As an employer or sole-proprietor in Cayuga County, you have options for health coverage for yourself and your employees. The New York State Department of Health has contracted with Cayuga/Seneca Community Action Agency, Inc. and its subcontractor, Cayuga County Chamber of Commerce, to provide Navigator services in Cayuga and Seneca Counties to assist potential enrollees with accessing affordable care through the Marketplace.
New York opened its Health Plan Marketplace, NY State of Health, in October 2013. The Marketplace’s one-stop health insurance shopping experience offers high quality comprehensive health plans.
There are many reasons why you should enroll in a health plan through NY State of Health:
- There are many health plans to choose from.
- The Marketplace gives you an easy way to compare health insurance plans, so you can choose the one that is right for your health needs and your budget.
- Health insurance offered through the Marketplace will include a comprehensive set of benefits and coverage.
- You can get in-person enrollment assistance from a trained assistor.
- NY State of Health is the only place where consumers can qualify, to get help paying for coverage through financial assistance provided by the federal government.
When you can enroll depends on which program you are eligible for, which is based on age, income and other factors. Enrollment occurs year round for those that are eligible for Medicaid, Child Health Plus or the Essential Plan. These public insurance programs make insurance more affordable for individuals and families who are eligible for the assistance.
Qualified Health Plans (QHPs) are licensed, commercial health plans that have been approved by The Marketplace to provide comprehensive coverage, follow limits on out-of-pocket expenses (such as deductibles, co-payments, and out-of-pocket maximums) and meet other requirements. Those eligible for a QHP must apply for insurance during the Open Enrollment Period. An Open Enrollment Period is a limited time of year – usually November through January. If you are eligible for a QHP and do not enroll during these months, you typically will need to wait until the next Open Enrollment Period. There are some exceptions. You may be able to enroll in a QHP outside of the Open Enrollment Period if you are eligible for a Special Enrollment Period. American Indians and Alaskan Natives can enroll anytime during the year for any NY State of Health program.
To be eligible for a Special Enrollment Period an individual must have a “Qualifying Life Event” that makes it possible for him or her to enroll in or change coverage through a QHP outside of the Open Enrollment Period. Qualifying Life Events include loss of health insurance (for reasons other than you did not pay your premium); a permanent move into New York State or a move within the State that makes new health plans available to you; marriage or domestic partnership; divorce or legal separation; pregnancy certified by a health care practitioner; birth or adoption of a child, or placement of a child in foster care; becoming eligible or ineligible for help paying for your Qualified Health Plan coverage; or becoming a citizen, national or lawfully present individual. Generally, to be eligible to enroll in or change enrollment in a QHP, you must report a Qualifying Life Event to the New York State of Health within 60 days of the event. You may need to provide proof of the Qualifying Life Event to your new health plan.
To find out which program you are eligible for, apply online at nystateofhealth.ny.gov. You can also call Customer Service at: (855) 355-5777 [TTY (800) 662-1220] during business hours, which are Monday-Friday 8 a.m. to 8 p.m. and Saturday 9 a.m. to 1 p.m. We have an in-person assistor at our offices at 2 State Street, Auburn, who you can meet with to discuss your individual health insurance needs. Contact Wendy Danner-Tollett, NY State of Health Navigator at (315) 252-7291 ext. 222 to set up an appointment.