New York Health Insurance Marketplace Invitation

On January 31, 2013, the New York Health Insurance Marketplace issued its invitation to health insurers and dental plans to participate in the New York Health Benefit Exchange. The invitation and related documents are listed below.

What is the New York Health Insurance Marketplace?

The New York Health Insurance Marketplace (Or "Health Benefit Exchange") is designed to help individuals, families and small businesses shop for and enroll in health insurance coverage. Through the marketplace, New Yorkers will compare Qualified Health Plans, calculate costs and select coverage online, in person, over-the-phone or by mail and determine what type of financial assistance may be available. Public health care programs will be available through the marketplace for those who are eligible. For more information about the New York Health Benefit Exchange, visit HealthBenefitExchange.ny.gov.

When Does the New York Health Insurance Marketplace Begin?

Enrollment in New York’s Health Insurance Marketplace will begin October 1, 2013, with coverage starting January 1, 2014. The initial open enrollment period will run for six months and end on March 31, 2014. It is estimated that, at full enrollment, more than one million New Yorkers will obtain insurance through the Exchange, including 615,000 individuals and 450,000 employees of small businesses. 

What are Qualified Health Plans?

Qualified Health Plans are health plans approved by the New York Health Insurance Marketplace will provide comprehensive health insurance coverage, follow limits on out-of-pocket expenses (such as deductibles, copayments, and federal out-of-pocket maximums), and meet other state and federal requirements.

According to its press release, Qualified Health Plans will:

• Offer comprehensive, affordable coverage in all areas of the state

• Balance innovation with reasonable choice

• Make it easy for consumers to compare options

• Have adequate provider networks

• Monitor quality, utilization of services and consumer satisfaction

• Preserve consumer protections, as defined in federal and state laws and regulations

• Ensure consistency with the market outside the Health Insurance Marketplace

How do Health Insurance Plans Apply?

The first step in the application process is submission of a non-binding letter of interest that should be provided as soon as possible, but no later than February 15, 2013. 

Key Highlights: 

• All licensed, certified insurers are invited to apply

• Insurer may choose to participate in the Individual Exchange, the SHOP Exchange or both

• Insurer must agree to participate in its entire approved Service Area, unless granted an exception by the Exchange

• Insurer must offer “standardized products” at each of the metal tiers to make it easier for consumers to compare options, but also allows them to offer up to 3 non-standard products to  ensure innovation

• Insurer must demonstrate they have an adequate network of providers

• Insurer must report quality results and financial data

Key Dates:

• January 31, 2013 - Invitation Released 

• February 15, 2013 - Letter of interest from Insurers due 

• March 1, 2013 - Written Questions re: Invitation due 

• March 15, 2013 Responses to Written Questions re: Invitation due 

• April 5, 2013 - Participation Form Submission due 

• April 12, 2013 - Provider Network Submission date 

• April 15, 2013 - Submission of Rates and Forms due 

• July 15, 2013 - Anticipated Notification of Certification by  

• September 2013 - Plans posted to Exchange webportal for consumer shopping

• October 1, 2013 - Intial Enrollment begins 

The Health Insurance Marketplace Application

Note: This should not be taken as legal or tax advice.