Find a plan below to view and download the forms and documents you need.
You can also log in to your secure Healthfirst account to find forms and documents specific to your plan.
Need help finding something? Contact us.
Find a plan below to view and download the forms and documents you need.
You can also log in to your secure Healthfirst account to find forms and documents specific to your plan.
Need help finding something? Contact us.
Viewing documents for:
* = managed long-term care plan
Comprehensive Formulary
2023 Star Ratings
Every year, Medicare evaluates plans based on a 5-star rating system.
Comprehensive Formulary
2023 Star Ratings
Every year, Medicare evaluates plans based on a 5-star rating system.
Comprehensive Formulary
2023 Star Ratings
Every year, Medicare evaluates plans based on a 5-star rating system.
Comprehensive Formulary
2023 Star Ratings
Every year, Medicare evaluates plans based on a 5-star rating system.
Comprehensive Formulary
2023 Star Ratings: New York City & Nassau
Every year, Medicare evaluates plans based on a 5-star rating system.
2023 Star Ratings: Orange, Rockland, Sullivan & Westchester
Every year, Medicare evaluates plans based on a 5-star rating system.
Comprehensive Formulary
2023 Star Ratings
Every year, Medicare evaluates plans based on a 5-star rating system.
Appointment of Representative Form
Appoint a representative to make requests for you—give a caregiver or another person permission to file a complaint (grievance), ask for coverage, or make an appeal for you. Have the person you appoint sign the completed Appointment of Representative form and send it to us. This person is then your appointed representative for one year from the date that you both sign an Appointment of Representative form.
Pharmacy Claims Reimbursement Form
Medicare Advantage Members:
Premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Plans contain exclusions and limitations.
Healthfirst Health Plan, Inc. offers HMO plans that contract with the Federal Government. Healthfirst Medicare Plan has a contract with New York State Medicaid for Healthfirst CompleteCare (HMO SNP) and a Coordination of Benefits Agreement with the New York State Department of Health for the Healthfirst Life Improvement Plan (HMO SNP). Enrollment in Healthfirst Medicare Plan depends on contract renewal.
Healthfirst Medicare Plan, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132).
注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-866-305-0408 (TTY 1-888-542-3821).
Last update January 3, 2023 @ 2:49 pm
Y0147_MKT23_90 0816-22_2023