Frequently asked questions

A traditional employer-sponsored health insurance plan works like this:

•  Your employer works with an insurance provider to get a group rate.
•  Your employer pays a significant portion of the premium, with the rest coming out of your paycheck before taxes.
•  You can add a spouse or dependents during enrollment periods, which will affect your monthly premium.
• When you use your insurance, your provider sends the claim to the insurer. You’re responsible for any remaining costs, such as deductibles or co-pays. These costs will depend on the plan that you have.
• If you don’t have employer-sponsored health insurance, you may be eligible for federally subsidized insurance such as Medicaid or New York State of Health Marketplace plans, or you may decide to purchase private insurance. The premiums will vary, but the overall process is otherwise the same.
•  If required, you’ll pay a monthly premium.
• You’ll be responsible for deductibles and co-pays as your plan outlines.

Covered medical services include:

• Preventative health services and physical exams
• Diagnosis and treatment of illness or injury
• Physical and occupational therapy
• Radiation, chemotherapy and hemodialysis
• Outpatient or inpatient treatment for mental health conditions and substance use disorders
• Obstetric and gynecological services
• Cervical cancer screening
• Speech therapy
• Emergency room visits, hospital admissions and ambulance services
• Diabetic equipment and supplies and diabetes management education
• Required durable medical equipment (i.e. hearing aids, prosthetics, nebulizers, wheelchairs, etc.)
• Emergency, preventive and routine dental and vision care
• Speech and hearing services
• Hospice services

Yes, all New York children can get Child Health Plus, regardless of immigration status

Yes, Child Health Plus covers non-resident children in New York.

There are no copays or deductibles for covered services. Depending on your income, you may have to pay a monthly premium.

Yes, Child Health Plus covers preventive and routine dental and vision care, including a pair of glasses each year.

Yes, Child Health Plus covers medically necessary, FDA-approved prescription drugs.

Enrollment is open year-round.

Call us at 866.496.6636 (TTY: 711). To begin with one of our enrollment specialists, please make sure you have 30 minutes to an hour set aside to get through the process.

You can make your premium payments online or by mail.

In health insurance, PPO stands for Preferred Provider Organization. This is a type of plan that contracts with hospitals and doctors to create a network of providers. Plan members then pay less to use providers within that network.

There are now many online options if you need to get a prescription.

1. You can use telehealth and schedule an online appointment. You’ll meet with a provider virtually so they can assess you and write a prescription if needed.
2. Major pharmacies, like Walgreens and CVS, also offer online healthcare services that allow you to consult with a clinician.
3. Your provider can typically send your prescription electronically to the pharmacy of your choice.

Click here for a list of participating online pharmacies.

Maternity and newborn care are considered essential health benefits, which means all qualified health plans must cover them.

If you get pregnant and don’t already have health insurance, you have a couple of options. If you qualify for a special enrollment period due to a life event, like losing coverage or moving, you can enroll in a Marketplace health plan. If you don’t qualify for a special enrollment period, the birth of your child will make you eligible. You must apply within 60 days of your child’s birth.

If you’re eligible for Medicaid or Child Health Plus (CHP), you can enroll at any time. Eligibility depends on your household size and income.

If you’re a parent who needs medical insurance for their children, you can take advantage of Child Health Plus (CHP), which provides free or low-cost health coverage. Your child must be under 19 years old and a resident of New York state.

Yes, while undocumented immigrants cannot get federally funded health insurance through Medicaid, CHP or the New York State of Health Marketplace, there are other options.

Ways that undocumented immigrants can get health insurance include:

1. Employer-sponsored plans
2. Private health insurance plans
3. Student health programs at universities
4. Federally Qualified Health Centers, which provide primary care to all
5. State/local programs: Some states, including New York, use state funds to provide health insurance coverage to some undocumented immigrants, particularly children and pregnant people.

For any other questions, call 1.800.303.9626 on weekdays from 8 a.m.- 6 p.m. and Saturdays from 9 a.m. – 5 p.m. During all other times, call 1.800.442.2560.