Am I eligible?
- Eligibility Criteria for Individuals
Reduced-cost health insurance is available under the Healthcore program to certain working uninsured individuals. Learn more » - Eligibility Criteria for Sole Proprietors
Reduced-cost health insurance is available under the Healthcore program to eligible sole proprietors. Healthcore defines a sole proprietor as the only employee and only owner of a business. Learn more » - Eligibility Criteria for Small Employers
The Healthcore program is designed to encourage small employers that do not currently provide comprehensive group health insurance coverage to purchase reduced cost coverage for their employees. Learn more »
Eligibility Criteria for Individuals
Reduced-cost health insurance is available under the Healthcore program to certain working uninsured individuals.
In order to participate, you must meet the following eligibility criteria:
- You must reside in New York State.
- You or your spouse must either be currently employed or must have been employed within the past 12 months.
- Your employer does not currently provide you with health insurance. (Please see the exceptions listed below and the Frequently Asked Questions to see if this rule applies to you).
- You have not had
health insurance for twelve months prior to your Healthcore application or have lost that coverage due to a specific
event.
Specific events include but are not limited to the following:- loss of employment
- death of a family member
- change to a new employer
- change of residence
- the group health plan offered by your employer has been discontinued
- termination or cancellation of COBRA coverage (if you are eligible for COBRA coverage or have COBRA coverage, you can still apply for Healthcore)
- termination of participation in a public health insurance program, including Family Health Plus, Child Health Plus or Medicaid
- legal separation, divorce or annulment
- loss of eligibility for group health insurance coverage
- aging off of a parent’s insurance policy
- You must be ineligible for Medicare.
- Your current gross (before taxes) household income meets the income guidelines of the program.
The Healthcore Income Guidelines table below displays family size in column one and monthly household income in column two. The amounts are effective as of January 1, 2009. Pregnant women count as two people.
Healthcore Income Guidelines*
| Family Size | Monthly Household Income |
|---|---|
| 1 | Up to $2,257 |
| 2 | Up to $3,036 |
| 3 | Up to $3,815 |
| 4 | Up to $4,594 |
| 5 | Up to $5,373 |
| 6 | Up to $6,153 |
| Each Additional Person | Add $780 |
*For purposes of counting your household size, count yourself, your spouse if your spouse lives with you, and dependent children, whether they live with you or not. Count all of these people, even if you are not going to include them on your Healthcore policy. Do not count parents, roommates, or those not dependent on you for support.
Mid-year fluctuations in household income and employment status will not result in termination of your Healthcore coverage. Proof of income will be required annually when an enrollee recertifies.
Eligibility Criteria for Sole Proprietors
Reduced-cost health insurance is available under the Healthcore program to eligible sole proprietors. Healthcore defines a sole proprietor as the only employee and only owner of a business.
In order to participate, you must meet the following eligibility criteria:
- You must reside in New York State.
- You or your spouse must either be currently employed or must have been employed within the past 12 months.
- You have not had health insurance for twelve months prior to your Healthcore application or have lost that coverage due to a specific event.
Specific events include but are not limited to the following:- loss of employment
- death of a family member
- change to a new employer
- change of residence
- involuntary discontinuation of a group health plan
- termination or cancellation of COBRA coverage (if you are eligible for COBRA coverage or have COBRA coverage, you can still apply for Healthcore)
- termination of participation in a public health insurance program, including Family Health Plus, Child Health Plus or Medicaid
- legal separation, divorce or annulment
- loss of eligibility for group health insurance coverage
- aging off of a parent’s insurance policy
- You must be ineligible for Medicare.
- Your current gross (before taxes) household income meets the income guidelines of the program.
The Healthcore Income Guidelines table below displays family size in column one and monthly household income in column two. The amounts are effective as of January 2009. Pregnant women count as two people. Sole proprietors may deduct documented monthly business expenses when calculating gross income.
Healthcore Income Guidelines*
| Family Size | Monthly Household Income |
|---|---|
| 1 | Up to $2,257 |
| 2 | Up to $3,036 |
| 3 | Up to $3,815 |
| 4 | Up to $4,594 |
| 5 | Up to $5,373 |
| 6 | Up to $6,153 |
| Each Additional Person | Add $780 |
*For purposes of counting your household size, count yourself, your spouse if your spouse lives with you, and dependent children, whether they live with you or not. Count all of these people, even if you are not going to include them on your Healthcore policy. Do not count parents, roommates, or those not dependent on you for support.
Mid-year fluctuations in household income and employment status will not result in termination of your Healthcore coverage. Proof of income will be required annually when an enrollee recertifies.
Eligibility Criteria for Small Employers
The Healthcore program is designed to encourage small employers that do not currently provide comprehensive group health insurance coverage to purchase reduced cost coverage for their employees.
In order to participate in the Healthcore program for small employers, the business must meet the following eligibility criteria:
- The business must be located within New York State.
- The small employer must have 2-50 eligible employees.
- 30% of the employees must earn wages of $40,000* or less.
- The business must not have provided group health insurance coverage to its employees within the last twelve months. A small employer is considered to have provided health insurance if the employer has BOTH arranged for and contributed more than $50 per employee per month toward health insurance.
If an eligible employer opts to enroll the business in Healthcore, the employer must assure that:
- 50% of the eligible employees will participate in the program and at least one participant earns annual wages of $40,000* or less. A small employer may count employees who have health insurance coverage through another source, such as a spouse or another government program, towards the 50% participation requirement for Healthcore.
- The employer will offer Healthcore to all employees who are working 20 or more hours per week and earning $40,000* or less.
* Adjusted annually for inflation