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Determining Regulated/Non-Regulated Status UPDATE

 New York State Department of Health

New York Early Intervention System (NYEIS) Electronic Mailing List

Reminder: Determining Regulated/Non-Regulated Status


Dear Colleague:

Service coordinators can take the following steps to determine whether an insurance plan/policy is regulated or not regulated by New York State Law: 

1. Contact the insurer using the toll-free phone number on the back of the card. 

2. Select the “Non-Member” option if there is one. If not, proceed as “Member” and enter “Policy Number” if asked. This will send you to the Department who manages this type of policy. Make your way through the prompts to speak to a representative. Any customer service representative should be able to assist you, however, you can ask for a supervisor if needed.

3. Tell the representative that you need to verify the child’s benefits under the policy/plan.

4. Provide the policy number or member identification number.

5. Ask the following question (the representative will most likely NOT be familiar with the terms ‘regulated’ or ‘non-regulated’):

   a. Is this policy a fully-insured policy issued in New York State?

      i. If yes, the policy/plan IS regulated by New York State.

      ii. If no, the policy/plan IS NOT regulated by New York State.

(Note: “Fully-insured” means it is NOT self-funded. “Issued” in New York State means it is NOT issued or written in another state and only administered in New York State. If the plan is identified as a Health Savings Account (HSA), remember this is NOT considered insurance.)

6. Additional Department guidance on regulated/non-regulated insurance can be found at the following link: https://support.eibilling.com/KB/a131/regulated-insurers-list.aspx.

Please do not respond to this e-mail.

Thank you.

Article ID: 153, Created On: 5/5/2014, Modified: 10/27/2015

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