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HIV and Enteropathy
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New York State Insurance Exchange
Exchange:
The New York Insurance Exchange (Marketplace) is called New York State of Health. The New York Health Benefit Exchange is administered by the State of New York.
General information about the New York Health Benefit Exchange can be found at: http://www.healthbenefitexchange.ny.gov/.
Learn more: Background 
 

Patients:
The New York Health Benefit Exchange is essentially a marketplace for individuals and small businesses with up to 100 employees to shop for health insurance if they do not already have insurance coverage from another source. If they have insurance from another source (such as employment, retirement benefits, or spousal benefits), they do not need to obtain it from the Marketplace.
HIV Providers:
Providers must contract with each of the plans in the marketplace individually in order to fully participate in the New York Health Benefit Exchange.
 
This process is similar to enrolling in insurance or managed care organization provider networks. See below for a list of insurers participating in the state marketplace, and information on contacting them.
As an HIV provider, you may qualify for the designation, of an “Essential Community Provider (ECP).” The Qualified Health Plans participating in the Insurance Exchange (Marketplace) are required to contract with a minimum number of ECPs and Specialists to ensure network adequacy.
 
Visit our Provider Resources Section for more specific instructions to assist you in contacting health plans.
 
 

Reporting Problems

 

The state Medicaid office is primarily responsible for examining and addressing issues with the Medicaid Managed Care plans offered in the state, and for working with the companies that offer them. If you are experiencing problems as a medical provider with the Managed Care plans or companies operating in the state, or if your patients are experiencing problems with the Managed Care plans or companies in the state, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state Medicaid Office:

One State Street
New York, NY 10004-1511
800-342-3736

www.dfs.ny.gov/
Complaints: http://www.dfs.ny.gov/consumer/fileacomplaint.htm

Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.

 
Qualified Health Plans Participating In the Exchange:
Below is a list of the Qualified Health Plans that have publicly announced that they will offer plans in the New York Health Benefit Exchange.
This list is being routinely updated, and may change as insurers join or leave the Exchange. Please check back for updates.
 
Affinity Health Plan, Inc.
Plan Website: http://www.affinityplan.org/       
Plan types offered: Individual
 
Capital District Physicians Health Plan, Inc.
Plan Website: http://www.cdphp.com/Providers            
Provider Enrollment: http://www.cdphp.com/Providers/Join-Our-Network       
Plan types offered: Individual, SHOP
 
Empire BlueCross BlueShield
Plan Website: http://www.empireblue.com/home-visitors.html             
Provider Enrollment: http://www.empireblue.com/home-providers.html          
Plan types offered: Individual
 
Excellus Health Plan, Blue Cross Blue Shield (Central NY and Univera in Western NY)
Plan types offered: Individual
 
Fidelis Care
Plan Website: http://www.fideliscare.org/Products.aspx            
Plan types offered: Individual
 
Health Insurance Plan of Greater New York- Emblem Health
Plan Website: http://www.emblemhealth.com/              
Provider Enrollment: http://www.emblemhealth.com/Contact-Us.aspx              
Plan types offered: Individual, SHOP
 
Health Republic Insurance Company
Plan Website: https://healthrepublicny.org/      
Provider Enrollment: https://healthrepublicny.org/for-providers/index/             
Plan types offered: Individual, SHOP
 
Healthfirst New York
Plan Website: http://www.healthfirstny.org/    
Provider Enrollment: http://www.healthfirstny.org/providerservices    
Plan types offered: Individual
 
HealthNow New York, Inc. (Blue Shield of North East New York, Blue Cross Blue Shield of Western New York)
Plan types offered: Individual, SHOP
 
Independent Health
Plan types offered: Individual
 
MetroPlus Health Plan (Market Plus)
Plan Website: http://www.metroplus.org/         
Plan types offered: Individual, SHOP
 
MVP Health Plan, Inc
Plan types offered: Individual, SHOP
 
North Shore LIJ Health System
Provider Enrollment: http://www.northshorelij.com/hospitals/contact-us          
Plan types offered: Individual, SHOP
 
Oscar Insurance Company
Plan Website: https://www.hioscar.com/           
Provider Enrollment: https://www.hioscar.com/provider/?planState=NY&planDate=2014          
Plan types offered: Individual
 
United Healthcare of New York Inc.
Plan types offered: Individual
 
Wellcare
Plan types offered: Individual
 
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