HMOs in New York are required by law to offer both standardized HMO plans and point of service (POS) to those who seek to purchase individual health insurance. An HMO is a health insurance provider that works directly with a particular network of doctors, hospitals, and other medical professionals. This means your medical care must be from someone in the network and your insurance most likely will not cover medical care from those who are not in the network. If you need to visit a specialist covered in the network you will need a referral.

HMO/POS plans are a bit more flexible because you can obtain medical care from both the HMO network and out-of-network medical professionals. Although, with an HMO/POS plan you will most likely pay more and the number of services offered is lower. You will still need a referral in order to visit a specialist covered in the network.

With individual health insurance in New York, you will be able to choose either type of plan (HMO or HMO/POS) at any time and not be denied coverage due to health reasons. If you have a pre-existing health condition that was diagnosed and treated within the six month period before you applied for individual health insurance coverage, you may be required to wait up to a year before your health insurance will cover the pre-existing health condition. However, if you have a pre-existing health condition but you were previously insured, the waiting period will most likely be reduced as long as you reapply for health insurance within 63 days of the time your previous coverage expires. This is why it is important to keep up with the expiration dates of your health coverage and prevent any time lapses between coverage periods.

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