Pro EPO and Pro Plus EPO Plans

Healthfirst offers comprehensive health insurance plans for New York small businesses (1–100 employees), available in various levels (Platinum, Gold, Silver, and Bronze) to fit your employees’ needs. Whether they’re full-time, part-time, or both, we'll make sure they’re enrolled in a health plan that’s right for them. Call us to get a quote today.

Plan Highlights:

  • No-cost annual checkups
  • Hospital stays, emergency room, urgent care, and retail health clinic visits
  • Lab tests (blood tests and X-rays)
  • Hearing, vision, and dental*
  • Maternity and newborn care
  • Prescription drug coverage
  • 24/7 access to care with telemedicine (Teladoc)
  • Unlimited acupuncture visits
  • HSA-compatible plans
  • Annual gym membership reimbursement**
  • 2022
  • 2021
Tier
Platinum Pro
Platinum Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), and Long Island
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $20 copay
Adult – not covered
Pediatric – $20 copay
Adult - $20 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult - $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Platinum Pro
Platinum Pro Plus
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$2,000
$2,000
Deductible (Family)
$0
$0
Maximum Out-of-Pocket (Family)
$4,000
$4,000
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$20 copay
$20 copay
Specialist Visit
$35 copay
$35 copay
Retail Health Clinic
$20 copay
$20 copay
Urgent Care
$50 copay
$50 copay
Emergency Room
$250 copay
$250 copay
Ambulance
$150 copay
$150 copay
Surgeon
$100 copay
$100 copay
Outpatient Facility
$200 copay
$200 copay
Inpatient Hospital Stay
$500 copay per admission
$500 copay per admission
Acupuncture
$35 copay
$35 copay
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$10 copay
Brand Name Preferred (Tier 2)
$30 copay
$30 copay
Brand Name Non-Preferred (Tier 3)
$60 copay
$60 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$20 copay
$20 copay
Covered Prescription Drugs (Formulary) English
Tier
Gold Pro
Gold Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), and Long Island
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $25 copay
Adult – not covered
Pediatric – $25 copay
Adult – $25 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Gold Pro
Gold Pro Plus
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$5,250
$5,250
Deductible (Family)
$0
$0
Maximum Out-of-Pocket (Family)
$10,500
$10,500
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$25 copay
$25 copay
Specialist Visit
$40 copay
$40 copay
Retail Health Clinic
$25 copay
$25 copay
Urgent Care
$60 copay
$60 copay
Emergency Room
$350 copay
$350 copay
Ambulance
$150 copay
$150 copay
Surgeon
$100 copay
$100 copay
Outpatient Facility
$300 copay
$300 copay
Inpatient Hospital Stay
$500 copay per admission
$500 copay per admission
Acupuncture
$40 copay
$40 copay
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$10 copay
Brand Name Preferred (Tier 2)
$50 copay
$50 copay
Brand Name Non-Preferred (Tier 3)
$85 copay
$85 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$20 copay
$20 copay
Covered Prescription Drugs (Formulary) English
Tier
Gold 25/50/0 Pro
Gold 25/50/0 Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), and Long Island
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $25 copay
Adult – not covered
Pediatric – $25 copay
Adult – $25 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Gold 25/50/0 Pro
Gold 25/50/0 Pro Plus
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$7,000
$7,000
Deductible (Family)
$0
$0
Maximum Out-of-Pocket (Family)
$14,000
$14,000
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$25 copay
$25 copay
Specialist Visit
$50 copay
$50 copay
Retail Health Clinic
$25 copay
$25 copay
Urgent Care
$60 copay
$60 copay
Emergency Room
$350 copay
$350 copay
Ambulance
$150 copay
$150 copay
Surgeon
$100 copay
$100 copay
Outpatient Facility
$300 copay
$300 copay
Inpatient Hospital Stay
$500 copay per admission
$500 copay per admission
Acupuncture
$50 copay
$50 copay
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$10 copay
Brand Name Preferred (Tier 2)
$50 copay
$50 copay
Brand Name Non-Preferred (Tier 3)
$85 copay
$85 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$20 copay
$20 copay
Covered Prescription Drugs (Formulary) English
Tier
Silver Pro
Silver Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), and Long Island
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $35 copay
Adult – not covered
Pediatric – $35 copay
Adult – $35 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Silver Pro
Silver Pro Plus
Deductible (Individual)
$4,300
$4,300
Maximum Out-of-Pocket (Individual)
$8,150
$8,150
Deductible (Family)
$8,600
$8,600
Maximum Out-of-Pocket (Family)
$16,300
$16,300
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$35 copay
$35 copay
Specialist Visit
$70 copay
$70 copay
Retail Health Clinic
$35 copay
$35 copay
Urgent Care
$70 copay
$70 copay
Emergency Room
$600 copay after deductible
$600 copay after deductible
Ambulance
$300 copay after deductible
$300 copay after deductible
Surgeon
$200 copay after deductible
$200 copay after deductible
Outpatient Facility
40% coinsurance after deductible
40% coinsurance after deductible
Inpatient Hospital Stay
40% coinsurance per admission after deductible
40% coinsurance per admission after deductible
Acupuncture
$70 copay
$70 copay
Prescriptions
Generic Drugs (Tier 1)
$20 copay
$20 copay
Brand Name Preferred (Tier 2)
$60 copay
$60 copay
Brand Name Non-Preferred (Tier 3)
$110 copay
$110 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$40 copay
$40 copay
Covered Prescription Drugs (Formulary) English
Tier
Silver 40/75/4700 Pro
Silver 40/75/4700 Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), and Long Island
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $40 copay
Adult – not covered
Pediatric – $40 copay
Adult – $40 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Silver 40/75/4700 Pro
Silver 40/75/4700 Pro Plus
Deductible (Individual)
$4,700
$4,700
Maximum Out-of-Pocket (Individual)
$7,900
$7,900
Deductible (Family)
$9,400
$9,400
Maximum Out-of-Pocket (Family)
$15,800
$15,800
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$40 copay
$40 copay
Specialist Visit
$75 copay
$75 copay
Retail Health Clinic
$40 copay
$40 copay
Urgent Care
$75 copay
$75 copay
Emergency Room
$600 copay after deductible
$600 copay after deductible
Ambulance
$300 copay after deductible
$300 copay after deductible
Surgeon
$200 copay after deductible
$200 copay after deductible
Outpatient Facility
45% coinsurance after deductible
45% coinsurance after deductible
Inpatient Hospital Stay
45% coinsurance per admission after deductible
45% coinsurance per admission after deductible
Acupuncture
$75 copay
$75 copay
Prescriptions
Generic Drugs (Tier 1)
$20 copay
$20 copay
Brand Name Preferred (Tier 2)
$60 copay
$60 copay
Brand Name Non-Preferred (Tier 3)
$110 copay
$110 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$40 copay
$40 copay
Covered Prescription Drugs (Formulary) English
Tier
Bronze Pro
Bronze Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), and Long Island
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – 50% coinsurance after deductible
Adult – not covered
Pediatric – 50% coinsurance after deductible
Adult – 50% coinsurance after deductible
Vision Exams
Pediatric – $10 copay after deductible
Adult – not covered
Pediatric – $10 copay after deductible
Adult – $10 copay after deductible
Telemedicine (Teladoc)
$0 copy after deductible
$0 copy after deductible
Costs & Benefits
Contact Us Tier
Bronze Pro
Bronze Pro Plus
Deductible (Individual)
$5,950
$5,950
Maximum Out-of-Pocket (Individual)
$6,900
$6,900
Deductible (Family)
$11,900
$11,900
Maximum Out-of-Pocket (Family)
$13,800
$13,800
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
50% coinsurance after deductible
50% coinsurance after deductible
Specialist Visit
50% coinsurance after deductible
50% coinsurance after deductible
Retail Health Clinic
50% coinsurance after deductible
50% coinsurance after deductible
Urgent Care
50% coinsurance after deductible
50% coinsurance after deductible
Emergency Room
50% coinsurance after deductible
50% coinsurance after deductible
Ambulance
50% coinsurance after deductible
50% coinsurance after deductible
Surgeon
50% coinsurance after deductible
50% coinsurance after deductible
Outpatient Facility
50% coinsurance after deductible
50% coinsurance after deductible
Inpatient Hospital Stay
50% coinsurance per admission after deductible
50% coinsurance per admission after deductible
Acupuncture
50% coinsurance after deductible
50% coinsurance after deductible
Prescriptions
Generic Drugs (Tier 1)
50% coinsurance after deductible
50% coinsurance after deductible
Brand Name Preferred (Tier 2)
50% coinsurance after deductible
50% coinsurance after deductible
Brand Name Non-Preferred (Tier 3)
50% coinsurance after deductible
50% coinsurance after deductible
Covered Prescription Drugs (Formulary) English
Tier
Bronze 6850 Pro
Bronze 6850 Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), and Long Island
Other Eligibility Requirements
Small business with 1-100 employees
Dental Cleanings
Pediatric – 0% coinsurance after deductible
Adult – not covered
Pediatric – 0% coinsurance after deductible
Adult – 0% coinsurance after deductible
Vision Exams
Pediatric – 0% coinsurance after deductible
Adult – not covered
Pediatric – 0% coinsurance after deductible
Adult – 0% coinsurance after deductible
Telemedicine (Teladoc)
$0 copy after deductible
$0 copy after deductible
Costs & Benefits
Contact Us Tier
Bronze 6850 Pro
Bronze 6850 Pro Plus
Deductible (Individual)
$6,850
$6,850
Maximum Out-of-Pocket (Individual)
$6,850
$6,850
Deductible (Family)
$13,700
$13,700
Maximum Out-of-Pocket (Family)
$13,700
$13,700
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
0% coinsurance after deductible
0% coinsurance after deductible
Specialist Visit
0% coinsurance after deductible
0% coinsurance after deductible
Retail Health Clinic
0% coinsurance after deductible
0% coinsurance after deductible
Urgent Care
0% coinsurance after deductible
0% coinsurance after deductible
Emergency Room
0% coinsurance after deductible
0% coinsurance after deductible
Ambulance
0% coinsurance after deductible
0% coinsurance after deductible
Surgeon
0% coinsurance after deductible
0% coinsurance after deductible
Outpatient Facility
0% coinsurance after deductible
0% coinsurance after deductible
Inpatient Hospital Stay
0% coinsurance per admission after deductible
0% coinsurance per admission after deductible
Acupuncture
0% coinsurance after deductible
0% coinsurance after deductible
Prescriptions
Generic Drugs (Tier 1)
0% coinsurance after deductible
0% coinsurance after deductible
Brand Name Preferred (Tier 2)
0% coinsurance after deductible
0% coinsurance after deductible
Brand Name Non-Preferred (Tier 3)
0% coinsurance after deductible
0% coinsurance after deductible
Covered Prescription Drugs (Formulary) English
Tier
Bronze 8150 Pro
Summary of Benefits and Coverage (PDF)
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island) and Long Island.
Other Eligibility Requirements
Small business with 1-100 employees
Dental Cleanings
Pediatric – 0% coinsurance after deductible
Adult – not covered
Vision Exams
Pediatric – 0% coinsurance after deductible
Adult – not covered
Telemedicine (Teladoc)
0% coinsurance after deductible
Costs & Benefits
Contact Us Tier
Bronze 8150 Pro
Deductible (Individual)
$8,150
Maximum Out-of-Pocket (Individual)
$8,150
Deductible (Family)
$16,300
Maximum Out-of-Pocket (Family)
$16,300
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
0% coinsurance 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
Acupuncture
0% coinsurance after deductible
Prescriptions
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
Covered Prescription Drugs (Formulary) English
Tier
Platinum Pro
Platinum Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $20 copay
Adult – not covered
Pediatric – $20 copay
Adult - $20 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult - $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Platinum Pro
Platinum Pro Plus
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$2,000
$2,000
Deductible (Family)
$0
$0
Maximum Out-of-Pocket (Family)
$4,000
$4,000
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$20 copay
$20 copay
Specialist Visit
$35 copay
$35 copay
Retail Health Clinic
$20 copay
$20 copay
Urgent Care
$50 copay
$50 copay
Emergency Room
$250 copay
$250 copay
Ambulance
$150 copay
$150 copay
Surgeon
$100 copay
$100 copay
Outpatient Facility
$200 copay
$200 copay
Inpatient Hospital Stay
$500 copay per admission
$500 copay per admission
Acupuncture
$35 copay
$35 copay
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$10 copay
Brand Name Preferred (Tier 2)
$30 copay
$30 copay
Brand Name Non-Preferred (Tier 3)
$60 copay
$60 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$20 copay
$20 copay
Covered Prescription Drugs (Formulary) English
Tier
Platinum Pro
Platinum Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $20 copay
Adult – not covered
Pediatric – $20 copay
Adult - $20 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult - $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Platinum Pro
Platinum Pro Plus
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$2,000
$2,000
Deductible (Family)
$0
$0
Maximum Out-of-Pocket (Family)
$4,000
$4,000
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$20 copay
$20 copay
Specialist Visit
$35 copay
$35 copay
Retail Health Clinic
$20 copay
$20 copay
Urgent Care
$50 copay
$50 copay
Emergency Room
$250 copay
$250 copay
Ambulance
$150 copay
$150 copay
Surgeon
$100 copay
$100 copay
Outpatient Facility
$200 copay
$200 copay
Inpatient Hospital Stay
$500 copay per admission
$500 copay per admission
Acupuncture
$35 copay
$35 copay
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$10 copay
Brand Name Preferred (Tier 2)
$30 copay
$30 copay
Brand Name Non-Preferred (Tier 3)
$60 copay
$60 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$20 copay
$20 copay
Covered Prescription Drugs (Formulary) English
Tier
Gold Pro
Gold Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $25 copay
Adult – not covered
Pediatric – $25 copay
Adult – $25 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Gold Pro
Gold Pro Plus
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$5,275
$5,275
Deductible (Family)
$0
$0
Maximum Out-of-Pocket (Family)
$10,550
$10,550
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$25 copay
$25 copay
Specialist Visit
$40 copay
$40 copay
Retail Health Clinic
$25 copay
$25 copay
Urgent Care
$60 copay
$60 copay
Emergency Room
$350 copay
$350 copay
Ambulance
$150 copay
$150 copay
Surgeon
$100 copay
$100 copay
Outpatient Facility
$300 copay
$300 copay
Inpatient Hospital Stay
$500 copay per admission
$500 copay per admission
Acupuncture
$40 copay
$40 copay
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$10 copay
Brand Name Preferred (Tier 2)
$50 copay
$50 copay
Brand Name Non-Preferred (Tier 3)
$85 copay
$85 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$20 copay
$20 copay
Covered Prescription Drugs (Formulary) English
Tier
Gold Pro
Gold Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $25 copay
Adult – not covered
Pediatric – $25 copay
Adult – $25 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Gold Pro
Gold Pro Plus
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$5,275
$5,275
Deductible (Family)
$0
$0
Maximum Out-of-Pocket (Family)
$10,550
$10,550
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$25 copay
$25 copay
Specialist Visit
$40 copay
$40 copay
Retail Health Clinic
$25 copay
$25 copay
Urgent Care
$60 copay
$60 copay
Emergency Room
$350 copay
$350 copay
Ambulance
$150 copay
$150 copay
Surgeon
$100 copay
$100 copay
Outpatient Facility
$300 copay
$300 copay
Inpatient Hospital Stay
$500 copay per admission
$500 copay per admission
Acupuncture
$40 copay
$40 copay
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$10 copay
Brand Name Preferred (Tier 2)
$50 copay
$50 copay
Brand Name Non-Preferred (Tier 3)
$85 copay
$85 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$20 copay
$20 copay
Covered Prescription Drugs (Formulary) English
Tier
Gold 25/50/0 Pro
Gold 25/50/0 Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $25 copay
Adult – not covered
Pediatric – $25 copay
Adult – $25 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Gold 25/50/0 Pro
Gold 25/50/0 Pro Plus
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$7,000
$7,000
Deductible (Family)
$0
$0
Maximum Out-of-Pocket (Family)
$14,000
$14,000
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$25 copay
$25 copay
Specialist Visit
$50 copay
$50 copay
Retail Health Clinic
$25 copay
$25 copay
Urgent Care
$60 copay
$60 copay
Emergency Room
$350 copay
$350 copay
Ambulance
$150 copay
$150 copay
Surgeon
$100 copay
$100 copay
Outpatient Facility
$300 copay
$300 copay
Inpatient Hospital Stay
$500 copay per admission
$500 copay per admission
Acupuncture
$50 copay
$50 copay
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$10 copay
Brand Name Preferred (Tier 2)
$50 copay
$50 copay
Brand Name Non-Preferred (Tier 3)
$85 copay
$85 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$20 copay
$20 copay
Covered Prescription Drugs (Formulary) English
Tier
Gold 25/50/0 Pro
Gold 25/50/0 Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $25 copay
Adult – not covered
Pediatric – $25 copay
Adult – $25 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Gold 25/50/0 Pro
Gold 25/50/0 Pro Plus
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$7,000
$7,000
Deductible (Family)
$0
$0
Maximum Out-of-Pocket (Family)
$14,000
$14,000
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$25 copay
$25 copay
Specialist Visit
$50 copay
$50 copay
Retail Health Clinic
$25 copay
$25 copay
Urgent Care
$60 copay
$60 copay
Emergency Room
$350 copay
$350 copay
Ambulance
$150 copay
$150 copay
Surgeon
$100 copay
$100 copay
Outpatient Facility
$300 copay
$300 copay
Inpatient Hospital Stay
$500 copay per admission
$500 copay per admission
Acupuncture
$50 copay
$50 copay
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$10 copay
Brand Name Preferred (Tier 2)
$50 copay
$50 copay
Brand Name Non-Preferred (Tier 3)
$85 copay
$85 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$20 copay
$20 copay
Covered Prescription Drugs (Formulary) English
Tier
Silver Pro
Silver Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $35 copay
Adult – not covered
Pediatric – $35 copay
Adult – $35 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Silver Pro
Silver Pro Plus
Deductible (Individual)
$4,300
$4,300
Maximum Out-of-Pocket (Individual)
$8,150
$8,150
Deductible (Family)
$8,600
$8,600
Maximum Out-of-Pocket (Family)
$16,300
$16,300
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$35 copay
$35 copay
Specialist Visit
$70 copay
$70 copay
Retail Health Clinic
$35 copay
$35 copay
Urgent Care
$70 copay
$70 copay
Emergency Room
$600 copay after deductible
$600 copay after deductible
Ambulance
$300 copay after deductible
$300 copay after deductible
Surgeon
$200 copay
$200 copay
Outpatient Facility
40% coinsurance after deductible
40% coinsurance after deductible
Inpatient Hospital Stay
40% coinsurance per admission after deductible
40% coinsurance per admission after deductible
Acupuncture
$70 copay
$70 copay
Prescriptions
Generic Drugs (Tier 1)
$20 copay
$20 copay
Brand Name Preferred (Tier 2)
$60 copay
$60 copay
Brand Name Non-Preferred (Tier 3)
$110 copay
$110 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$40 copay
$40 copay
Covered Prescription Drugs (Formulary) English
Tier
Silver Pro
Silver Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $35 copay
Adult – not covered
Pediatric – $35 copay
Adult – $35 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Silver Pro
Silver Pro Plus
Deductible (Individual)
$4,300
$4,300
Maximum Out-of-Pocket (Individual)
$8,150
$8,150
Deductible (Family)
$8,600
$8,600
Maximum Out-of-Pocket (Family)
$16,300
$16,300
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$35 copay
$35 copay
Specialist Visit
$70 copay
$70 copay
Retail Health Clinic
$35 copay
$35 copay
Urgent Care
$70 copay
$70 copay
Emergency Room
$600 copay after deductible
$600 copay after deductible
Ambulance
$300 copay after deductible
$300 copay after deductible
Surgeon
$200 copay
$200 copay
Outpatient Facility
40% coinsurance after deductible
40% coinsurance after deductible
Inpatient Hospital Stay
40% coinsurance per admission after deductible
40% coinsurance per admission after deductible
Acupuncture
$70 copay
$70 copay
Prescriptions
Generic Drugs (Tier 1)
$20 copay
$20 copay
Brand Name Preferred (Tier 2)
$60 copay
$60 copay
Brand Name Non-Preferred (Tier 3)
$110 copay
$110 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$40 copay
$40 copay
Covered Prescription Drugs (Formulary) English
Tier
Silver 40/75/4700 Pro
Silver 40/75/4700 Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $40 copay
Adult – not covered
Pediatric – $40 copay
Adult – $40 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Silver 40/75/4700 Pro
Silver 40/75/4700 Pro Plus
Deductible (Individual)
$4,700
$4,700
Maximum Out-of-Pocket (Individual)
$7,900
$7,900
Deductible (Family)
$9,400
$9,400
Maximum Out-of-Pocket (Family)
$15,800
$15,800
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$40 copay
$40 copay
Specialist Visit
$75 copay
$75 copay
Retail Health Clinic
$40 copay
$40 copay
Urgent Care
$75 copay
$75 copay
Emergency Room
$600 copay after deductible
$600 copay after deductible
Ambulance
$300 copay after deductible
$300 copay after deductible
Surgeon
$200 copay
$200 copay
Outpatient Facility
45% coinsurance after deductible
45% coinsurance after deductible
Inpatient Hospital Stay
45% coinsurance per admission after deductible
45% coinsurance per admission after deductible
Acupuncture
$75 copay
$75 copay
Prescriptions
Generic Drugs (Tier 1)
$20 copay
$20 copay
Brand Name Preferred (Tier 2)
$60 copay
$60 copay
Brand Name Non-Preferred (Tier 3)
$110 copay
$110 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$40 copay
$40 copay
Covered Prescription Drugs (Formulary) English
Tier
Silver 40/75/4700 Pro
Silver 40/75/4700 Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $40 copay
Adult – not covered
Pediatric – $40 copay
Adult – $40 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Silver 40/75/4700 Pro
Silver 40/75/4700 Pro Plus
Deductible (Individual)
$4,700
$4,700
Maximum Out-of-Pocket (Individual)
$7,900
$7,900
Deductible (Family)
$9,400
$9,400
Maximum Out-of-Pocket (Family)
$15,800
$15,800
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$40 copay
$40 copay
Specialist Visit
$75 copay
$75 copay
Retail Health Clinic
$40 copay
$40 copay
Urgent Care
$75 copay
$75 copay
Emergency Room
$600 copay after deductible
$600 copay after deductible
Ambulance
$300 copay after deductible
$300 copay after deductible
Surgeon
$200 copay
$200 copay
Outpatient Facility
45% coinsurance after deductible
45% coinsurance after deductible
Inpatient Hospital Stay
45% coinsurance per admission after deductible
45% coinsurance per admission after deductible
Acupuncture
$75 copay
$75 copay
Prescriptions
Generic Drugs (Tier 1)
$20 copay
$20 copay
Brand Name Preferred (Tier 2)
$60 copay
$60 copay
Brand Name Non-Preferred (Tier 3)
$110 copay
$110 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$40 copay
$40 copay
Covered Prescription Drugs (Formulary) English
Tier
Bronze Pro
Bronze Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – 50% coinsurance after deductible
Adult – not covered
Pediatric – 50% coinsurance after deductible
Adult – 50% coinsurance after deductible
Vision Exams
Pediatric – $10 copay after deductible
Adult – not covered
Pediatric – $10 copay after deductible
Adult – $10 copay after deductible
Telemedicine (Teladoc)
$0 copy after deductible
$0 copy after deductible
Costs & Benefits
Contact Us Tier
Bronze Pro
Bronze Pro Plus
Deductible (Individual)
$5,950
$5,950
Maximum Out-of-Pocket (Individual)
$6,900
$6,900
Deductible (Family)
$11,900
$11,900
Maximum Out-of-Pocket (Family)
$13,800
$13,800
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
50% coinsurance after deductible
50% coinsurance after deductible
Specialist Visit
50% coinsurance after deductible
50% coinsurance after deductible
Retail Health Clinic
50% coinsurance after deductible
50% coinsurance after deductible
Urgent Care
50% coinsurance after deductible
50% coinsurance after deductible
Emergency Room
50% coinsurance after deductible
50% coinsurance after deductible
Ambulance
50% coinsurance after deductible
50% coinsurance after deductible
Surgeon
50% coinsurance after deductible
50% coinsurance after deductible
Outpatient Facility
50% coinsurance after deductible
50% coinsurance after deductible
Inpatient Hospital Stay
50% coinsurance per admission after deductible
50% coinsurance per admission after deductible
Acupuncture
50% coinsurance after deductible
50% coinsurance after deductible
Prescriptions
Generic Drugs (Tier 1)
50% coinsurance after deductible
50% coinsurance after deductible
Brand Name Preferred (Tier 2)
50% coinsurance after deductible
50% coinsurance after deductible
Brand Name Non-Preferred (Tier 3)
50% coinsurance after deductible
50% coinsurance after deductible
Covered Prescription Drugs (Formulary) English
Tier
Bronze Pro
Bronze Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – 50% coinsurance after deductible
Adult – not covered
Pediatric – 50% coinsurance after deductible
Adult – 50% coinsurance after deductible
Vision Exams
Pediatric – $10 copay after deductible
Adult – not covered
Pediatric – $10 copay after deductible
Adult – $10 copay after deductible
Telemedicine (Teladoc)
$0 copy after deductible
$0 copy after deductible
Costs & Benefits
Contact Us Tier
Bronze Pro
Bronze Pro Plus
Deductible (Individual)
$5,950
$5,950
Maximum Out-of-Pocket (Individual)
$6,900
$6,900
Deductible (Family)
$11,900
$11,900
Maximum Out-of-Pocket (Family)
$13,800
$13,800
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
50% coinsurance after deductible
50% coinsurance after deductible
Specialist Visit
50% coinsurance after deductible
50% coinsurance after deductible
Retail Health Clinic
50% coinsurance after deductible
50% coinsurance after deductible
Urgent Care
50% coinsurance after deductible
50% coinsurance after deductible
Emergency Room
50% coinsurance after deductible
50% coinsurance after deductible
Ambulance
50% coinsurance after deductible
50% coinsurance after deductible
Surgeon
50% coinsurance after deductible
50% coinsurance after deductible
Outpatient Facility
50% coinsurance after deductible
50% coinsurance after deductible
Inpatient Hospital Stay
50% coinsurance per admission after deductible
50% coinsurance per admission after deductible
Acupuncture
50% coinsurance after deductible
50% coinsurance after deductible
Prescriptions
Generic Drugs (Tier 1)
50% coinsurance after deductible
50% coinsurance after deductible
Brand Name Preferred (Tier 2)
50% coinsurance after deductible
50% coinsurance after deductible
Brand Name Non-Preferred (Tier 3)
50% coinsurance after deductible
50% coinsurance after deductible
Covered Prescription Drugs (Formulary) English
Tier
Bronze 5250 Pro
Summary of Benefits and Coverage (PDF)
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – 50% coinsurance after deductible
Adult – not covered
Vision Exams
Pediatric – 50% coinsurance after deductible
Adult – not covered
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Contact Us Tier
Bronze 5250 Pro
Deductible (Individual)
$5,250
Maximum Out-of-Pocket (Individual)
$8,550
Deductible (Family)
$10,500
Maximum Out-of-Pocket (Family)
$17,100
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
$0 copay for first 3 visits (any combination of PCP or outpatient mental health/substance use disorder)
50% coinsurance after deductible for additional visits
Specialist Visit
50% coinsurance after deductible
Retail Health Clinic
50% coinsurance after deductible
Urgent Care
50% coinsurance after deductible
Emergency Room
50% coinsurance after deductible
Ambulance
50% coinsurance after deductible
Surgeon
50% coinsurance after deductible
Outpatient Facility
50% coinsurance after deductible
Inpatient Hospital Stay
50% coinsurance per admission after deductible
Acupuncture
50% coinsurance after deductible
Prescriptions
Generic Drugs (Tier 1)
50% coinsurance after deductible
Brand Name Preferred (Tier 2)
50% coinsurance after deductible
Brand Name Non-Preferred (Tier 3)
50% coinsurance after deductible
Covered Prescription Drugs (Formulary) English
Tier
Bronze 5250 Pro
Summary of Benefits and Coverage (PDF)
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – 50% coinsurance after deductible
Adult – not covered
Vision Exams
Pediatric – 50% coinsurance after deductible
Adult – not covered
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Contact Us Tier
Bronze 5250 Pro
Deductible (Individual)
$5,250
Maximum Out-of-Pocket (Individual)
$8,550
Deductible (Family)
$10,500
Maximum Out-of-Pocket (Family)
$17,100
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
$0 copay for first 3 visits (any combination of PCP or outpatient mental health/substance use disorder)
50% coinsurance after deductible for additional visits
Specialist Visit
50% coinsurance after deductible
Retail Health Clinic
50% coinsurance after deductible
Urgent Care
50% coinsurance after deductible
Emergency Room
50% coinsurance after deductible
Ambulance
50% coinsurance after deductible
Surgeon
50% coinsurance after deductible
Outpatient Facility
50% coinsurance after deductible
Inpatient Hospital Stay
50% coinsurance per admission after deductible
Acupuncture
50% coinsurance after deductible
Prescriptions
Generic Drugs (Tier 1)
50% coinsurance after deductible
Brand Name Preferred (Tier 2)
50% coinsurance after deductible
Brand Name Non-Preferred (Tier 3)
50% coinsurance after deductible
Covered Prescription Drugs (Formulary) English
Tier
Bronze 6850 Pro
Bronze 6850 Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1-100 employees
Dental Cleanings
Pediatric – 0% coinsurance after deductible
Adult – not covered
Pediatric – 0% coinsurance after deductible
Adult – 0% coinsurance after deductible
Vision Exams
Pediatric – 0% coinsurance after deductible
Adult – not covered
Pediatric – 0% coinsurance after deductible
Adult – 0% coinsurance after deductible
Telemedicine (Teladoc)
$0 copy after deductible
$0 copy after deductible
Costs & Benefits
Contact Us Tier
Bronze 6850 Pro
Bronze 6850 Pro Plus
Deductible (Individual)
$6,850
$6,850
Maximum Out-of-Pocket (Individual)
$6,850
$6,850
Deductible (Family)
$13,700
$13,700
Maximum Out-of-Pocket (Family)
$13,700
$13,700
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
0% coinsurance after deductible
0% coinsurance after deductible
Specialist Visit
0% coinsurance after deductible
0% coinsurance after deductible
Retail Health Clinic
0% coinsurance after deductible
0% coinsurance after deductible
Urgent Care
0% coinsurance after deductible
0% coinsurance after deductible
Emergency Room
0% coinsurance after deductible
0% coinsurance after deductible
Ambulance
0% coinsurance after deductible
0% coinsurance after deductible
Surgeon
0% coinsurance after deductible
0% coinsurance after deductible
Outpatient Facility
0% coinsurance after deductible
0% coinsurance after deductible
Inpatient Hospital Stay
0% coinsurance per admission after deductible
0% coinsurance per admission after deductible
Acupuncture
0% coinsurance after deductible
0% coinsurance after deductible
Prescriptions
Generic Drugs (Tier 1)
0% coinsurance after deductible
0% coinsurance after deductible
Brand Name Preferred (Tier 2)
0% coinsurance after deductible
0% coinsurance after deductible
Brand Name Non-Preferred (Tier 3)
0% coinsurance after deductible
0% coinsurance after deductible
Covered Prescription Drugs (Formulary) English
Tier
Bronze 6850 Pro
Bronze 6850 Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1-100 employees
Dental Cleanings
Pediatric – 0% coinsurance after deductible
Adult – not covered
Pediatric – 0% coinsurance after deductible
Adult – 0% coinsurance after deductible
Vision Exams
Pediatric – 0% coinsurance after deductible
Adult – not covered
Pediatric – 0% coinsurance after deductible
Adult – 0% coinsurance after deductible
Telemedicine (Teladoc)
$0 copy after deductible
$0 copy after deductible
Costs & Benefits
Contact Us Tier
Bronze 6850 Pro
Bronze 6850 Pro Plus
Deductible (Individual)
$6,850
$6,850
Maximum Out-of-Pocket (Individual)
$6,850
$6,850
Deductible (Family)
$13,700
$13,700
Maximum Out-of-Pocket (Family)
$13,700
$13,700
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
0% coinsurance after deductible
0% coinsurance after deductible
Specialist Visit
0% coinsurance after deductible
0% coinsurance after deductible
Retail Health Clinic
0% coinsurance after deductible
0% coinsurance after deductible
Urgent Care
0% coinsurance after deductible
0% coinsurance after deductible
Emergency Room
0% coinsurance after deductible
0% coinsurance after deductible
Ambulance
0% coinsurance after deductible
0% coinsurance after deductible
Surgeon
0% coinsurance after deductible
0% coinsurance after deductible
Outpatient Facility
0% coinsurance after deductible
0% coinsurance after deductible
Inpatient Hospital Stay
0% coinsurance per admission after deductible
0% coinsurance per admission after deductible
Acupuncture
0% coinsurance after deductible
0% coinsurance after deductible
Prescriptions
Generic Drugs (Tier 1)
0% coinsurance after deductible
0% coinsurance after deductible
Brand Name Preferred (Tier 2)
0% coinsurance after deductible
0% coinsurance after deductible
Brand Name Non-Preferred (Tier 3)
0% coinsurance after deductible
0% coinsurance after deductible
Covered Prescription Drugs (Formulary) English
Tier
Gold 1350 Pro
Gold 1350 Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $25 copay
Adult – not covered
Pediatric – $25 copay
Adult –$25 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Gold 1350 Pro
Gold 1350 Pro Plus
Deductible (Individual)
$1,350
$1,350
Maximum Out-of-Pocket (Individual)
$8,150
$8,150
Deductible (Family)
$2,700
$2,700
Maximum Out-of-Pocket (Family)
$16,300
$16,300
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$25 copay
$25 copay
Specialist Visit
$70 copay
$70 copay
Retail Health Clinic
$25 copay
$25 copay
Urgent Care
$60 copay
$60 copay
Emergency Room
$600 copay after deductible
$600 copay after deductible
Ambulance
$150 copay
$150 copay
Surgeon
20% coinsurance after deductible
20% coinsurance after deductible
Outpatient Facility
20% coinsurance after deductible
20% coinsurance after deductible
Inpatient Hospital Stay
20% coinsurance after deductible
20% coinsurance after deductible
Acupuncture
$70 copay
$70 copay
Prescriptions
Generic Drugs (Tier 1)
$20 copay
$20 copay
Brand Name Preferred (Tier 2)
$60 copay
$60 copay
Brand Name Non-Preferred (Tier 3)
$110 copay
$110 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$40 copay
$40 copay
Covered Prescription Drugs (Formulary) English
Tier
Gold 1350 Pro
Gold 1350 Pro Plus
Summary of Benefits and Coverage (PDF)
English
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1–100 employees
Dental Cleanings
Pediatric – $25 copay
Adult – not covered
Pediatric – $25 copay
Adult –$25 copay
Vision Exams
Pediatric – $10 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Gold 1350 Pro
Gold 1350 Pro Plus
Deductible (Individual)
$1,350
$1,350
Maximum Out-of-Pocket (Individual)
$8,150
$8,150
Deductible (Family)
$2,700
$2,700
Maximum Out-of-Pocket (Family)
$16,300
$16,300
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$25 copay
$25 copay
Specialist Visit
$70 copay
$70 copay
Retail Health Clinic
$25 copay
$25 copay
Urgent Care
$60 copay
$60 copay
Emergency Room
$600 copay after deductible
$600 copay after deductible
Ambulance
$150 copay
$150 copay
Surgeon
20% coinsurance after deductible
20% coinsurance after deductible
Outpatient Facility
20% coinsurance after deductible
20% coinsurance after deductible
Inpatient Hospital Stay
20% coinsurance after deductible
20% coinsurance after deductible
Acupuncture
$70 copay
$70 copay
Prescriptions
Generic Drugs (Tier 1)
$20 copay
$20 copay
Brand Name Preferred (Tier 2)
$60 copay
$60 copay
Brand Name Non-Preferred (Tier 3)
$110 copay
$110 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$40 copay
$40 copay
Covered Prescription Drugs (Formulary) English
Tier
Bronze 8225 Pro
Summary of Benefits and Coverage (PDF)
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1-100 employees
Dental Cleanings
Pediatric – 0% coinsurance after deductible
Adult – not covered
Vision Exams
Pediatric – 0% coinsurance after deductible
Adult – not covered
Telemedicine (Teladoc)
0% copay
Costs & Benefits
Contact Us Tier
Bronze 8225 Pro
Deductible (Individual)
$8,225
Maximum Out-of-Pocket (Individual)
$8,225
Deductible (Family)
$16,450
Maximum Out-of-Pocket (Family)
$16,450
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
0% coinsurance 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 per admission after deductible
Acupuncture
0% coinsurance after deductible
Prescriptions
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
Covered Prescription Drugs (Formulary) English
Tier
Bronze 8225 Pro
Summary of Benefits and Coverage (PDF)
English
Premium
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, Westchester, and Rockland counties
Other Eligibility Requirements
Small business with 1-100 employees
Dental Cleanings
Pediatric – 0% coinsurance after deductible
Adult – not covered
Vision Exams
Pediatric – 0% coinsurance after deductible
Adult – not covered
Telemedicine (Teladoc)
0% copay
Costs & Benefits
Contact Us Tier
Bronze 8225 Pro
Deductible (Individual)
$8,225
Maximum Out-of-Pocket (Individual)
$8,225
Deductible (Family)
$16,450
Maximum Out-of-Pocket (Family)
$16,450
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
0% coinsurance 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 per admission after deductible
Acupuncture
0% coinsurance after deductible
Prescriptions
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
Covered Prescription Drugs (Formulary) English

*Available with the Pro Plus Plan.

**Up to $200 per reward period. There are two reward cycles—January through June, and July through December.

The benefit information provided is a brief summary, not a complete description, of benefits. For more information, contact the plan.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Plans contain exclusions and limitations.

Additional Benefits

  • 24/7 Access to Telemedicine with Teladoc<sup>*</sup>

    24/7 Access to Telemedicine with Teladoc*

    Talk to a doctor anytime—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

    Active & Fit Direct

    Healthfirst makes working out affordable too! For just $25/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.

  • ExerciseRewards™ Program

    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.

Additional Benefits

  • 24/7 Access to Telemedicine with Teladoc*

    Additional plan dropdown arrow
  • Active & Fit Direct

    Additional plan dropdown arrow
  • ExerciseRewards™ Program

    Additional plan dropdown arrow

Frequently Asked
Questions

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Support When You Need It

We're happy to answer your questions.

Learn about enrollment

1-855-949-3668

Monday to Friday, 9am—5pm

Member Services

1-855-789-3668

Monday to Friday, 9am—5pm

TTY English: 1-855-779-1033

Can’t talk right now?

Request a callback and we’ll get back to 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.

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