Frequently Asked Questions
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Sole Proprietors and Individuals
What documentation is required for Healthcore? answer »
What if I already have other insurance, but it provides limited benefits? answer »
One of the requirements is that my employer does not "provide" health insurance. When is an employer considered to be "providing” health insurance? answer »
What if my employer offers coverage to other employees and contributes to the premium, but I am not eligible for the coverage because of my hours or job duties? Would this prevent me from participating in Healthcore? answer »
Can my family be covered by Healthcore? answer »
My child just graduated from college and will no longer be eligible to remain on my policy. Would my child be eligible for Healthcore? answer »
Does my adult child have to count my income when listing household income? answer »
What if my children are eligible for or currently covered under the Child Health Plus program? answer »
What if I had coverage through a public benefit program, like Medicaid, Family Health Plus, Child Health Plus or Healthcore, within the last twelve months? answer »
How does this program compare to Medicaid, Family Health Plus, and Child Health Plus? answer »
Is there a recertification process? answer »
What if I receive an increase in wages during the year that would take me above the eligibility income levels? What if there is a change in my employment status? Would the coverage be terminated? answer »
If I do not qualify for Healthcore, are there other affordable health insurance products available? answer »
What documentation is required for Healthcore?
You will need to complete a certification at the time of application. You will also be asked to provide the documentation of your New York State residency, your employment status or status as a sole proprietor, and proof of income for the last 4-6 weeks.
Proof of NYS RESIDENCE (may submit any of the following)
- NYS driver license
- Utility bill (gas, electric, cable, etc.) or postmarked mail with address
- Letter/lease/rent receipt from landlord
- Property tax records or mortgage statement
Proof of EMPLOYMENT (may submit any of the following)
- Pay stubs
- Letter from employer
- Documentation sufficient to demonstrate self-employment
Proof of HOUSEHOLD INCOME (May submit any of the following)
- Pay stubs
- Award letters/ benefit checks
- Business records
- Letter from employer
What if I already have other insurance, but it provides limited benefits?
If you have other insurance but it does not provide comprehensive coverage, (For example, it includes only medical benefits or other hospital benefits, but not both) then you still may be eligible for Healthcore. However, if you have other insurance that provides both medical and hospital coverage, then you would not be eligible for the Healthcore program
One of the requirements is that my employer does not "provide” health insurance. When is an employer considered to be "providing” health insurance?
An employer provides health insurance if the employer arranges for comprehensive group health insurance and contributes towards the cost of the insurance. Also if your employer provides only limited benefits, you may still qualify for Healthcore.
What if my employer offers coverage to other employees and contributes to the premium, but I am not eligible for the coverage because of my hours or job duties? Would this prevent me from participating in Healthcore?
No, you may still be eligible for the Healthycore program if your employer provides coverage to other employees, but not to you.
Can my family be covered by Healthcore?
Yes, you may elect to obtain coverage for certain dependents, including dependent children up to age 19 and full-time students up to age 23.
My child just graduated from college and will no longer be eligible to remain on my policy. Would my child be eligible for Healthcore?
Students who are graduating from high school or college who are aging off a parent’s policy may be eligible for Healthcore if they meet the other eligibility guidelines of the program.
Does my adult child have to count my income when listing household income?
Adult children who are 18 years of age or older do not have to include their parents’ income. They are only required to list their income and any income of a spouse with whom they reside, if applicable.
What if my children are eligible for or currently covered under the Child Health Plus program?
Your children’s coverage under the Child Health Plus program will not affect your eligibility for Healthcore. In fact, because the Child Health Plus program is a more highly subsidized program, it may be to your financial advantage to enroll your children in Child Health Plus while enrolling yourself and your spouse in Healthcore. The income limits for the Healthcore individual program were designed to be similar to the income limits for the Child Health Plus program. So, if you are eligible for Healthcore, it is likely that your children will be eligible for Child Health Plus and vice-versa. To obtain more information about Child Health Plus, you may call New York’s toll free hotline at 1-800-698-4543.
What if I had coverage through a public benefit program, like Medicaid, Family Health Plus, Child Health Plus or Healthcore, within the last twelve months?
If you had coverage in one of those public programs, that would not prevent you from enrolling in Healthcore.
How does this program compare to Medicaid, Family Health Plus, and Child Health Plus?
Medicaid provides coverage to very low-income children and adults, regardless of employment status.Family Health Plus (FHP) provides insurance coverage for low-income adults who do not have health insurance but are making too much to qualify for Medicaid. Child Health Plus (CHP) offers coverage to children up to 19 at higher income levels than those required under Medicaid or Family Health Plus. Healthcore builds on the CHP program to offer insurance to working uninsured adults at the same income levels.
Is there a re-certification process?
Yes. On an annual basis, participants in the Healthcore program will be asked to submit a re-certification that attests to their continued eligibility for the Healthcore program. Your health plan will notify you when this re-certification is due and will provide you with all necessary forms.
What if I receive an increase in wages during the year that would take me above the eligibility income levels? What if there is a change in my employment status? Would the coverage be terminated?
No, coverage will remain in effect. Mid-year fluctuations in household income and employment status do not serve as a basis for immediate termination. However, Healthcore requires an annual re-certification process at which time your eligibility would be reevaluated. If you do not meet the eligibility criteria at the time of re-certification, you will be unable to continue to participate in the program. Please note that household income requirements for eligibility for the Healthcore program will be adjusted on annual basis to account for inflation.
If I do not qualify for Healthcore, are there other affordable health insurance products available?
Yes, there are several other affordable options available to individuals, sole proprietors and small businesses. For a list of other programs, contact information and general eligibility requirements, please visit Benefit Specialsits of NY.
Small Employers
The goal of the Healthcore program is to promote and provide affordable insurance coverage to eligible small businesses that are not currently offering health insurance coverage to their employees. It is also available to eligible uninsured working individuals and sole proprietors.
Listed below are some frequently asked questions by small employers about the Healthcore program.
This program does not allow employers to participate if they have "provided" group health insurance to their employees in the past year. Under what circumstances is my business considered to have "provided" group health insurance? answer »
What if my business has provided other health insurance during the past twelve months, but the insurance had limited benefits? answer »
What if my business has not provided group health insurance coverage in the past twelve months, but some of the employees have been covered through other sources, like their spouse’s employer plan? answer »
I have 5 employees. One is enrolled in Medicare and two others receive health insurance through a spouse. The remaining two employees wish to enroll in Healthy New York. Is my business eligible? answer »
Why is this program available only to small employers who did not provide insurance during the twelve months preceding application? Doesn’t this penalize the "good guys" who struggled to maintain coverage for their employees over the past few years? answer »
Can my business offer coverage to part-time and seasonal workers? answer »
If my business offers family coverage through Healthcore, does my business have to contribute towards the cost of the premiums for my employees’ dependents? answer »
Is there a re-certification process? answer »
What if my business qualifies for Healthcore and things change? What if I hire more employees and it brings my workforce total over 50? What if some of my employees drop coverage and my business no longer satisfies the 50% employee participation requirement? Would the coverage then be terminated? answer »
Can my business offer coverage to part-time and seasonal workers? answer »
Can I count the wages of part-time and seasonal workers in determining if my business is eligible for participation in the Healthcore program? answer »
Which employees must be offered Healthcore coverage? answer »
My child just graduated from college and will no longer be eligible to remain on my policy. Would my child be eligible for Healthcore? answer »
If I do not qualify for Healthcore, are there other affordable health insurance products available? answer »
This program does not allow employers to participate if they have "provided" group health insurance to their employees in the past year. Under what circumstances is my business considered to have "provided" group health insurance?
An employer is considered to have "provided" health insurance if the employer arranges for group health insurance and contributes more than $50 (or $75 if the business is located in the Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, and Westchester counties) per month per employee towards the premiums for coverage. If an employer has merely arranged for health insurance coverage for employees but has not contributed more than the previously noted amounts, then the business may still be eligible for Healthcore.
What if my business has provided other health insurance during the past twelve months, but the insurance had limited benefits?
If your business has provided other insurance during the past twelve months, but the coverage included only limited benefits (for example – only medical benefits or only hospital benefits, but not both) then your business may still be eligible for Healthcore.
What if my business has not provided group health insurance coverage in the past twelve months, but some of the employees have been covered through other sources, like their spouse’s employer plan?
The coverage of individual employees through other sources does not affect a small employer’s eligibility to participate in the Healthcore program.
I have 5 employees. One is enrolled in Medicare and two others receive health insurance through a spouse. The remaining two employees wish to enroll in Healthy New York. Is my business eligible?
Your business would be eligible because the three employees who have other coverage count towards satisfying the minimum 50% participation requirement.
Why is this program available only to small employers who did not provide insurance during the twelve months preceding application? Doesn’t this penalize the "good guys" who struggled to maintain coverage for their employees over the past few years?
Healthcore was designed to target those individuals who were completely uninsured. These so called "crowd out" provisions of the legislation are also designed to ensure that employers and individuals do not drop existing coverage in favor of this new product.
Can my business offer Healthcore coverage to my employees’ families?
Yes, the employer may choose to offer coverage for dependents through the Healthcore program. Qualifying dependents include dependent children up to age 19 and full time students up to age 23. However, it may be financially beneficial to employees to obtain health insurance coverage for their children through New York’s Child Health Plus program, rather than Healthcore. For more information about Child Health Plus, contact New York’s toll free hotline at 1-800-698-4543.
If my business offers family coverage through Healthcore, does my business have to contribute towards the cost of the premiums for my employees’ dependents?
No. Employers are encouraged to share in the cost of the Healthcore premium for their employees. However, there is no requirement that the employer contribute towards the cost of dependent coverage.
Is there a re-certification process?
Yes. On an annual basis, employers participating in the Healthcore program are required to submit a re-certification that attests to their continued eligibility for the Healthcore program. The employer’s health plan will notify participating employers of when this re-certification is due and will provide them with the necessary forms.
What if my business qualifies for Healthcore and things change? What if I hire more employees and it brings my workforce total over 50? What if some of my employees drop coverage and my business no longer satisfies the 50% employee participation requirement? Would the coverage then be terminated?
Mid-year fluctuations in group size, wage levels and employee participation will not result in immediate termination of Healthcore coverage. However, Healthcore requires an annual re-certification process at which time your business’ eligibility would be reevaluated. If your business does not meet the eligibility criteria at the time of re-certification, you will be unable to continue to participate in the program. Please note that the wage levels set forth in the eligibility criteria for the Healthcore program are increased annually to account for inflation.
Can my business offer coverage to part-time and seasonal workers?
Yes, employers may offer coverage to part-time and seasonal workers who work less than 20 hours weekly, but they are not required to do so. If they choose to offer coverage to these employees, the employer may choose to contribute toward the cost of their premium but is not required to do so.
Can I count the wages of part-time and seasonal workers in determining if my business is eligible for participation in the Healthcore program?
Yes, the annual wages of part-time and seasonal workers may be included for the purpose of determining an employer’s eligibility if the employer also extends coverage to part-time workers.
Which employees must be offered Healthcore coverage?
Small businesses must offer Healthcore to all employees working more than 20 hours weekly and earning $38,000 or less annually.
My child just graduated from college and will no longer be eligible to remain on my policy. Would my child be eligible for Healthcore?
Students who are graduating from high school or college who are aging off a parent’s policy may be eligible for Healthcore if they meet the other eligibility guidelines of the program.
If I do not qualify for Healthcore, are there other affordable health insurance products available?
Yes, there are several other affordable options available to individuals, sole proprietors and small businesses. For a list of other programs, contact information and general eligibility requirements, please visit Benefit Specialsits of NY.