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Medicaid Plans

Plan Documents

Medicaid Managed Care
Personal Wellness Plan
Child Health Plus

General Forms and Documents

Member Resources
Privacy and Protected Health Information (PHI)

Essential Plans

Plan Documents

Essential Plan 1
Summary of Benefits
Formularies (Covered Prescription Drugs)
Essential Plan 2
Summary of Benefits
Formularies (Covered Prescription Drugs)
Essential Plan 3
Summary of Benefits
Formularies (Covered Prescription Drugs)
Essential Plan 4
Summary of Benefits

General Forms and Documents

Member Resources
Privacy and Protected Health Information (PHI)

Leaf and Leaf Premier Plans

Plan Documents

Platinum
Summary of Benefits
Formularies (Covered Prescription Drugs)
Gold
Summary of Benefits
Formularies (Covered Prescription Drugs)
Silver
Summary of Benefits
Bronze
Summary of Benefits
Formularies (Covered Prescription Drugs)
Green
Summary of Benefits
Formularies (Covered Prescription Drugs)

General Forms and Documents

Member Resources
Privacy and Protected Health Information (PHI)

Total EPO Plans

Plan Documents

Platinum
Summary of Benefits
Formulary (Covered Prescription Drugs)
Gold
Summary of Benefits
Formulary (Covered Prescription Drugs)
Silver
Summary of Benefits
Formulary (Covered Prescription Drugs)
Bronze
Summary of Benefits
Formulary (Covered Prescription Drugs)

General Forms and Documents

Member Resources
Privacy and Protected Health Information (PHI)

Medicare & Long Term Care Plans

* = long-term care plan

Plan Documents

Life Improvement Plan (HMO SNP)
Increased Benefits Plan (HMO)
65 Plus Plan (HMO)
Coordinated Benefits Plan (HMO)
CompleteCare (HMO SNP)*
AbsoluteCare FIDA Plan (Medicare-Medicaid)

General Forms, Documents, and Resources

Member Resources
Medicare Part D Resources
Medicare Advantage Plan Enrollment Resources
Privacy, Protected Health Information (PHI), and Non-Discrimination

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).

AbsoluteCare FIDA (Medicare-Medicaid) Members:

You must use contracted network pharmacies to access your prescription drug benefit except under non-routine circumstances, in which case quantity limitations and restrictions may apply. The State of New York has created a Participant Ombudsman Program called the Independent Consumer Advocacy Network (ICAN) to provide Participants free, confidential assistance on any services offered by Healthfirst Health Plan, Inc. ICAN may be reached toll-free at 1-844-614-8800 or online at icannys.org. (TTY users call 711, then follow the prompts to dial 844-614-8800.) Healthfirst Health 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 September 2, 2019 @ 10:04 am

H3359_MKT20_59_2019
H3359_MKT20_01_2019

Pro and Pro Plus Plans

Plan Documents

Platinum
Summary of Benefits
Gold
Summary of Benefits
Silver
Summary of Benefits
Bronze
Summary of Benefits

Pro and Pro Plus Plans

Plan Documents

Platinum
Summary of Benefits
Gold
Summary of Benefits
Silver
Summary of Benefits
Bronze
Summary of Benefits