Early Intervention Health Insurance Information

It is very important for your service coordinator to obtain your family’s most recent and accurate health insurance information. Your service coordinator will explore with you the type of health insurance plan your family has and help identify if your plan operates under New York State Insurance Law (“regulated”), or is not regulated by New York State Insurance Law (“non-regulated”). Your service coordinator also will obtain information on the extent of benefits available to your child under your family’s insurance policy. If your family’s health insurance plan is not regulated by New York State Insurance Law, the plan will not be billed unless you give informed written consent.

Types of Health Insurance Coverage 

• Medicaid and Medicaid Managed Care plans are managed by a number of health plans throughout the state. Services are billed directly to Medicaid.
• Child Health Plus (CHP) is managed by a number of health care plans throughout the state. CHP is subject to NYS Insurance Law with regard to the EIP
• Health Insurance plans that are issued/written outside of New York State are not regulated (e.g., Blue Cross/Blue Shield plans that are issued in another state are not regulated).
• Health Spending Accounts/Health Savings Accounts (HSAs) are medical savings accounts and are not considered insurance; information about these accounts should not be collected by your service coordinator.
• Your ISC will also discuss with you the requirements in New York State Public Health and Insurance Law, including:
  • Under New York State Public Health Law, EI services must be provided at no cost to parents;
  • Private insurance and Medicaid are part of NYS’ system of payments for EI services. These private payors are important resources for the EIP;
  • Health insurance will only be used for payment of EI services if your child’s/ family’s policy is regulated, or with your consent, if the policy is non-regulated; and
  • All EIP services in your child’s IFSP, including service coordination and evaluations, must be provided if you decline to provide insurance information, or if your child is uninsured.

Protections for Use of Regulated Insurance 

• Parents do not pay any out-of-pocket costs, such as deductibles or co-payments for EI services.
• Insurers are not allowed to charge any benefits paid for EI services against any maximum annual or lifetime policy limits.
• EI visits reimbursed by the insurer cannot reduce the number of visits otherwise available to the child and family for health care.
• Insurers cannot discontinue or fail to renew a family’s insurance coverage solely because a child is receiving EI services.
• Insurers cannot increase health insurance premiums solely because a child is receiving EI services.

Use of Non-Regulated Insurance

• If a family’s insurance plan is not regulated by NYS Insurance Law, the plan will not be billed unless you give informed written consent. If you give written consent to use non-regulated insurance for payment of EIP services, this consent will need to be signed again at every IFSP meeting.
• If your family’s insurance is not regulated by NYS Insurance Law, your insurance benefits may not be protected if billed for EIP services. In this case, the insurance can only be used if you are fully informed and choose to give written consent.

Parent Responsibilities 

• If there are any changes in your family’s insurance policy, including Medicaid and Child Health Plus, you should let your service coordinator know as soon as possible.
• If your health insurance company sends you a check for payment of EI services, that payment was sent to you in error. The payment should have been sent directly to your child’s EI provider or the provider agency that your child’s provider works for or contracts with. You should not cash the check. Immediately notify your insurance company of the error, and contact your service coordinator for assistance with returning the check to the insurance company
• If your NYS regulated health insurance company applies payment for EI services to the annual and lifetime limits specified in your insurance policy, you should immediately notify the insurance company of the error, and contact your service coordinator for assistance.
• If your Health Spending Account (HSA) funds were incorrectly sent to your child’s EI service provider by your health insurance company for payment of EI services, you should immediately notify your service coordinator. These payments are not allowed under the EI program and must be refunded to your HSA by the insurer immediately. Your EI provider is responsible for contacting your health insurance company to ask for direction to return the payment which will be returned to your available benefits.

Information provided by the New York State Early Intervention Program