Marketplace

Marketplace plans are for individuals and family members under the age of 65. Marketplace Leaf plans cover the essential health benefits you need to feel secure. Marketplace Leaf Premier plans provide the same health benefits as Marketplace Leaf plans, plus adult vision and dental care.

Plan Highlights:

  • No-cost annual checkups
  • Preventive and wellness visits
  • Hospital, emergency room, and urgent care visits
  • Lab tests and X-rays
  • Prescription drug coverage
  • Maternity and newborn coverage
  • Optional dental and vision coverage
  • 24/7 access to care with telemedicine (Teladoc)
  • Physical, occupational, and speech therapy
  • Annual gym membership reimbursement*
Monthly premium costs depend on household income and size Get a Quote
Choose Plan Year
Choose Plan Level
Plan Tier
Platinum Leaf
Platinum Leaf Premier
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Platinum Leaf $0
Platinum Leaf Premier $0
Maximum Out-of-Pocket (individual)
Platinum Leaf $2,000
Platinum Leaf Premier $2,000
Deductible (Family)
Platinum Leaf $0
Platinum Leaf Premier $0
Maximum Out-of-Pocket (Family)
Platinum Leaf $4,000
Platinum Leaf Premier $4,000
Your Annual Checkup
Platinum Leaf $0 copay
Platinum Leaf Premier $0 copay
Primary Care Provider (PCP) Visit
Platinum Leaf $15 copay
Platinum Leaf Premier $10 copay
Dental Care Adult
Platinum Leaf Not covered
Platinum Leaf Premier $10 copay
Dental Pediatrics (up to Age 19)
Platinum Leaf $15 copay
Platinum Leaf Premier $10 copay
Vision Exams
Platinum Leaf Not covered
Platinum Leaf Premier $10 copay
Vision Exams Pediatrics (up to Age 19)
Platinum Leaf $15 copay
Platinum Leaf Premier $10 copay
Telemedicine (Teladoc)
Platinum Leaf $0 copay
Platinum Leaf Premier $0 copay
Specialist Visit
Platinum Leaf $35 copay
Platinum Leaf Premier $40 copay
Retail Health Clinic
Platinum Leaf $15 copay
Platinum Leaf Premier $10 copay
Urgent Care
Platinum Leaf $55 copay
Platinum Leaf Premier $55 copay
Emergency Room
Platinum Leaf $100 copay
Platinum Leaf Premier $100 copay
Ambulance
Platinum Leaf $100 copay
Platinum Leaf Premier $100 copay
Surgeon
Platinum Leaf $100 copay
Platinum Leaf Premier $100 copay
Outpatient Facility
Platinum Leaf $100 copay
Platinum Leaf Premier $100 copay
Inpatient Hospital Stay
Platinum Leaf $500 copay per admission
Platinum Leaf Premier $500 copay per admission

Prescription Drug Benefits

Plan Tier
Platinum Leaf
Platinum Leaf Premier
Generic Drugs (Tier 1)
Platinum Leaf $10 copay
Platinum Leaf Premier $5 copay
Brand Name Preferred (Tier 2)
Platinum Leaf $30 copay
Platinum Leaf Premier $50 copay
Brand Name Non-Preferred (Tier 3)
Platinum Leaf $60 copay
Platinum Leaf Premier $85 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Platinum Leaf $25 copay
Platinum Leaf Premier $10 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Platinum Leaf Plan

General Plan Information
Summary of Benefits and Coverage - Platinum Leaf Premier
Summary of Benefits and Coverage - Platinum Leaf
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Gold Leaf
Gold Leaf Premier
Gold Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island and Westchester.
Deductible (individual)
Gold Leaf $600
Gold Leaf Premier $1,125
Gold Leaf Premier Plus $850
Maximum Out-of-Pocket (individual)
Gold Leaf $7,900
Gold Leaf Premier $7,000
Gold Leaf Premier Plus $6,200
Deductible (Family)
Gold Leaf $1,200
Gold Leaf Premier $2,250
Gold Leaf Premier Plus $1,700
Maximum Out-of-Pocket (Family)
Gold Leaf $15,800
Gold Leaf Premier $14,000
Gold Leaf Premier Plus $12,400
Your Annual Checkup
Gold Leaf $0 copay
Gold Leaf Premier $0 copay
Gold Leaf Premier Plus $0 copay
Primary Care Provider (PCP) Visit
Gold Leaf $25 copay after deductible
Gold Leaf Premier $20 copay not subject to deductible
Gold Leaf Premier Plus $25 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$25 copay after deductible for additional visits
Dental Care Adult
Gold Leaf Not covered
Gold Leaf Premier $20 copay
Gold Leaf Premier Plus $25 copay
Dental Pediatrics (up to Age 19)
Gold Leaf $25 copay after deductible
Gold Leaf Premier $20 copay
Gold Leaf Premier Plus $25 copay
Vision Exams Adult
Gold Leaf Not covered
Gold Leaf Premier $20 copay after deductible
Gold Leaf Premier Plus $25 copay after deductible
Vision Exams Pediatrics (up to Age 19)
Gold Leaf $25 copay after deductible
Gold Leaf Premier $20 copay after deductible
Gold Leaf Premier Plus $25 copay after deductible
Telemedicine (Teladoc)
Gold Leaf $0 copay
Gold Leaf Premier $0 copay
Gold Leaf Premier Plus $0 copay
Specialist Visit
Gold Leaf $40 copay after deductible
Gold Leaf Premier $40 copay after deductible
Gold Leaf Premier Plus $40 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$40 copay after deductible for additional visits
Retail Health Clinic
Gold Leaf $25 copay after deductible
Gold Leaf Premier $20 copay not subject to deductible
Gold Leaf Premier Plus $25 copay not subject to deductible
Urgent Care
Gold Leaf $60 copay after deductible
Gold Leaf Premier $60 copay after deductible
Gold Leaf Premier Plus $60 copay after deductible
Emergency Room
Gold Leaf $150 copay after deductible
Gold Leaf Premier $175 copay after deductible
Gold Leaf Premier Plus $250 copay after deductible
Ambulance
Gold Leaf $150 copay after deductible
Gold Leaf Premier $150 copay after deductible
Gold Leaf Premier Plus $150 copay after deductible
Surgeon
Gold Leaf $100 copay after deductible
Gold Leaf Premier $100 copay after deductible
Gold Leaf Premier Plus $100 copay after deductible
Outpatient Facility
Gold Leaf $100 copay after deductible
Gold Leaf Premier $100 copay after deductible
Gold Leaf Premier Plus $100 copay after deductible
Inpatient Hospital Stay
Gold Leaf $1,000 copay per admission
Gold Leaf Premier $1,000 copay per admission
Gold Leaf Premier Plus $1,000 copay per admission

Prescription Drug Benefits

Plan Tier
Gold Leaf
Gold Leaf Premier
Gold Leaf Premier Plus
Generic Drugs (Tier 1)
Gold Leaf $10 copay
Gold Leaf Premier $7 copay
Gold Leaf Premier Plus $10 copay
Brand Name Preferred (Tier 2)
Gold Leaf $35 copay
Gold Leaf Premier $50 copay
Gold Leaf Premier Plus $50 copay
Brand Name Non-Preferred (Tier 3)
Gold Leaf $70 copay
Gold Leaf Premier $100 copay
Gold Leaf Premier Plus $100 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Gold Leaf $25 copay
Gold Leaf Premier $14 copay
Gold Leaf Premier Plus $20 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Gold Leaf Plan

General Plan Information
Summary of Benefits and Coverage - Gold Leaf Premier Plus
Summary of Benefits and Coverage - Gold Leaf Premier
Summary of Benefits and Coverage - Gold Leaf
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

To see costs, please select your household size and income

Need help? Contact us for more information.

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Maximum Out-of-Pocket (individual)
Deductible (Family)
Maximum Out-of-Pocket (Family)
Your Annual Checkup
Primary Care Provider (PCP) Visit
Dental Care Adult
Dental Pediatrics (up to Age 19)
Vision Exams Adult
Vision Exams Pediatrics (up to Age 19)
Telemedicine (Teladoc)
Specialist Visit
Retail Health Clinic
Urgent Care
Emergency Room
Ambulance
Surgeon
Outpatient Facility
Inpatient Hospital Stay

Prescription Drug Benefits

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Generic Drugs (Tier 1)
Brand Name Preferred (Tier 2)
Brand Name Non-Preferred (Tier 3)
90-Day Mail-Order Supply for Generic (Tier 1)

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Silver Leaf Plan

General Plan Information
Federal Poverty Guidelines
Summary of Benefits and Coverage - Silver Leaf Premier Plus (>400% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier Plus (350 - 400% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier Plus (150 - 350% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier Plus (100 - 150% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (>400% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (350 - 400% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (150 - 350% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (100 - 150% FPL)
Summary of Benefits and Coverage - Silver Leaf (>400% FPL)
Summary of Benefits and Coverage - Silver Leaf (350 - 400% FPL)
Summary of Benefits and Coverage - Silver Leaf (150 - 350% FPL)
Summary of Benefits and Coverage - Silver Leaf (100 - 150% FPL)
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Silver Leaf $0
Silver Leaf Premier $0
Silver Leaf Premier Plus $0
Maximum Out-of-Pocket (individual)
Silver Leaf $1,075
Silver Leaf Premier $1,100
Silver Leaf Premier Plus $1,000
Deductible (Family)
Silver Leaf $0
Silver Leaf Premier $0
Silver Leaf Premier Plus $0
Maximum Out-of-Pocket (Family)
Silver Leaf $2,150
Silver Leaf Premier $2,200
Silver Leaf Premier Plus $2,000
Your Annual Checkup
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Primary Care Provider (PCP) Visit
Silver Leaf $10 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Dental Care Adult
Silver Leaf not covered
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Dental Pediatrics (up to Age 19)
Silver Leaf $10 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Vision Exams Adult
Silver Leaf not covered
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Vision Exams Pediatrics (up to Age 19)
Silver Leaf $10 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Telemedicine (Teladoc)
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Specialist Visit
Silver Leaf $20 copay
Silver Leaf Premier $20 copay
Silver Leaf Premier Plus $20 copay
Retail Health Clinic
Silver Leaf $10 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Urgent Care
Silver Leaf $30 copay
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay
Emergency Room
Silver Leaf $50 copay
Silver Leaf Premier $50 copay
Silver Leaf Premier Plus $50 copay
Ambulance
Silver Leaf $50 copay
Silver Leaf Premier $150 copay
Silver Leaf Premier Plus $150 copay
Surgeon
Silver Leaf $25 copay
Silver Leaf Premier $25 copay
Silver Leaf Premier Plus $25 copay
Outpatient Facility
Silver Leaf $25 copay
Silver Leaf Premier $25 copay
Silver Leaf Premier Plus $25 copay
Inpatient Hospital Stay
Silver Leaf $100 copay per admission
Silver Leaf Premier $100 copay per admission
Silver Leaf Premier Plus $100 copay per admission

Prescription Drug Benefits

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Generic Drugs (Tier 1)
Silver Leaf $6 copay
Silver Leaf Premier $6 copay
Silver Leaf Premier Plus $10 copay
Brand Name Preferred (Tier 2)
Silver Leaf $15 copay
Silver Leaf Premier $40 copay
Silver Leaf Premier Plus $55 copay
Brand Name Non-Preferred (Tier 3)
Silver Leaf $30 copay
Silver Leaf Premier $100 copay
Silver Leaf Premier Plus $100 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Silver Leaf $15 copay
Silver Leaf Premier $12 copay
Silver Leaf Premier Plus $20 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Silver Leaf Plan 100 - 150%

General Plan Information
Federal Poverty Guidelines
Summary of Benefits and Coverage - Silver Leaf Premier Plus (100 - 150% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (100 - 150% FPL)
Summary of Benefits and Coverage - Silver Leaf (100 - 150% FPL)
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Silver Leaf $350
Silver Leaf Premier $250
Silver Leaf Premier Plus $250
Maximum Out-of-Pocket (individual)
Silver Leaf $3,050
Silver Leaf Premier $2,500
Silver Leaf Premier Plus $2,100
Deductible (Family)
Silver Leaf $700
Silver Leaf Premier $500
Silver Leaf Premier Plus $500
Maximum Out-of-Pocket (Family)
Silver Leaf $6,100
Silver Leaf Premier $5,000
Silver Leaf Premier Plus $4,200
Your Annual Checkup
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Primary Care Provider (PCP) Visit
Silver Leaf $15 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$15 copay after deductible for additional visits
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$30 copay after deductible for additional visits
Dental Care Adult
Silver Leaf not covered
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay
Dental Pediatrics (up to Age 19)
Silver Leaf $15 copay after deductible
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay
Vision Exams Adult
Silver Leaf not covered
Silver Leaf Premier $30 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Vision Exams Pediatrics (up to Age 19)
Silver Leaf $15 copay after deductible
Silver Leaf Premier $30 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Telemedicine (Teladoc)
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Specialist Visit
Silver Leaf $35 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$35 copay after deductible for additional visits
Silver Leaf Premier $55 copay after deductible
Silver Leaf Premier Plus $65 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$65 copay after deductible for additional visits
Retail Health Clinic
Silver Leaf $15 copay after deductible
Silver Leaf Premier $30 copay not subject to deductible
Silver Leaf Premier Plus $30 copay not subject to deductible
Urgent Care
Silver Leaf $50 copay after deductible
Silver Leaf Premier $70 copay after deductible
Silver Leaf Premier Plus $70 copay after deductible
Emergency Room
Silver Leaf $75 copay after deductible
Silver Leaf Premier $250 copay after deductible
Silver Leaf Premier Plus $500 copay after deductible
Ambulance
Silver Leaf $75 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Surgeon
Silver Leaf $75 copay after deductible
Silver Leaf Premier $100 copay after deductible
Silver Leaf Premier Plus $100 copay after deductible
Outpatient Facility
Silver Leaf $75 copay after deductible
Silver Leaf Premier $100 copay after deductible
Silver Leaf Premier Plus $100 copay after deductible
Inpatient Hospital Stay
Silver Leaf $250 copay per admission after deductible
Silver Leaf Premier $1,500 copay per admission after deductible
Silver Leaf Premier Plus $1,500 copay per admission after deductible

Prescription Drug Benefits

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Generic Drugs (Tier 1)
Silver Leaf $9 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $15 copay
Brand Name Preferred (Tier 2)
Silver Leaf $20 copay
Silver Leaf Premier $55 copay
Silver Leaf Premier Plus $55 copay
Brand Name Non-Preferred (Tier 3)
Silver Leaf $40 copay
Silver Leaf Premier $100 copay
Silver Leaf Premier Plus $100 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Silver Leaf $22.50 copay
Silver Leaf Premier $20 copay
Silver Leaf Premier Plus $30 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Silver Leaf Plan 150 - 350%

General Plan Information
Federal Poverty Guidelines
Summary of Benefits and Coverage - Silver Leaf Premier Plus (150 - 350% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (150 - 350% FPL)
Summary of Benefits and Coverage - Silver Leaf (150 - 350% FPL)
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Silver Leaf $1,855
Silver Leaf Premier $4,000
Silver Leaf Premier Plus $2,000
Maximum Out-of-Pocket (individual)
Silver Leaf $7,350
Silver Leaf Premier $7,500
Silver Leaf Premier Plus $7,250
Deductible (Family)
Silver Leaf $3,710
Silver Leaf Premier $8,000
Silver Leaf Premier Plus $4,000
Maximum Out-of-Pocket (Family)
Silver Leaf $14,700
Silver Leaf Premier $15,000
Silver Leaf Premier Plus $14,500
Your Annual Checkup
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Primary Care Provider (PCP) Visit
Silver Leaf $30 copay not subject to deductible for the first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$30 copay after deductible for additional visits
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay not subject to deductible for the first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$30 copay after deductible for additional visits
Dental Care Adult
Silver Leaf not covered
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay
Dental Pediatrics (up to Age 19)
Silver Leaf $30 copay after deductible
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay
Vision Exams Adult
Silver Leaf not covered
Silver Leaf Premier $30 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Vision Exams Pediatrics (up to Age 19)
Silver Leaf $30 copay after deductible
Silver Leaf Premier $30 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Telemedicine (Teladoc)
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Specialist Visit
Silver Leaf $65 copay not subject to deductible for the first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$65 copay after deductible for additional visits
Silver Leaf Premier $60 copay after deductible
Silver Leaf Premier Plus $65 copay not subject to deductible for the first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$65 copay after deductible for additional visits
Retail Health Clinic
Silver Leaf $30 copay after deductible
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay
Urgent Care
Silver Leaf $70 copay after deductible
Silver Leaf Premier $70 copay after deductible
Silver Leaf Premier Plus $70 copay after deductible
Emergency Room
Silver Leaf $275 copay after deductible
Silver Leaf Premier $500 copay after deductible
Silver Leaf Premier Plus $500 copay after deductible
Ambulance
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Surgeon
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Outpatient Facility
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Inpatient Hospital Stay
Silver Leaf $1,500 copay per admission after deductible
Silver Leaf Premier $1,500 copay per admission after deductible
Silver Leaf Premier Plus $1,500 copay per admission after deductible

Prescription Drug Benefits

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Generic Drugs (Tier 1)
Silver Leaf $15 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $15 copay
Brand Name Preferred (Tier 2)
Silver Leaf $40 copay
Silver Leaf Premier $55 copay
Silver Leaf Premier Plus $55 copay
Brand Name Non-Preferred (Tier 3)
Silver Leaf $75 copay
Silver Leaf Premier $100 copay
Silver Leaf Premier Plus $100 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Silver Leaf $37.50 copay
Silver Leaf Premier $20 copay
Silver Leaf Premier Plus $30 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Silver Leaf Plan 350 - 400%

General Plan Information
Federal Poverty Guidelines
Summary of Benefits and Coverage - Silver Leaf Premier Plus (350 - 400% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (350 - 400% FPL)
Summary of Benefits and Coverage - Silver Leaf (350 - 400% FPL)
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Silver Leaf $2,100
Silver Leaf Premier $3,500
Silver Leaf Premier Plus $2,000
Maximum Out-of-Pocket (individual)
Silver Leaf $9,200
Silver Leaf Premier $9,000
Silver Leaf Premier Plus $9,100
Deductible (Family)
Silver Leaf $4,200
Silver Leaf Premier $7,000
Silver Leaf Premier Plus $4,000
Maximum Out-of-Pocket (Family)
Silver Leaf $18,400
Silver Leaf Premier $18,000
Silver Leaf Premier Plus $18,200
Your Annual Checkup
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Primary Care Provider (PCP) Visit
Silver Leaf $30 copay not subject to deductible for the first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$30 copay after deductible for additional visits
Silver Leaf Premier $40 copay not subject to deductible
Silver Leaf Premier Plus $30 copay not subject to deductible for the first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$30 copay after deductible for additional visits
Dental Care Adult
Silver Leaf not covered
Silver Leaf Premier $40 copay
Silver Leaf Premier Plus $30 copay
Dental Pediatrics (up to Age 19)
Silver Leaf $30 copay after deductible
Silver Leaf Premier $40 copay
Silver Leaf Premier Plus $30 copay
Vision Exams Adult
Silver Leaf not covered
Silver Leaf Premier $40 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Vision Exams Pediatrics (up to Age 19)
Silver Leaf $30 copay after deductible
Silver Leaf Premier $40 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Telemedicine (Teladoc)
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Specialist Visit
Silver Leaf $65 copay not subject to deductible for the first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$65 copay after deductible for additional visits
Silver Leaf Premier $60 copay after deductible
Silver Leaf Premier Plus $65 copay not subject to deductible for the first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$65 copay after deductible for additional visits
Retail Health Clinic
Silver Leaf $30 copay after deductible
Silver Leaf Premier $40 copay not subject to deductible
Silver Leaf Premier Plus $30 copay not subject to deductible
Urgent Care
Silver Leaf $70 copay after deductible
Silver Leaf Premier $70 copay after deductible
Silver Leaf Premier Plus $70 copay after deductible
Emergency Room
Silver Leaf $500 copay after deductible
Silver Leaf Premier $500 copay after deductible
Silver Leaf Premier Plus $500 copay after deductible
Ambulance
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Surgeon
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Outpatient Facility
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Inpatient Hospital Stay
Silver Leaf $1,500 copay per admission after deductible
Silver Leaf Premier $1,500 copay per admission after deductible
Silver Leaf Premier Plus $1,500 copay per admission after deductible

Prescription Drug Benefits

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Generic Drugs (Tier 1)
Silver Leaf $15 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $15 copay
Brand Name Preferred (Tier 2)
Silver Leaf $40 copay
Silver Leaf Premier $55 copay
Silver Leaf Premier Plus $55 copay
Brand Name Non-Preferred (Tier 3)
Silver Leaf $75 copay
Silver Leaf Premier 50% coinsurance not subject to deductible
Silver Leaf Premier Plus 50% coinsurance not subject to deductible
90-Day Mail-Order Supply for Generic (Tier 1)
Silver Leaf $37.50 copay
Silver Leaf Premier $20 copay
Silver Leaf Premier Plus $30 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Silver Leaf Plan 400 - 600%

General Plan Information
Federal Poverty Guidelines
Summary of Benefits and Coverage - Silver Leaf Premier Plus (>400% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (>400% FPL)
Summary of Benefits and Coverage - Silver Leaf (>400% FPL)
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Bronze Leaf
Bronze Leaf Premier
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Bronze Leaf $3,800
Bronze Leaf Premier $6,000
Maximum Out-of-Pocket (individual)
Bronze Leaf $9,200
Bronze Leaf Premier $8,700
Deductible (Family)
Bronze Leaf $7,600
Bronze Leaf Premier $12,000
Maximum Out-of-Pocket (Family)
Bronze Leaf $18,400
Bronze Leaf Premier $17,400
Your Annual Checkup
Bronze Leaf $0 copay
Bronze Leaf Premier $0 copay
Primary Care Provider (PCP) Visit
Bronze Leaf $50 copay not subject to deductible for first three visits (any combination of PCP, specialist, or outpatient mental health/substance use disorder)
$50 copay after deductible for additional visits
Bronze Leaf Premier $50 copay not subject to deductible
Dental Care Adult
Bronze Leaf Not covered
Bronze Leaf Premier $50 copay after deductible
Dental Pediatrics (up to Age 19)
Bronze Leaf $50 copay after deductible
Bronze Leaf Premier $50 copay after deductible
Vision Exams
Bronze Leaf Not covered
Bronze Leaf Premier $50 copay after deductible
Vision Exams Pediatrics (up to Age 19)
Bronze Leaf $50 copay after deductible
Bronze Leaf Premier $50 copay after deductible
Telemedicine (Teladoc)
Bronze Leaf $0 copay
Bronze Leaf Premier $0 copay
Specialist Visit
Bronze Leaf $75 copay not subject to deductible for first three visits (any combination of PCP, specialist, or outpatient mental health/substance use disorder)
$75 copay after deductible for additional visits
Bronze Leaf Premier $75 copay after deductible
Retail Health Clinic
Bronze Leaf $50 copay after deductible
Bronze Leaf Premier $50 copay not subject to deductible
Urgent Care
Bronze Leaf $75 copay after deductible
Bronze Leaf Premier $75 copay after deductible
Emergency Room
Bronze Leaf $500 copay after deductible
Bronze Leaf Premier $500 copay after deductible
Ambulance
Bronze Leaf $300 copay after deductible
Bronze Leaf Premier $300 copay after deductible
Surgeon
Bronze Leaf $150 copay after deductible
Bronze Leaf Premier $150 copay after deductible
Outpatient Facility
Bronze Leaf $150 copay after deductible
Bronze Leaf Premier $150 copay after deductible
Inpatient Hospital Stay
Bronze Leaf $1,500 copay per admission after deductible
Bronze Leaf Premier $1,500 copay per admission after deductible

Prescription Drug Benefits

Plan Tier
Bronze Leaf
Bronze Leaf Premier
Generic Drugs (Tier 1)
Bronze Leaf $10 copay after deductible
Bronze Leaf Premier $10 copay after deductible
Brand Name Preferred (Tier 2)
Bronze Leaf $35 copay after deductible
Bronze Leaf Premier $35 copay after deductible
Brand Name Non-Preferred (Tier 3)
Bronze Leaf $70 copay after deductible
Bronze Leaf Premier $70 copay after deductible
90-Day Mail-Order Supply for Generic (Tier 1)
Bronze Leaf $25 copay after deductible
Bronze Leaf Premier $20 copay after deductible

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Bronze Leaf Plan

General Plan Information
Summary of Benefits and Coverage - Bronze Leaf Premier
Summary of Benefits and Coverage - Bronze Leaf
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Green Leaf
Premium
Monthly premium costs depend on household income and size
Eligible Age
Individuals under 30
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island and Westchester.
Deductible (individual)
$9,200
Maximum Out-of-Pocket (individual)
$9,200
Deductible (Family)
$18,400
Maximum Out-of-Pocket (Family)
$18,400
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay not subject to deductible for first three visits (PCP, outpatient MH/SUD or any combination);
0% coinsurance after deductible for additional visits
Dental Pediatrics (up to Age 19)
0% coinsurance after deductible
Vision Exams Pediatrics (up to Age 19)
0% coinsurance after deductible
Telemedicine (Teladoc)
$0 copay after deductible
Specialist Visit
0% coinsurance after deductible
Retail Health Clinic
0% coinsurance after deductible
Urgent Care
0% coinsurance after deductible
Emergency Room
0% coinsurance after deductible
Ambulance
0% coinsurance after deductible
Surgeon
0% coinsurance after deductible
Outpatient Facility
0% coinsurance after deductible
Inpatient Hospital Stay
0% coinsurance after deductible

Prescription Drug Benefits

Plan Tier
Green Leaf
Generic Drugs (Tier 1)
0% coinsurance after deductible
Brand Name Preferred (Tier 2)
0% coinsurance after deductible
Brand Name Non-Preferred (Tier 3)
0% coinsurance after deductible
90-Day Mail-Order Supply for Generic (Tier 1)
0% coinsurance after deductible

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2025 Green Leaf Plan

General Plan Information
Summary of Benefits and Coverage
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Choose Plan Level
Plan Tier
Platinum Leaf
Platinum Leaf Premier
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Platinum Leaf $0
Platinum Leaf Premier $0
Maximum Out-of-Pocket (individual)
Platinum Leaf $2,000
Platinum Leaf Premier $2,000
Deductible (Family)
Platinum Leaf $0
Platinum Leaf Premier $0
Maximum Out-of-Pocket (Family)
Platinum Leaf $4,000
Platinum Leaf Premier $4,000
Your Annual Checkup
Platinum Leaf $0 copay
Platinum Leaf Premier $0 copay
Primary Care Provider (PCP) Visit
Platinum Leaf $15 copay
Platinum Leaf Premier $10 copay
Dental Care Adult
Platinum Leaf Not covered
Platinum Leaf Premier $10 copay
Dental Pediatrics (up to Age 19)
Platinum Leaf $15 copay
Platinum Leaf Premier $10 copay
Vision Exams
Platinum Leaf Not covered
Platinum Leaf Premier $10 copay
Vision Exams Pediatrics (up to Age 19)
Platinum Leaf $15 copay
Platinum Leaf Premier $10 copay
Telemedicine (Teladoc)
Platinum Leaf $0 copay
Platinum Leaf Premier $0 copay
Specialist Visit
Platinum Leaf $35 copay
Platinum Leaf Premier $40 copay
Retail Health Clinic
Platinum Leaf $15 copay
Platinum Leaf Premier $10 copay
Urgent Care
Platinum Leaf $55 copay
Platinum Leaf Premier $55 copay
Emergency Room
Platinum Leaf $100 copay
Platinum Leaf Premier $100 copay
Ambulance
Platinum Leaf $100 copay
Platinum Leaf Premier $100 copay
Surgeon
Platinum Leaf $100 copay
Platinum Leaf Premier $100 copay
Outpatient Facility
Platinum Leaf $100 copay
Platinum Leaf Premier $100 copay
Inpatient Hospital Stay
Platinum Leaf $500 copay per admission
Platinum Leaf Premier $500 copay per admission

Prescription Drug Benefits

Plan Tier
Platinum Leaf
Platinum Leaf Premier
Generic Drugs (Tier 1)
Platinum Leaf $10 copay
Platinum Leaf Premier $5 copay
Brand Name Preferred (Tier 2)
Platinum Leaf $30 copay
Platinum Leaf Premier $50 copay
Brand Name Non-Preferred (Tier 3)
Platinum Leaf $60 copay
Platinum Leaf Premier $85 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Platinum Leaf $25 copay
Platinum Leaf Premier $10 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Platinum Leaf Plan

General Plan Information
Summary of Benefits and Coverage - Platinum Leaf Premier
Summary of Benefits and Coverage - Platinum Leaf
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Gold Leaf
Gold Leaf Premier
Gold Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island and Westchester.
Deductible (individual)
Gold Leaf $600
Gold Leaf Premier $1,050
Gold Leaf Premier Plus $750
Maximum Out-of-Pocket (individual)
Gold Leaf $5,900
Gold Leaf Premier $6,500
Gold Leaf Premier Plus $6,000
Deductible (Family)
Gold Leaf $1,200
Gold Leaf Premier $2,100
Gold Leaf Premier Plus $1,500
Maximum Out-of-Pocket (Family)
Gold Leaf $11,800
Gold Leaf Premier $13,000
Gold Leaf Premier Plus $12,000
Your Annual Checkup
Gold Leaf $0 copay
Gold Leaf Premier $0 copay
Gold Leaf Premier Plus $0 copay
Primary Care Provider (PCP) Visit
Gold Leaf $25 copay after deductible
Gold Leaf Premier $20 copay not subject to deductible
Gold Leaf Premier Plus $25 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$25 copay after deductible for additional visits
Dental Care Adult
Gold Leaf Not covered
Gold Leaf Premier $20 copay
Gold Leaf Premier Plus $25 copay
Dental Pediatrics (up to Age 19)
Gold Leaf $25 copay after deductible
Gold Leaf Premier $20 copay
Gold Leaf Premier Plus $25 copay
Vision Exams Adult
Gold Leaf Not covered
Gold Leaf Premier $20 copay after deductible
Gold Leaf Premier Plus $25 copay after deductible
Vision Exams Pediatrics (up to Age 19)
Gold Leaf $25 copay after deductible
Gold Leaf Premier $20 copay after deductible
Gold Leaf Premier Plus $25 copay after deductible
Telemedicine (Teladoc)
Gold Leaf $0 copay
Gold Leaf Premier $0 copay
Gold Leaf Premier Plus $0 copay
Specialist Visit
Gold Leaf $40 copay after deductible
Gold Leaf Premier $40 copay after deductible
Gold Leaf Premier Plus $40 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$40 copay after deductible for additional visits
Retail Health Clinic
Gold Leaf $25 copay after deductible
Gold Leaf Premier $20 copay not subject to deductible
Gold Leaf Premier Plus $25 copay not subject to deductible
Urgent Care
Gold Leaf $60 copay after deductible
Gold Leaf Premier $60 copay after deductible
Gold Leaf Premier Plus $60 copay after deductible
Emergency Room
Gold Leaf $150 copay after deductible
Gold Leaf Premier $175 copay after deductible
Gold Leaf Premier Plus $250 copay after deductible
Ambulance
Gold Leaf $150 copay after deductible
Gold Leaf Premier $150 copay after deductible
Gold Leaf Premier Plus $150 copay after deductible
Surgeon
Gold Leaf $100 copay after deductible
Gold Leaf Premier $100 copay after deductible
Gold Leaf Premier Plus $100 copay after deductible
Outpatient Facility
Gold Leaf $100 copay after deductible
Gold Leaf Premier $100 copay after deductible
Gold Leaf Premier Plus $100 copay after deductible
Inpatient Hospital Stay
Gold Leaf $1,000 copay per admission
Gold Leaf Premier $1,000 copay per admission
Gold Leaf Premier Plus $1,000 copay per admission

Prescription Drug Benefits

Plan Tier
Gold Leaf
Gold Leaf Premier
Gold Leaf Premier Plus
Generic Drugs (Tier 1)
Gold Leaf $10 copay
Gold Leaf Premier $7 copay
Gold Leaf Premier Plus $10 copay
Brand Name Preferred (Tier 2)
Gold Leaf $35 copay
Gold Leaf Premier $50 copay
Gold Leaf Premier Plus $50 copay
Brand Name Non-Preferred (Tier 3)
Gold Leaf $70 copay
Gold Leaf Premier $100 copay
Gold Leaf Premier Plus $100 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Gold Leaf $25 copay
Gold Leaf Premier $14 copay
Gold Leaf Premier Plus $20 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Gold Leaf Plan

General Plan Information
Summary of Benefits and Coverage - Gold Leaf Premier Plus
Summary of Benefits and Coverage - Gold Leaf Premier
Summary of Benefits and Coverage - Gold Leaf
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

To see costs, please select your household size and income

Need help? Contact us for more information.

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Maximum Out-of-Pocket (individual)
Deductible (Family)
Maximum Out-of-Pocket (Family)
Your Annual Checkup
Primary Care Provider (PCP) Visit
Dental Care Adult
Dental Pediatrics (up to Age 19)
Vision Exams Adult
Vision Exams Pediatrics (up to Age 19)
Telemedicine (Teladoc)
Specialist Visit
Retail Health Clinic
Urgent Care
Emergency Room
Ambulance
Surgeon
Outpatient Facility
Inpatient Hospital Stay

Prescription Drug Benefits

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Generic Drugs (Tier 1)
Brand Name Preferred (Tier 2)
Brand Name Non-Preferred (Tier 3)
90-Day Mail-Order Supply for Generic (Tier 1)

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Silver Leaf Plan

General Plan Information
Federal Poverty Guidelines
Summary of Benefits and Coverage - Silver Leaf Premier Plus (>250% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier Plus (200 - 250% FPL)
Summary of Benefits and Coverage -Silver Leaf Premier Plus (150 - 200% FPL)
Summary of Benefits and Coverage -Silver Leaf Premier Plus (100 - 150% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (>250% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (200 - 250% FPL)
Summary of Benefits and Coverage -Silver Leaf Premier (150 - 200% FPL)
Summary of Benefits and Coverage -Silver Leaf Premier (100 - 150% FPL)
Summary of Benefits and Coverage - Silver Leaf (>250% FPL)
Summary of Benefits and Coverage - Silver Leaf (200 - 250% FPL)
Summary of Benefits and Coverage -Silver Leaf (150 - 200% FPL)
Summary of Benefits and Coverage -Silver Leaf (100 - 150% FPL)
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Silver Leaf $0
Silver Leaf Premier $0
Silver Leaf Premier Plus $0
Maximum Out-of-Pocket (individual)
Silver Leaf $1,000
Silver Leaf Premier $1,000
Silver Leaf Premier Plus $900
Deductible (Family)
Silver Leaf $0
Silver Leaf Premier $0
Silver Leaf Premier Plus $0
Maximum Out-of-Pocket (Family)
Silver Leaf $2,000
Silver Leaf Premier $2,000
Silver Leaf Premier Plus $1,800
Your Annual Checkup
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Primary Care Provider (PCP) Visit
Silver Leaf $10 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Dental Care Adult
Silver Leaf not covered
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Dental Pediatrics (up to Age 19)
Silver Leaf $10 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Vision Exams Adult
Silver Leaf not covered
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Vision Exams Pediatrics (up to Age 19)
Silver Leaf $10 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Telemedicine (Teladoc)
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Specialist Visit
Silver Leaf $20 copay
Silver Leaf Premier $20 copay
Silver Leaf Premier Plus $20 copay
Retail Health Clinic
Silver Leaf $10 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $10 copay
Urgent Care
Silver Leaf $30 copay
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay
Emergency Room
Silver Leaf $50 copay
Silver Leaf Premier $50 copay
Silver Leaf Premier Plus $50 copay
Ambulance
Silver Leaf $50 copay
Silver Leaf Premier $150 copay
Silver Leaf Premier Plus $150 copay
Surgeon
Silver Leaf $25 copay
Silver Leaf Premier $25 copay
Silver Leaf Premier Plus $25 copay
Outpatient Facility
Silver Leaf $25 copay
Silver Leaf Premier $25 copay
Silver Leaf Premier Plus $25 copay
Inpatient Hospital Stay
Silver Leaf $100 copay per admission
Silver Leaf Premier $100 copay per admission
Silver Leaf Premier Plus $100 copay per admission

Prescription Drug Benefits

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Generic Drugs (Tier 1)
Silver Leaf $6 copay
Silver Leaf Premier $6 copay
Silver Leaf Premier Plus $10 copay
Brand Name Preferred (Tier 2)
Silver Leaf $15 copay
Silver Leaf Premier $40 copay
Silver Leaf Premier Plus $55 copay
Brand Name Non-Preferred (Tier 3)
Silver Leaf $30 copay
Silver Leaf Premier $100 copay
Silver Leaf Premier Plus $100 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Silver Leaf $15 copay
Silver Leaf Premier $12 copay
Silver Leaf Premier Plus $20 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Silver Leaf Plan 100 - 150%

General Plan Information
Federal Poverty Guidelines
Summary of Benefits and Coverage -Silver Leaf Premier Plus (100 - 150% FPL)
Summary of Benefits and Coverage -Silver Leaf Premier (100 - 150% FPL)
Summary of Benefits and Coverage -Silver Leaf (100 - 150% FPL)
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Silver Leaf $275
Silver Leaf Premier $250
Silver Leaf Premier Plus $250
Maximum Out-of-Pocket (individual)
Silver Leaf $3,150
Silver Leaf Premier $2,500
Silver Leaf Premier Plus $2,100
Deductible (Family)
Silver Leaf $550
Silver Leaf Premier $500
Silver Leaf Premier Plus $500
Maximum Out-of-Pocket (Family)
Silver Leaf $6,300
Silver Leaf Premier $5,000
Silver Leaf Premier Plus $4,200
Your Annual Checkup
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Primary Care Provider (PCP) Visit
Silver Leaf $15 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$15 copay after deductible for additional visits
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$30 copay after deductible for additional visits
Dental Care Adult
Silver Leaf not covered
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay
Dental Pediatrics (up to Age 19)
Silver Leaf $15 copay after deductible
Silver Leaf Premier $30 copay
Silver Leaf Premier Plus $30 copay
Vision Exams Adult
Silver Leaf not covered
Silver Leaf Premier $30 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Vision Exams Pediatrics (up to Age 19)
Silver Leaf $15 copay after deductible
Silver Leaf Premier $30 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Telemedicine (Teladoc)
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Specialist Visit
Silver Leaf $35 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$35 copay after deductible for additional visits
Silver Leaf Premier $55 copay after deductible
Silver Leaf Premier Plus $65 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$65 copay after deductible for additional visits
Retail Health Clinic
Silver Leaf $15 copay after deductible
Silver Leaf Premier $30 copay not subject to deductible
Silver Leaf Premier Plus $30 copay not subject to deductible
Urgent Care
Silver Leaf $50 copay after deductible
Silver Leaf Premier $70 copay after deductible
Silver Leaf Premier Plus $70 copay after deductible
Emergency Room
Silver Leaf $75 copay after deductible
Silver Leaf Premier $250 copay after deductible
Silver Leaf Premier Plus $500 copay after deductible
Ambulance
Silver Leaf $75 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Surgeon
Silver Leaf $75 copay after deductible
Silver Leaf Premier $100 copay after deductible
Silver Leaf Premier Plus $100 copay after deductible
Outpatient Facility
Silver Leaf $75 copay after deductible
Silver Leaf Premier $100 copay after deductible
Silver Leaf Premier Plus $100 copay after deductible
Inpatient Hospital Stay
Silver Leaf $250 copay per admission after deductible
Silver Leaf Premier $1,500 copay per admission after deductible
Silver Leaf Premier Plus $1,500 copay per admission after deductible

Prescription Drug Benefits

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Generic Drugs (Tier 1)
Silver Leaf $9 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $15 copay
Brand Name Preferred (Tier 2)
Silver Leaf $20 copay
Silver Leaf Premier $55 copay
Silver Leaf Premier Plus $55 copay
Brand Name Non-Preferred (Tier 3)
Silver Leaf $40 copay
Silver Leaf Premier $100 copay
Silver Leaf Premier Plus $100 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Silver Leaf $22.50 copay
Silver Leaf Premier $20 copay
Silver Leaf Premier Plus $30 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Silver Leaf Plan 150 - 200%

General Plan Information
Federal Poverty Guidelines
Summary of Benefits and Coverage -Silver Leaf Premier Plus (150 - 200% FPL)
Summary of Benefits and Coverage -Silver Leaf Premier (150 - 200% FPL)
Summary of Benefits and Coverage -Silver Leaf (150 - 200% FPL)
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Silver Leaf $1,925
Silver Leaf Premier $4,000
Silver Leaf Premier Plus $2,000
Maximum Out-of-Pocket (individual)
Silver Leaf $7,550
Silver Leaf Premier $7,500
Silver Leaf Premier Plus $7,250
Deductible (Family)
Silver Leaf $3,850
Silver Leaf Premier $8,000
Silver Leaf Premier Plus $4,000
Maximum Out-of-Pocket (Family)
Silver Leaf $15,100
Silver Leaf Premier $15,000
Silver Leaf Premier Plus $14,500
Your Annual Checkup
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Primary Care Provider (PCP) Visit
Silver Leaf $30 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$30 copay after deductible for additional visits
Silver Leaf Premier $40 copay not subject to deductible
Silver Leaf Premier Plus $30 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$30 copay after deductible for additional visits
Dental Care Adult
Silver Leaf not covered
Silver Leaf Premier $40 copay
Silver Leaf Premier Plus $30 copay
Dental Pediatrics (up to Age 19)
Silver Leaf $30 copay after deductible
Silver Leaf Premier $40 copay
Silver Leaf Premier Plus $30 copay
Vision Exams Adult
Silver Leaf not covered
Silver Leaf Premier $40 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Vision Exams Pediatrics (up to Age 19)
Silver Leaf $30 copay after deductible
Silver Leaf Premier $40 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Telemedicine (Teladoc)
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Specialist Visit
Silver Leaf $65 copay not subject to deductible for first three visits (any combination of PCP, specialist, or outpatient mental health/substance use disorder)
$65 copay after deductible for additional visits
Silver Leaf Premier $60 copay after deductible
Silver Leaf Premier Plus $65 copay not subject to deductible for first three visits (any combination of PCP, specialist, or outpatient mental health/substance use disorder)
$65 copay after deductible for additional visits
Retail Health Clinic
Silver Leaf $30 copay after deductible
Silver Leaf Premier $40 copay
Silver Leaf Premier Plus $30 copay
Urgent Care
Silver Leaf $70 copay after deductible
Silver Leaf Premier $70 copay after deductible
Silver Leaf Premier Plus $70 copay after deductible
Emergency Room
Silver Leaf $275 copay after deductible
Silver Leaf Premier $500 copay after deductible
Silver Leaf Premier Plus $500 copay after deductible
Ambulance
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Surgeon
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Outpatient Facility
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Inpatient Hospital Stay
Silver Leaf $1,500 copay per admission after deductible
Silver Leaf Premier $1,500 copay per admission after deductible
Silver Leaf Premier Plus $1,500 copay per admission after deductible

Prescription Drug Benefits

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Generic Drugs (Tier 1)
Silver Leaf $15 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $15 copay
Brand Name Preferred (Tier 2)
Silver Leaf $40 copay
Silver Leaf Premier $55 copay
Silver Leaf Premier Plus $55 copay
Brand Name Non-Preferred (Tier 3)
Silver Leaf $75 copay
Silver Leaf Premier $100 copay
Silver Leaf Premier Plus $100 copay
90-Day Mail-Order Supply for Generic (Tier 1)
Silver Leaf $37.50 copay
Silver Leaf Premier $20 copay
Silver Leaf Premier Plus $30 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Silver Leaf Plan 200 - 250%

General Plan Information
Federal Poverty Guidelines
Summary of Benefits and Coverage - Silver Leaf Premier Plus (200 - 250% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (200 - 250% FPL)
Summary of Benefits and Coverage - Silver Leaf (200 - 250% FPL)
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Silver Leaf $2,100
Silver Leaf Premier $4,100
Silver Leaf Premier Plus $2,000
Maximum Out-of-Pocket (individual)
Silver Leaf $9,450
Silver Leaf Premier $9,000
Silver Leaf Premier Plus $9,100
Deductible (Family)
Silver Leaf $4,200
Silver Leaf Premier $8,200
Silver Leaf Premier Plus $4,000
Maximum Out-of-Pocket (Family)
Silver Leaf $18,900
Silver Leaf Premier $18,000
Silver Leaf Premier Plus $18,200
Your Annual Checkup
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Primary Care Provider (PCP) Visit
Silver Leaf $30 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$30 copay after deductible for additional visits
Silver Leaf Premier $40 copay not subject to deductible
Silver Leaf Premier Plus $30 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$30 copay after deductible for additional visits
Dental Care Adult
Silver Leaf not covered
Silver Leaf Premier $40 copay
Silver Leaf Premier Plus $30 copay
Dental Pediatrics (up to Age 19)
Silver Leaf $30 copay after deductible
Silver Leaf Premier $40 copay
Silver Leaf Premier Plus $30 copay
Vision Exams Adult
Silver Leaf not covered
Silver Leaf Premier $40 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Vision Exams Pediatrics (up to Age 19)
Silver Leaf $30 copay after deductible
Silver Leaf Premier $40 copay after deductible
Silver Leaf Premier Plus $30 copay after deductible
Telemedicine (Teladoc)
Silver Leaf $0 copay
Silver Leaf Premier $0 copay
Silver Leaf Premier Plus $0 copay
Specialist Visit
Silver Leaf $65 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$65 copay after deductible for additional visits
Silver Leaf Premier $60 copay after deductible
Silver Leaf Premier Plus $65 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$65 copay after deductible for additional visits
Retail Health Clinic
Silver Leaf $30 copay after deductible
Silver Leaf Premier $40 copay not subject to deductible
Silver Leaf Premier Plus $30 copay not subject to deductible
Urgent Care
Silver Leaf $70 copay after deductible
Silver Leaf Premier $70 copay after deductible
Silver Leaf Premier Plus $70 copay after deductible
Emergency Room
Silver Leaf $500 copay after deductible
Silver Leaf Premier $500 copay after deductible
Silver Leaf Premier Plus $500 copay after deductible
Ambulance
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Surgeon
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Outpatient Facility
Silver Leaf $150 copay after deductible
Silver Leaf Premier $150 copay after deductible
Silver Leaf Premier Plus $150 copay after deductible
Inpatient Hospital Stay
Silver Leaf $1,500 copay per admission after deductible
Silver Leaf Premier $1,500 copay per admission after deductible
Silver Leaf Premier Plus $1,500 copay per admission after deductible

Prescription Drug Benefits

Plan Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Generic Drugs (Tier 1)
Silver Leaf $15 copay
Silver Leaf Premier $10 copay
Silver Leaf Premier Plus $15 copay
Brand Name Preferred (Tier 2)
Silver Leaf $40 copay
Silver Leaf Premier $55 copay
Silver Leaf Premier Plus $55 copay
Brand Name Non-Preferred (Tier 3)
Silver Leaf $75 copay
Silver Leaf Premier 50% coinsurance after deductible
Silver Leaf Premier Plus 50% coinsurance after deductible
90-Day Mail-Order Supply for Generic (Tier 1)
Silver Leaf $37.50 copay
Silver Leaf Premier $20 copay
Silver Leaf Premier Plus $30 copay

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Silver Leaf Plan 250 - 400%

General Plan Information
Federal Poverty Guidelines
Summary of Benefits and Coverage - Silver Leaf Premier Plus (>250% FPL)
Summary of Benefits and Coverage - Silver Leaf Premier (>250% FPL)
Summary of Benefits and Coverage - Silver Leaf (>250% FPL)
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Bronze Leaf
Bronze Leaf Premier
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Deductible (individual)
Bronze Leaf $4,600
Bronze Leaf Premier $6,000
Maximum Out-of-Pocket (individual)
Bronze Leaf $9,450
Bronze Leaf Premier $8,700
Deductible (Family)
Bronze Leaf $9,200
Bronze Leaf Premier $12,000
Maximum Out-of-Pocket (Family)
Bronze Leaf $18,900
Bronze Leaf Premier $17,400
Your Annual Checkup
Bronze Leaf $0 copay
Bronze Leaf Premier $0 copay
Primary Care Provider (PCP) Visit
Bronze Leaf $50 copay not subject to deductible for first three visits (any combination of PCP, specialist, or outpatient mental health/substance use disorder)
$50 copay after deductible for additional visits
Bronze Leaf Premier $50 copay not subject to deductible
Dental Care Adult
Bronze Leaf Not covered
Bronze Leaf Premier $50 copay after deductible
Dental Pediatrics (up to Age 19)
Bronze Leaf $50 copay after deductible
Bronze Leaf Premier $50 copay after deductible
Vision Exams
Bronze Leaf Not covered
Bronze Leaf Premier $50 copay after deductible
Vision Exams Pediatrics (up to Age 19)
Bronze Leaf $50 copay after deductible
Bronze Leaf Premier $50 copay after deductible
Telemedicine (Teladoc)
Bronze Leaf $0 copay
Bronze Leaf Premier $0 copay
Specialist Visit
Bronze Leaf $75 copay not subject to deductible for first three visits (any combination of PCP, specialist, or outpatient mental health/substance use disorder)
$75 copay after deductible for additional visits
Bronze Leaf Premier $75 copay after deductible
Retail Health Clinic
Bronze Leaf $50 copay after deductible
Bronze Leaf Premier $50 copay not subject to deductible
Urgent Care
Bronze Leaf $75 copay after deductible
Bronze Leaf Premier $75 copay after deductible
Emergency Room
Bronze Leaf $500 copay after deductible
Bronze Leaf Premier $500 copay after deductible
Ambulance
Bronze Leaf $300 copay after deductible
Bronze Leaf Premier $300 copay after deductible
Surgeon
Bronze Leaf $150 copay after deductible
Bronze Leaf Premier $150 copay after deductible
Outpatient Facility
Bronze Leaf $150 copay after deductible
Bronze Leaf Premier $150 copay after deductible
Inpatient Hospital Stay
Bronze Leaf $1,500 copay per admission after deductible
Bronze Leaf Premier $1,500 copay per admission after deductible

Prescription Drug Benefits

Plan Tier
Bronze Leaf
Bronze Leaf Premier
Generic Drugs (Tier 1)
Bronze Leaf $10 copay after deductible
Bronze Leaf Premier $10 copay after deductible
Brand Name Preferred (Tier 2)
Bronze Leaf $35 copay after deductible
Bronze Leaf Premier $35 copay after deductible
Brand Name Non-Preferred (Tier 3)
Bronze Leaf $70 copay after deductible
Bronze Leaf Premier $70 copay after deductible
90-Day Mail-Order Supply for Generic (Tier 1)
Bronze Leaf $25 copay after deductible
Bronze Leaf Premier $20 copay after deductible

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Bronze Leaf Plan

General Plan Information
Summary of Benefits and Coverage - Bronze Leaf Premier
Summary of Benefits and Coverage - Bronze Leaf
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Plan Tier
Green Leaf
Premium
Monthly premium costs depend on household income and size
Eligible Age
Individuals under 30
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island and Westchester.
Deductible (individual)
$9,450
Maximum Out-of-Pocket (individual)
$9,450
Deductible (Family)
$18,900
Maximum Out-of-Pocket (Family)
$18,900
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay for first three (3) visits (any combination of PCP, specialist, or outpatient mental health/substance use disorder)
$0 coinsurance after deductible for additional visits
Dental Pediatrics (up to Age 19)
$0 copay after deductible; Pediatrics Only - for members up to Age 19
Vision Exams Pediatrics (up to Age 19)
$0 copay after deductible; Pediatrics Only - for members up to Age 19
Telemedicine (Teladoc)
$0 copay
Specialist Visit
$0 copay after deductible
Retail Health Clinic
$0 copay after deductible
Urgent Care
0% coinsurance after deductible
Emergency Room
0% coinsurance after deductible
Ambulance
0% coinsurance after deductible
Surgeon
0% coinsurance after deductible
Outpatient Facility
0% coinsurance after deductible
Inpatient Hospital Stay
0% coinsurance after deductible

Prescription Drug Benefits

Plan Tier
Green Leaf
Generic Drugs (Tier 1)
0% coinsurance after deductible
Brand Name Preferred (Tier 2)
0% coinsurance after deductible
Brand Name Non-Preferred (Tier 3)
0% coinsurance after deductible
90-Day Mail-Order Supply for Generic (Tier 1)
0% coinsurance after deductible

Additional Benefits

24/7 Access to Telemedicine with Teladoc

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

Active&Fit Direct

Healthfirst makes working out affordable too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

E8F603C3-4D94-4DCE-818B-75031FE268CE Created with sketchtool.

ExerciseRewards Program

Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.

Plan Documents

2024 Green Leaf Plan

General Plan Information
Summary of Benefits and Coverage
Prescription Drug Information
Comprehensive Formulary (List of Covered Drugs)
See all forms & documents

This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.
Healthfirst 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)。

Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

DentaQuest® is contracted with Healthfirst to provide dental benefits to its members.

EyeMed® is contracted with Healthfirst to provide vision benefits to its members.

* Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.

Frequently Asked Questions

Also known as Qualified Health Plans (QHP), NY Marketplace insurance plans:

  • Are certified by the Health Insurance Marketplace
  • Provide essential health benefits
  • Follow established limits on cost sharing (e.g., deductibles, copays, and out-of-pocket maximums)
  • Meet the Affordable Care Act requirement for having health coverage, known as “minimum essential coverage”

You may qualify for a Marketplace insurance plan if you are:

  • A New York State resident
  • Lawfully present in the U.S.
  • Not eligible for Medicaid, an Essential Plan, or Child Health Plus

Yes! You can apply to lower the cost of your health insurance and see if you qualify for free or low-cost coverage from Medicaid, the Essential Plan, or Child Health Plus. Here’s how:

Have questions about your plan? Looking to enroll?

Have questions or
ready to enroll?

We can help!

Support When You Need It

We’re happy to answer your questions.

Learn about enrollment 1-844-488-1486

Monday to Friday, 9am—6pm

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132
Member Services 1-888-250-2220

Monday to Saturday, 8am—8pm

TTY English: 1-888-542-3821
TTY Español: 1-888-867-4132

Need help enrolling in a health plan?

Request a call and our sales team will call you within one business day.

You can also visit our Virtual Community Office to connect with a local Healthfirst representative or to find a community office near you.

You can also go to the NY State of Health website to view your choices, or call the NY State of Health customer service center at 1-855-355-5777.