Group Health Incorporated administers New York's high-risk insurance pool.
Federal health care reform laws passed in 2010, including the Health Care and Education Reconciliation Act and the Patient Protection and Affordable Care Act, established temporary insurance pools for people who cannot obtain health insurance because of preexisting conditions. The pools provide health insurance coverage for high-risk citizens, and each state administers its own program. In the state of New York, people considered high risk can purchase health insurance through the NY Bridge Plan.
NY Bridge Plan
Group Health Incorporated (GHI), owned by EmblemHealth, administers the NY Bridge Plan. Participants can receive benefits to pay for specialist and primary health care, prescription medications and hospital care. Once the person is accepted into the plan, there is no waiting period to receive coverage. The NY Bridge Plan offers coverage until 2014, at which time health benefit exchanges will offer additional coverage options, in accordance with health care reform laws.
Plan Features
The NY Bridge Plan does not include deductibles and patients pay $20 copayments for doctor visits. Emergency room care requires a $100 copayment and hospitalization requires a copayment of $500. Additional plan benefits include pharmacy services, preventive care and vision care. The program does not require annual recertification.
Preexisting Medical Conditions
The NY Bridge Plan provides coverage only for people with one or more eligible preexisting health condition. People with conditions of the circulatory system or heart might qualify for the plan. Transplant patients, including transplants of the heart, liver or kidney, can qualify. Patients with respiratory conditions, such as chronic obstructive pulmonary disease (COPD), asthma, emphysema or tuberculosis, might receive coverage. People with digestive disorders, such as ulcers, ulcerative colitis or Crohn's disease, can qualify.
Enrollment
Applicants must provide proof of a preexisting condition in the form of a letter from a primary care doctor, medical records or an online personal health record. Eligibility is open only to New York State residents. In the majority of cases, applicants must be uninsured for a minimum of six months at the time of application. The NY Bridge Plan only insures individuals up to the age of 65, at which time the participant can apply for Medicare coverage. Enrollment in the program is limited. Upon reaching capacity, the administrators create a waiting list of qualified individuals. GHI offers an online application or applicants can submit an application by mail. Upon acceptance, enrollees receive a letter stating their eligibility, along with a bill for the first premium payment. Coverage begins after GHI receives payment.
Coverage Cost
The NY Bridge Plan only provides coverage for individuals and does not offer dependent or family plans. The plan has standardized rates, based on where a participant lives, not on health conditions. Participants in downstate New York counties, including Bronx, Kings, Westchester, Dutchess, Ulster, New York and other counties, pay $421 per month, as of November 2010. Enrollees in upstate New York, including Albany, Warren, Clinton, Yates, Essex, Delaware, Orleans and other counties, pay $362 per month. GHI administers the NY Bridge Plan in all counties throughout the state of New York.
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