Health Equity

DFS remains committed to closing the health equity gap and reducing health disparities.

• Learn more about how New York State is working to build a more equitable and accessible health care system.

Mental Health and Substance Use Disorders

There are many protections and coverage requirements for mental health and substance use disorder services under comprehensive health insurance policies that are sold in New York.

• Learn more about Mental Health and Substance Use Disorder coverage in New York.

Women's Healthcare

Comprehensive health insurance policies sold in New York must include coverage for women’s health care services, including preventive care screenings, cancer screenings and treatment, contraceptives, infertility, maternity care, maternal depression, and medically necessary abortions.

• Learn more about when Women’s Health Care Protections Apply.

Gender Affirming Care

Learn more about New York protections, treatment your Insurer is required to cover, and how to manage and appeal denials of service.

• Learn more about Health Coverage for Transgender New Yorkers

COBRA, Age 29 and Continued Coverage Information

The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers who work for employers with 20 or more employees and their families the right to continue to purchase group health insurance for limited periods of time when they would otherwise lose coverage due to certain events. Qualifying events include voluntary or involuntary job loss, reduction in hours, transition between jobs, death, divorce and other life events.

• Learn more about COBRA, Age 29 and Continued Coverage Information

Confidentiality for Victims of Domestic Violence

You have the right to request that claim-related communications from your health insurer be sent to you in alternative ways if disclosing the information could endanger you. “Claim-related information” means claim or billing information relating specifically to you, including your name, address, any services you received, and the name and address of your provider or doctor. Your request will remain in effect until you revoke it.

• Learn more about health insurance confidentiality for victims of domestic violence.
• See a sample confidential communication request form that a health insurer may ask you to submit.
• Visit the OPDV website to download and print a Reference Guide for Health Insurance Rights for Victims and Survivors of Domestic Violence.

New York State Paid Family Leave

Under the New York State Law, all eligible employees are entitled to job-protected, paid time off to bond with a newly born, adopted, or fostered child, to care for a family member with a serious health condition, to assist loved ones when a spouse, domestic partner, child or parent is deployed abroad on active military service, or when an employee or their minor dependent child are subject to a mandatory or precautionary order of quarantine or isolation due to COVID-19.

• Learn more about Paid Family Leave in New York State

Help for the Seriously Ill and Their Caregivers

If your claim or your request for a specific treatment is denied, you have certain rights. A grievance can be filed for any determination other than a denial based on the policy provisions excluding services which are deemed not medically necessary, experimental or investigational. A utilization review appeal can be filed for any denial of care that the HMO or insurer has decided is experimental, investigational or not medically necessary, and an external appeal is available if you have been denied coverage for participation in a clinical trial.

• Learn more about how to get Help For the Seriously Ill and Their Caregivers.

Child Health Plus

Every child in New York under the age of 19 who does not have health insurance is eligible for the Child Health Plus program. Visit the Department of Health for more information on Child Health Plus or call (800) 698-4543 or your local department of social services.

Healthy NY

DFS oversees the Healthy NY program which, in partnership with HMOs and other insurance companies in New York State, offers comprehensive health insurance for small businesses.

Medicare and Medigap Insurance

Medicare beneficiaries pay nothing for most preventive services if the services are received from a doctor or other health care provider who participates with Medicare (also known as accepting assignment). For some preventive services, the Medicare beneficiary pays nothing for the service, but may have to pay coinsurance for the office visit to receive these services.

• Learn more about Protections for Medicare Beneficiaries Residing in New York State

Long Term Care and Continuing Care Retirement Communities

DFS shares information intended to help you make informed decisions about the need for financial protection and, should you choose to obtain long term care insurance, to help you choose a policy that will meet your individual needs.

• Understanding Long Term Care and LTC Insurance Policies

External Appeals

If your insurer or HMO denies health care services as not medically necessary, experimental/investigational or out-of-network, you have the right to file an appeal with DFS. This is known as an External Appeal. Health care providers also have the right to appeal when services are denied.

• Learn how to file an External Appeal.
• Search prior appeal decisions using our External Appeals Database.

Consumers in New York are protected from surprise bills when treated by an out-of-network provider at a participating hospital or ambulatory surgical center in their health plan’s network. Additionally, consumers with health insurance coverage provided by an insurer or HMO are protected from surprise bills when a participating doctor refers them to a non-participating provider. Consumers in New York are also protected from bills for emergency services in hospitals, including inpatient care following emergency room treatment.

• Learn how to protect yourself from a surprise medical bill and the patient-provider dispute resolution process.

Appointing a Designee

If you need assistance with a preauthorization request, complaint, grievance, or appeal with your health insurer, you can designate a person or persons or organization to assist you by completing the New York Standard Health Insurance Designee Form and submitting it to the address or fax number on your member identification card or by the method specified by your insurer.

• This form is available in other languages on the File a Complaint page.

The Department has the authority to investigate significant price increases for prescriptions drugs sold, offered for sale, purchased, or advertised within New York. DFS requires drug manufacturers to show a reasonable justification for sudden prescription drug price increases. As of June, 2024, DFS also requires drug manufacturers to report prescription drug price increases 60 days in advance of the effective date of the increase.

• Learn more about drug prices and what to do if you experience a significant increase or “spike” in the price of a prescription drug.
• Drug manufacturers needing to report a drug price increase, should visit the Prescription Drug Manufacturer Filings page.

Pharmacy benefit managers (PBMs) are companies that manage prescription drug benefits on behalf of health plans. PBMs must be licensed to operate in New York. DFS monitors PBM activities to address problematic practices in the industry, help lower prescription drug and health insurance costs, and protect New Yorkers who need access to medications.

• Learn more about Pharmacy Benefit Managers.

Your Rights as a Health Insurance Consumer

You have many rights and protections if you have health insurance coverage through an HMO or insurer (health plan) subject to New York Law (your health insurance ID card says “fully insured”).

1. Health plans must give you important information about your coverage.
2. Health care providers must tell you which health plans they are in-network with, and upon your request, the fees they will charge if they are not in-network.
3. Hospitals must tell you which health plans they are in-network with and their fee information if you request it.
4. Health plans must make sure you can get the health care services you need (access to care).
5. Health plans must cover emergency services in a hospital with no additional charge to you beyond your in-network copayment, coinsurance or deductible.
6. You are protected from surprise bills.
7. Women have coverage for preventive health care services.
8. Health plans must have a grievance and utilization review process in place for you to appeal coverage denials.

• Read more detailed information on each of these important protections. Also, be sure to check your health insurance contract for the terms and conditions of your coverage.

Health Care Provider Rights and Responsibilities

The Insurance Law and Public Health Law include important protections for health care providers with respect to network participation, provider contracting, claims processing, prompt payment for health care services, and dispute resolution for surprise bills and bills for emergency services. Some protections apply to all HMO and insurance coverage, while others apply only to HMO coverage and to managed care coverage offered by insurers (which most insurers do not offer). The Public Health Law also includes disclosure requirements for health care providers.

• Read more detailed information about these important health care provider rights and responsibilities.

Health insurance premiums are the monthly amount that you or your employer pay to an insurance company. The insurance company collects premiums from all of its policyholders and uses that money to pay medical claims. The insurance company can also use premiums to pay for administrative expenses and to earn a profit. 

Health insurers must submit proposed rate changes to DFS. DFS then reviews the application and the insurer’s calculations to make sure that a rate increase is justified and not excessive. During review, DFS may consider comments from policyholders or the public.

DFS allows policyholders to submit comments about an insurer’s proposed premium rate increase. Insurers must also send their customers a notice about a proposed premium rate increase when they file the application with DFS. 

• Learn more about Health Insurance Premiums and Applications for Rate Increases.

Each year, New York State (via the DFS and Department of Health) receives complaints about health insurance companies from consumers and health care providers. Complaints typically involve issues related to prompt payment, reimbursement, coverage, benefits, rates and premiums. 

The following guide contains a ranking of HMOs and health insurance companies based on complaint statistics and enrollee satisfaction surveys and includes information on the number of successful appeals to independent external review agents. This Guide may help you when choosing a health insurance company and also contains telephone numbers for health insurance companies.

• 2025 New York State Consumer Guide to Health Insurers (PDF)
• See previous years' versions of the New York State Consumer Guide to Health Insurers.

If you are unable to find the answer to your questions here on our website, check our FAQs. If you still have questions, or want to file a complaint with DFS call the DFS Hotline at (800) 342-3736, Monday to Friday, from 8:30 AM to 4:30 PM or send us an email.