Affordable Care for New Yorkers
On June 5, 2017, New York Governor Andrew Cuomo directed the New York State Department of Financial Services (DFS) to promulgate new emergency regulations mandating health insurance providers to not discriminate against New Yorkers with pre-existing conditions or based on age or gender, in addition to safeguarding the 10 categories of protections guaranteed by the Affordable Care Act (ACA).
At the Governor’s direction, the New York Department of Health will ban all insurers who withdraw from offering qualified health plans on the State Health Marketplace from future participation in any program that interacts with the marketplace, including Medicaid, Child Health Plus, and the Essential Plan. The Governor will also direct state agencies and authorities to ban those insurers who withdraw from the State Health Marketplace from contracting with the state and to consider all available actions to protect New Yorker’s access to quality healthcare.
The administration also finalized regulations that ensure both the following:
- That contraceptive drugs and devices are covered by commercial health insurance policies without co-pays, co-insurance, or deductibles regardless of federal action.
- All medically necessary abortion services are covered by commercial health insurance policies without co-pays, co-insurance, or deductibles.
Under the new regulations, the DFS will require that individual and small group accident and health insurance policies that provide hospital, surgical, or medical expense coverage, as well as student accident and health insurance policies, cover the same categories of essential health benefits and be subject to the same benchmark plan rules that currently apply through the ACA.
Insurers must comply with these new regulations as a requirement of their license in New York.
The DFS superintendent may issue model contract language identifying the coverage requirements for all individual and small group accident and health insurance policies that provide hospital, surgical, or medical expense coverage and all student accident and health insurance policies delivered or issued for delivery in New York State.
The DFS will also mandate under existing New York law that health insurers provide all the following:
- Coverage for all contraceptive drugs and devices, and coverage for at least one form of contraception in each of the FDA-approved contraceptive delivery methods without co-pays, co-insurance, or deductibles, regardless of the future of the ACA.
- Coverage for the dispensing of an initial three-month supply of a contraceptive to an insured person. For subsequent dispensing of the same contraceptive covered under the same policy or renewal, an insurer must allow coverage for the dispensing of the entire prescribed contraceptive supply, up to 12 months, at the same time.
- Coverage for abortion services that are medically necessary without co-pays, co-insurance, or deductibles (unless the plan is a high deductible plan).
- Full and accurate information about coverage.
Read the Governor’s Press Release
Paid Family Leave
New York State has created a new website with updated information about New York’s Paid Family Leave law (NYPFL). NYPFL provides wage replacement to employees to help them bond with a child, care for a close relative with a serious health condition, or help relieve family pressures when someone is called to active military service. Employees are also guaranteed the ability to return to their job and continue their health insurance (so long as continued payments are made by the employee, as applicable). Benefits will be phased in starting in 2018 and capped at 67 percent of the statewide average weekly wage when fully implemented in 2021.
NYPFL is fully funded by employees, and payroll deductions may begin on or about July 1, 2017. Eligibility is based on full-time employment for 26 weeks or part-time employment for 175 days. Employers may not discriminate against employees for taking family leave.
Read more specifics on the new website