistent with their gender identity (for example, when assigning hospital rooms).

Individuals can't be denied health care because they need services that are not consistent with their gender (e.g. mammograms for transgender males).

For more information about the proposed rule, including a link to submit comments, visit the website of the Department of Health and Human Services, Office of Civil Rights.

New Health Insurance Protections for Transgender New Yorkers

Last Updated: September 15, 2015

**UPDATE:** Recent changes in New York State and federal private and public insurance policies will help transgender New Yorkers access care.

Private/Commercial Insurance

Private insurance companies in New York may no longer deny medically necessary treatment for gender dysphoria,* if that same treatment would be covered for other conditions. This means that if a person needs treatment related to gender transition (like a mastectomy) an insurance company may not deny that treatment just because the patient is transgender. An insurance company can still review a treatment for medical necessity, as it may do with any benefit. But, if the insurance company denies the treatment they must offer the full set of appeal rights to the consumer. This includes an internal appeal and, if needed, an external appeal with an independent third-party.

Read the letter New York's Department of Financial Services sent to all private insurance companies about this

Medicaid – Public Insurance

As of March 11, 2015, New York's Medicaid program will cover transition-related transgender care and services for the treatment of gender dysphoria.* Covered services include cross-sex hormone therapy and gender reassignment surgery. Medicaid already covered, and will continue to cover counseling services for the treatment of gender dysphoria. Learn more about age limits and other exceptions, see the new Medicaid rule.

*Gender dysphoria is a condition when a person's gender at birth is different than who they know to be inside.

**UPDATE:** In June 2015, New York State issued a Medicaid Update with a slight change to the transition-related transgender care regulations. The original March regulation provided a list of services that would not be covered, such as collagen injections, drugs to promote hair growth or loss, and facial bone reconstruction. The Update includes different language that says this list of services may be covered, if a doctor says they are medically necessary and the patient receives prior authorization. You can see the full list of services and read the full update here.

Coverage of Sex-Specific Recommended Preventive Services

The federal government recently clarified that all insurance companies must cover medically appropriate preventive services regardless of a patient's sex at birth, gender identity, or recorded gender. For example, if a provider decides that a pap smear is appropriate for a transgender man who has an intact cervix, the insurance company must cover the service without cost-sharing. The federal government issued this new guidance in the form of a Q&A available online.

2016 Health Insurance Rates for New York City

Last Updated: September 15, 2015

On July 31, the Department of Financial Services released approved health insurance premium rates for 2016 plans. The final rates are 30% lower than the average rates insurance companies had requested earlier in the summer. The Department projects this reduction in rates will save consumers more than $430 million this year. The two tables below show requested and approved rate changes for individual/family and small business plans offered through the NY State of Health Marketplace.

2016 Approved Health Insurance Rates for NYC Plans offering coverage through the NY State of Health Marketplace (Individual/Family)

Health Insurance Company	Requested Average Change	Approved Average Change

Affinity Health Plan
+6.63%

Emblem Health (Health Insurance Plan Of Greater NY)
+13.20%
+10.51%

Empire Blue
Cross Blue Shield
+14.50%
+13.20%

Fidelis
+4.66%

Health Republic
+14.36%
+14.03%

Healthfirst
+12.89%
+9.60%

Metroplus
-7.00%

North Shore-LIJ Care Connect
+4.93%
+4.43%

Oscar
+4.54%

United Healthcare of NY
+22.00%
+1.65%

Wellcare
+4.72%
-3.30%

2016 Approved Health Insurance Rates for NYC Plans offering coverage through the NY State of Health Marketplace (Small Business)

Health Insurance Company	Requested Average Change	Approved Average Change

Capital District Physician's Health Plan (CDPHP)
+16.56%

Emblem Health (Health Insurance Plan Of Greater NY)
+29.74%

Health Republic
+20.00%

Metroplus
-0.81%

MVP Health Plan, Inc.
+7.28%
+6.36%

North Shore-LIJ Care Connect
+3.27%

NYC Enrollment by the Numbers

Last Updated: August 19, 2015

NY State of Health, New York's official health plan marketplace, just released a new report about New Yorkers who enrolled in health insurance in the past two years. New Yorkers can enroll through the NY State of Health website in private health insurance, Medicaid, or Child Health Plus – all through one application. The NY State of Health Marketplace opened for enrollments on October 1, 2013, and the report covers enrollments through February 28, 2015.

Read the full report.

More than 2.1 million New Yorkers have enrolled in coverage across New York. Of these, more than 1.2 million are New York City residents, which is about 14% of the City's population. Brooklyn and Queens – the most populous boroughs in NYC - had the highest enrollment numbers. Check out the table below to see how many New Yorkers in each borough enrolled in the three programs: Medicaid, Child Health Plus (CHP) and private insurance plans known as Qualified Health Plans (QHPs).

Table 1: Number of Enrollees, by Borough, Citywide and Statewide

Borough	Medicaid	CHP	All QHPs	All Programs

Bronx
213,702
9,742
17,066
240,510

Brooklyn
307,662
21,519
58,396
387,577

Manhattan
122,588
5,436
41,276
169,300

Queens
288,008
22,812
55,492
366,312

Staten Island
33,411
3,122
8,167
44,700

Total NYC
965,371
62,631
180,397
1,208,399

Total NY State
1,568,345
159,716
415,352
2,143,413

Here are a few facts about people who enrolled in the insurance plans on the NY State of Health:

Nearly 3 out of 4 got financial help (such as tax credits) to enroll in Qualified Health Plans

More than 2/3 got help from one of New York's certified in-person assistors (people who are trained to help people enroll in health insurance on the NY State of Health Marketplace)
52% are female and 48% are male

More than half a million children enrolled in Medicaid, Child Health Plus, or Qualified Health Plans
About 1/3 are young adults between 18 and 35

1/4 are Hispanic, and 13% selected Spanish as their preferred language

Your IDNYC and Your Health

Last Updated: August 18, 2015

Did you know you can get access to health services with your IDNYC card?

Have you signed up for your IDNYC? New York City's IDNYC program offers government-issued identification to all New York City residents age 14 and older. IDNYC is more than an ID card. You can also use your IDNYC to access health services and many other benefits!

You can use your IDNYC to get discounts on prescription drugs at most pharmacies through the BigAppleRX program. Just show the back of the card to the pharmacist. You can save up to 50% off most FDA-approved prescription drugs. For more information about BigAppleRX call: 1-888-454-7128.

If you apply health insurance through the NY State of Health Marketplace, your IDNYC counts as an official type of identification.

Your IDNYC also includes discounts to NYC Parks and Recreation Centers, YMCAs (including free access to New Americans Welcome Centers), and grocery stores, which can help you stay heathy.

Don't have your IDNYC yet? Learn more about the benefits and make an appointment online.

Supreme Court Rules in Favor of Health Insurance Subsidies

Last Updated: July 1, 2015

On June 25, 2015, the U.S. Supreme Court decided that people who enrolled in health insurance through the federal health insurance marketplace can keep their subsidies. The case was called King v. Burwell.

What was the King v. Burwell case about?

The King v. Burwell case concerned the federal subsidies (tax credits) that people with low to moderate incomes can receive to help them afford health insurance. These subsidies are an important part of the Affordable Care Act, also known as Obamacare. The Supreme Court Justices were deciding who has the authority to give out the subsidies. They were asked:

Is the Internal Revenue Service (IRS) only allowed to give out these subsidies to people who enroll in a marketplace run by a state (like New York)?

Or, can the IRS also give out these subsidies to people who enroll through the federal health care marketplace?

What did the Court decide?

The Court decided that the IRS can give out health insurance subsidies to any qualified individual who enrolls through a marketplace, no matter whether a state or the federal government runs that marketplace. They agreed that the part of the law that talks about which entity can give out subsidies is confusing. But, upon reading the law as a whole, the Court decided that it was clear that Congress meant for subsidies to be available to everyone who qualifies, not just people getting coverage through state marketplaces.

Will this impact my health insurance in New York?

No. That's because New York State operates its own health insurance marketplace called the NY State of Health. This Court decision has made a big difference for about 6.4 million people in other states who had received health insurance subsidies when enrolling through the federal marketplace known as healthcare.gov.

Health Insurance Rates for Next Year

Last Updated: June 19, 2015

Health insurance companies recently sent applications to New York State to request raising, lowering, or maintaining health insurance premiums for next year. Every year, the Department of Financial Services reviews these rate proposal applications to decide whether to approve or reduce a rate increase request. Under New York State law, the Department of Financial Services may disapprove or modify an insurance company's request for a premium rate increase if it is "unreasonable, excessive, inadequate, or unfairly discriminatory." The Department considers many factors in its decision, like the cost of health care, history of rate changes, and administrative costs of a company.

Insurance companies are required to send customers a notice when they file their proposed rate application with the Department of Financial Services. Individuals and small businesses can send comments about their plan's rate proposal. Comments must be received 30 days from when the application was posted on the Department of Financial Services website. For most plans comments are due before July 2nd.

Once a final premium has been approved, each insurance company must send a second notice to customers 60 days before the premium change takes effect. The notice includes more specific information about their premiums.

New Health Insurance Protections for Transgender New Yorkers

Last Updated: May 21, 2015

Recent changes in New York State and federal private and public insurance policies will help transgender New Yorkers access care.

Private/Commercial Insurance

Private insurance companies in New York may no longer deny medically necessary treatment for gender dysphoria,* if that same treatment would be covered for other conditions. This means that if a person needs treatment related to gender transition (like a mastectomy) an insurance company mfy not deny that treatment just because the patient is transgender. An insurance company can still review a treatment for medical necessity, as it may do with any benefit. But, if the insurance company denies the treatment they must offer the full set of appeal rights to the consumer. This includes an internal appeal and, if needed, an external appeal with an independent third-party.

Download the letter New York's Department of Financial Services sent to all private insurance companies.

Medicaid – Public Insurance

As of March 11, 2015, New York's Medicaid program will cover transition-related transgender care and services for the treatment of gender dysphoria.* Covered services include cross-sex hormone therapy and gender reassignment surgery. Medicaid already covered, and will continue to cover counseling services for the treatment of gender dysphoria. For more information about age limits and other exceptions, you can see the new Medicaid rule here.

*Gender dysphoria is a condition when a person's gender at birth is different than who they know to be inside.

Coverage of Sex-specific Recommended Preventive Services

The federal government recently clarified that all insurance companies must cover medically appropriate preventive services regardless of a patient's sex at birth, gender identity, or recorded gender. For example, if a provider decides that a pap smear is appropriate for a transgender man who has an intact cervix, the insurance company must cover the service without cost-sharing. The federal government issued this new guidance in the form of a Q&A available online.

Making Sure Birth Control Methods are Free

Last Updated: May 21, 2015

The federal government issued new guidance to tell insurance companies they must cover all methods of contraceptive care without charging patients copays or deductibles. These include all 18 of the methods the FDA identifies in its current Birth Control Guide, including oral contraceptives (birth control pill), the patch, the vaginal ring, sterilization surgery, and other methods. Insurance companies must also cover contraceptive care patient education and counseling. Insurance companies may still impose cost-sharing for brand name methods if there is a generic equivalent, unless a provider deems that a brand name method is medically necessary for their patient.

Insurance companies must start following this guidance for plan years starting July 10, 2015 or after. For most people, the next insurance plan year for their policy will start January 1, 2016.

A Roadmap to Better Care and a Healthier You

Last Updated: April 23, 2015

Getting enrolled is the first step to getting care. You may have questions about how to use your health plan. You can find answers to your questions here.

If you have questions about your health plan benefits, please call your health plan's customer service center. Find plan numbers online.

The Roadmap is also available in Arabic, Chinese, Haitian Creole, Korean, Russian, Spanish and Vietnamese.

Tax Season Special Enrollment Period for Individuals Facing Tax Penalties for Lack of Coverage in 2014: March 1, 2015 – April 30, 2015

Last updated: February 25, 2015

Did you have to pay a penalty for not having health insurance when you filed your 2014 taxes?

If yes, you may still be able to apply and enroll in health insurance if you:

Are uninsured

Attest that you paid the penalty with your 2014 federal income tax return, for not having health insurance in 2014, and

Were confused or didn't know about open enrollment dates for 2015 coverage, and need another opportunity to enroll in coverage for the remainder of 2015.
The maximum penalty will increase in 2015 and again in 2016. The penalty for those who are uninsured in 2015 and do not have an exemption will be the greater of two percent of income or $325 per adult. That will increase to the greater of two-and-a-half percent of income or $695 per adult in 2016.

This special enrollment period in New York will start on March 1, 2015 and end April 30, 2015.

The IRS has announced relief measures for certain taxpayers who were enrolled in the Marketplace in 2014

Last Updated: March 20, 2015

Who do the relief measures apply to?

The relief applies to taxpayers who meet all four of the following conditions:

Enrolled in a Platinum, Gold, Silver or Bronze QHP through the Marketplace for part or all of 2014

Received an original 1095-A tax form from NY State of Health

Subsequently received a corrected 1095-A tax from NY State of Health

Filed a federal tax return based on the original 1095-A tax return, regardless of whether or not the consumer had already received the corrected 1095-A tax return.

What is the relief?

Taxpayers who meet the four conditions above will not need to amend their tax return with the corrected 1095-A tax form. The IRS will not pursue the collection of any additional taxes from these individuals based on updated information in the corrected 1095-A tax forms.

If the relief measures apply to me and I already filed my tax return, could I benefit from amending my tax return?
If you met all four conditions listed above, you are not required to amend your federal income tax return. If you do not amend your federal income tax return, the IRS will not pursue the collection of any additional taxes from these individuals based on updated information in the corrected forms.

However, some taxpayers may benefit from filing an amended return. Whether or not a taxpayer would get a refund or a larger refund, or have to pay less in taxes would depend on that household's circumstances. Revising the federal tax form 8962 that was filed with the federal tax return would indicate if it would be beneficial to amend a federal tax return. Consumers who need assistance with this process should talk to their tax preparer or tax advisor.

The relief measures do **NOT** apply to:

Consumers who received a 1095-A tax form in error from the Marketplace and had not actually enrolled in a Platinum, Gold, Silver or Bronze QHP through the Marketplace in 2014. These consumers will be issued a Voided 1095-A from the Marketplace to indicate that their original 1095-A tax form has been voided. If these consumers filed their federal tax returns based on the original 1095-A form from the Marketplace, they will need to amend their return.

Consumers who were enrolled in a Platinum, Gold, Silver or Bronze QHP through the Marketplace in 2014, but have not yet received their 1095-A from the Marketplace. These consumers should wait for their 1095-A tax form, but should file their federal tax return by April 15. If these consumers have already filed their federal tax return, they will be required to file an amended return once they receive their 1095-A tax form from the Marketplace.

Download the information.

Life Events Special Enrollment Period: February 16, 2015 – October 30, 2015

Last updated: February 25, 2015

What if I missed open enrollment?

After February 15, 2015, you can enroll in a 2015 health insurance plan through the NY State of Health Marketplace if you have an event that qualifies you for a Special Enrollment Period.

If you experience certain changes in your circumstances, you may qualify for a special enrollment period. During aIf you qualify for a special enrollment period, you can:

Immediately sign up for new coverage or change your health plan – you don't have to wait until open enrollment.

Special enrollment periods are time-limited:

If your coverage is through a job, you may only have 30 days from the time of the qualifying
event to make a change.

If you have or are getting insurance on your own, you must act within 60 days of the qualifying event.

Qualifying events that may qualify you for a Special Enrollment Period

Getting married or divorced

Having a baby

Adopting a child or placing a child for adoption or foster care
Losing your current health insurance coverage

Permanently moving outside your plan's coverage area

Leaving the prison system

Becoming a citizen or lawful resident

Being a member of an Indian tribe or an Alaska Native shareholder.

For people already enrolled in Marketplace coverage:
Having a change in income or household size that affects
eligibility for premium tax credits or cost-sharing reductions

Enrollment Assistance

To find in-person assistance near you, text CoveredNYC to 877877 or call 311. For more information, visit the NY State of Health at nystateofhealth.ny.gov, or call 855-355-5777.

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