Question 1

Why Essential Plans premium are $0?

Accepted Answer

The Essential Plans are funded by NY State of Health to help qualified applicants get health insurance.

Question 2

What service do the Essential Plans cover?

Accepted Answer

Here is a list of the 10 essential health benefits and what they mean.
Prescription Drugs
The federal government has categorized approved prescription drugs. One from each category must be covered.
Pediatric Services
This includes dental care, vision care, well-child visits, vaccinations, and immunizations. Dental and vision care must be offered to children through the age of 19 (pediatric oral health services can include two routine dental exams per year; ocular care can include one annual eye exam).
Preventive and Wellness Services and Chronic Disease Management
This includes services such as diet counseling, colorectal cancer screening, Type 2 diabetes screenings, and immunization vaccines.
Emergency Services
This is a trip to the emergency room where you truly need care as soon as possible. It means that you won’t be penalized if the hospital is out of network.
Hospitalization
Treatment you receive in the hospital as part of inpatient care. Plans may limit coverage for extended stay.
Mental Health and Addiction Services
This includes services to treat behavioral health, provide counseling, or provide psychotherapy.
Pregnancy, Maternity, and Newborn Care
These are services that care for you and your baby before, during, and shortly after giving birth.
Ambulatory Patient Services
This is outpatient care you receive without being admitted to the hospital.
Laboratory Services
This includes testing to diagnose, to gauge effectiveness, and some preventive screenings.
Rehabilitative and Habilitative Services and Devices
These services help you recover if you are injured, have a disability, or have a chronic condition. Services may include physical therapy, occupational therapy, or speech therapy.

Question 3

Who is eligible for Essential Plan?

Accepted Answer

Adult who is 19 - 64 years of age. 
Is a New York State resident. 
Meet income eligibility requirements. (Examples: single adults earning up to $37,650) 
Are U.S. citizens or meet immigration status/visa requirements.

Question 4

Does Essential Plan cover out-of-state visit medical service?

Accepted Answer

No. Essential Plan network are within NY State. When you are out of NY State,  you are only covered for emergency and urgent care.

Question 5

Does Essential Plan affect my immigration/visa status (OPT, H1B and then Green card application)?

Accepted Answer

No.
Enrolling in the Essential Plan will not affect your immigration status as this is a state funding instead of a federal benefit. 
Further more, the public charge rule is no longer in effect according to USCIS.

Question 6

How can I enroll in Essential Plan?

Accepted Answer

You can submit the application document by filling out the form on our website and submitting the related documents.

Question 7

Can I waive my school insurance with the Essential Plan?

Accepted Answer

Depends on which school you are enrolling in. Your school health center can make final decision, please check their website to see if the Essential Plan meets the school waiver requirement

Question 8

What is the process to waive my school insurance with the Essential Plan?

Accepted Answer

The waiver process varies and depends on the school. We will assist you in the process after you enroll in Essential Plan.

Question 9

I already have Essential Plan, can you still help me?

Accepted Answer

Yes, if you got essential plan, we can still help you if you agree, we can contact NY State of Health to change your Insurance representative.

Question 10

I'm in OPT status. Am I eligible for the Essential Plan?

Accepted Answer

OPT visa holder and also meets the following requirements are eligible for Essential Plan:
1. live in NY State
2. meet Essential Plan income guideline
3. over 21 years old
4.not eligible for group insurance

Question 11

What is the income guideline for Essential Plan?

Accepted Answer

According public information, NY State set the income guideline as follows:

For single person:

Essential Plan 1 - Individuals with annual income greater than $20,385 and less than or equal to $27,180.

Essential Plan 2 -   Individuals with income greater than $18,755 and less than or equal to $20,385.

Essential Plan 3 - Individuals with income equal to or greater than $13,590 and less than or equal to $18,755, and not eligible for Medicaid due to immigration status.

Essential Plan 4 - Individuals with income below $13,590, and not eligible for Medicaid due to immigration status.

If you need information about income guideline for a family of more than 1 person, please contact us.

Question 12

Can my plan be terminated?

Accepted Answer

Yes, you can voluntarily terminate it, or if your circumstance changed and you will be involuntarily ineligible:
- If you fail the income guideline
- Immigration status expired
- move out of New York State
your Essential Plan might be terminated.

Question 13

How will I receive my insurance card and how long will it take?

Accepted Answer

Generally the insurance card will arrive to your MAILBOX in about 10 business days.

Question 14

Will the essential plan cover pregnancy and maternity?

Accepted Answer

Yes, it covers family planning and OB check up.
However, the New York State of Health requires that you report your pregnancy when you found you're pregnant. And then, the system will turn your essential plan into Medicaid.

Question 15

When can I enroll in Essential Plan?

Accepted Answer

Enrollment for the  Essential Plan is open  all year long.

Frequently asked questions

Why Essential Plans premium are $0?

What service do the Essential Plans cover?

Who is eligible for Essential Plan?

Does Essential Plan cover out-of-state visit medical service?

Does Essential Plan affect my immigration/visa status (OPT, H1B and then Green card application)?

How can I enroll in Essential Plan?

Can I waive my school insurance with the Essential Plan?

What is the process to waive my school insurance with the Essential Plan?

I already have Essential Plan, can you still help me?

I'm in OPT status. Am I eligible for the Essential Plan?

What is the income guideline for Essential Plan?

Can my plan be terminated?

How will I receive my insurance card and how long will it take?

Will the essential plan cover pregnancy and maternity?

When can I enroll in Essential Plan?

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Frequently asked questions

Why Essential Plans premium are $0?

What service do the Essential Plans cover?

Who is eligible for Essential Plan?

Does Essential Plan cover out-of-state visit medical service?

Does Essential Plan affect my immigration/visa status (OPT, H1B and then Green card application)?

How can I enroll in Essential Plan?

Can I waive my school insurance with the Essential Plan?

What is the process to waive my school insurance with the Essential Plan?

I already have Essential Plan, can you still help me?

I'm in OPT status. Am I eligible for the Essential Plan?

What is the income guideline for Essential Plan?

Can my plan be terminated?

How will I receive my insurance card and how long will it take?

Will the essential plan cover pregnancy and maternity?

When can I enroll in Essential Plan?

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