Which groups are eligible: Small businesses with one to 100 full-time equivalent employees and a primary business address in New York State.
Which employees are eligible: Qualifying individuals and families living in one of the 28 New York counties, including the five NYC boroughs, Westchester, Long Island, and regions stretching north of Albany. Children and young adults can stay on a parent’s plan until age 26, or through age 29 for an added cost.
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| Referralsinfo | Not required for specialist visits |
| Deductibleinfo | $3,100 individual/$6,200 family |
| Out-of-pocket maximuminfo | $7,800 individual/$15,600 family |
| Out-of-networkinfo coverage | No coverage for non-emergency services |
| Primary care physicianinfo | $30 after deductible |
| Preventive careinfo | Fully covered |
| Specialist | $50 after deductible |
| Urgent care | $100 after deductible |
| Pharmacy | $15 generic drugs after deductible |
| Telemedicineinfo | Covered ($0 after deductible) |
| Gym | Reimbursement up to $400 per plan year if qualified |
| Dental | Pediatric dental care |
| Vision | Pediatric vision benefits |
Use the FAIR Health Calculator* to estimate the cost of non-emergency medical services and procedures by zip code.
*FAIR Health, Inc. is an independent nonprofit organization that uses actual provider charges when calculating fees. FAIR Health ensures that its fee information is accurate and complete. Please review the privacy policy and terms and conditions posted on the FAIR Health website.
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