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A health plan for New Yorkers who don’t qualify for Medicaid. The Essential Plan offers the same essential health benefits you get with other health plans but with no monthly premiums.
Who can buy it?
Lower-income individuals who don’t qualify for Medicaid or Child Health Plus.
Household size | Most you can make |
---|---|
1 | $25,760 |
2 | $34,840 |
3 | $43,920 |
4 | $53,000 |
How much does it cost?
There are no monthly premiums with the Essential Plan. And now, dental and vision benefits are included at no additional cost.
How else does it save me money?
The Essential Plan has no deductible, so it starts paying for your health care right away.
What does the Essential Plan cover?
The same services covered by other plans:
- Doctor visits, including specialists
- Tests ordered by your doctor
- Prescription drugs
- Inpatient and outpatient care at a hospital
How do I enroll?
Call us directly at 866-247-5678, and we will help you apply. Or, you can enroll by visiting the NY State of Health Marketplace.
When can I enroll?
ANYTIME! That's right—you don't have to wait until Open Enrollment to sign up. You can find out if you qualify today.
Plan Resources
With a year long rolling enrollment period, you don't have to wait. You can sign up for an Essential Plan at any time of the year.
Member Handbooks
Click below for information on how your Essential Plan works. Find out how to get care when you need it, what services are covered, or who to talk to when you have a question, so you can get the most out of your coverage.
Important Notice
Schedule of Benefits
- Essential Plan 1: English | Spanish | Chinese
- Essential Plan 1 with Dental and Vision: English | Spanish | Chinese
- Essential Plan 1 AI/AN: English | Spanish | Chinese
- Essential Plan 1 AI/AN with Dental and Vision: English | Spanish | Chinese
- Essential Plan 2: English | Spanish | Chinese
- Essential Plan 2 with Dental and Vision: English | Spanish | Chinese
- Essential Plan 2 AI/AN: English | Spanish | Chinese
- Essential Plan 2 AI/AN with Dental and Vision: English | Spanish | Chinese
- Essential Plan 3: English | Spanish | Chinese
- Essential Plan 4: English | Spanish | Chinese
Summary of Benefits and Coverage
- Essential Plan 1 with Dental and Vision: English | Spanish | Chinese
- Essential Plan 1 AI/AN with Dental and Vision: English | Spanish | Chinese
- Essential Plan 2 with Dental and Vision: English | Spanish | Chinese
- Essential Plan 2 AI/AN with Dental and Vision: English | Spanish | Chinese
- Essential Plan 3: English | Spanish | Chinese
- Essential Plan 4: English | Spanish | Chinese
Subscriber Contracts
- Essential Plan 1: English | Spanish | Chinese
- Essential Plan 1 with Dental and Vision: English | Spanish | Chinese
- Essential Plan 2: English | Spanish | Chinese
- Essential Plan 2 with Dental and Vision: English | Spanish | Chinese
- Essential Plan 3: English | Spanish | Chinese
- Essential Plan 4: English | Spanish | Chinese
Plan Assistance
Research or Buy a Plan
Phone: 866.731.8001
TTY: 711
Monday - Friday, 8:30 AM - 6:00 PM (ET)
Visit the New York State of Health website and select Affinity Health Plan
Customer Service
Have a question about how your plan works? Don’t see what you’re looking for? We’re here to help!
Call Us (Monday - Friday, 8:30 AM - 6:00 PM ET):
- Phone: 866.247.5678
- TTY: 711
Visit a Community Service Center (CSC)
Online Access
Set up and manage your personal account options, including:
- View/pay your monthly bill
- Schedule automatic payments
- Select/change your PCP
- Print a temporary ID card
- Review your benefits
Log in or create an account
Payment Options
Claims
Phone: 866.247.5678
Monday - Friday, 8:30 AM – 6:00 PM (ET)
By Mail:
Affinity Health Plan
Metro Center Atrium
1776 Eastchester Road
Bronx, NY 10461
Documents and Forms
Find more information about your plan.
Patient Health Information Release Notification: English | Spanish | Chinese
Surprise Bill - Assignment of Benefits
Pharmacy Reimbursement Claim Form
Benefits Assistance
Important Numbers and Contacts
Call, write, fax or follow the Web links to get answers:
Operations
Grievance and Appeals (GA), including expedition
Phone:
Fax: 718.536.3358
Pre-authorization
Phone: 888.543.9074
Monday - Friday, 8:00 A.M. – 6:00 P.M. (ET)
Medical Services
Medical Emergency
Phone: 911
Hospitalizations
Phone: 888.543.9074
Beacon Health Options (Mental Health program)
Phone: 888.438.1914
www.beaconhealthoptions.com
Dental
Phone: 866.731.8004
dentaquest.com
Superior Vision
Phone: 866.810.3312
superiorvision.com
CVS Caremark Pharmacy
Phone: 855.722.6228
caremark.com
- Authorization: 800.294.5979
- Appeals: 888.543.9069
Laboratory Services
BioReference Laboratories
Phone: 800.229.5227
- GeneDX: 888.729.1206
- GenPath Women’s Health: 800.633.4522
- GenPath Oncology: 800.627.1479
Empire City Laboratories, Inc.
Phone: 718.788.3840
LabCorp
Phone: 888.522.2677
- Integrated Oncology: 800.710.1800
- Dianon Systems, Inc.: 800.328.2666
- Integrated Genetics: 800.848.4436
- Litholink Corporation: 800.338.4333
- MedTox Laboratories, Inc.: 800.832.3244
- Monogram Biosciences, Inc.: 800.777.0177
Lenco Diagnostic Lab
Phone: 855.870.0097
Spectra (including Shiel Medical Lab)
Phone: 800.553.0873
Sunrise Medical Laboratories
Phone: 800.782.0282
Xeron Clinical Laboratories
Phone: 718.762.3310
Quest Diagnostics, Inc.
Phone: 866.697.8378
Additional Resources
Interested in learning more about the Health Care Reform Law? Check out these additional resources:
- New York State of Health, The Official Health Plan Marketplace
- Healthcare.gov
- CuidadoDeSalud.gov
- Get Covered Calculator (estimated monthly health insurance cost)
- Kaiser Family Foundation
Fitness Rewards Program
We know that staying with an exercise routine isn’t always easy. To encourage you to get fit and stay healthy, Affinity Health Plan provides partial reimbursement to subscribers for exercise facility fees or membership fees. It’s simple! Learn more about Affinity Health Plan Fitness Rewards.
Programs
Behavioral Health and Substance Abuse Services
Beacon Health Strategies provides behavioral health and substance abuse services. Beacon’s network specialists develop and deliver services for our Members. Visit beaconhealthstrategies.com for a listing of providers, to research community resources or to access the Beacon Healthwise Knowledge Base.
- Member Contact Information
24 Hour Clinical Access: 800.974.6831
Main Number: 781.994.7500
Fax Number: 781.994.7600
TTY Number [For Hearing Impaired]: 781.994.7660
Visit their Web site at www.beaconhealthstrategies.com or contact them at 888.438.1914. To view your claims, visit MyBeacon portal. Additionally, there are resources available to access information regarding Transition Age Youth (TAY) and members with First Episode Psychosis (FEP), community forums, volunteer activities, and community organizations.
Vision
Superior Vision is a national vision benefits manager. Superior Vision’s network of optometrists provides routine vision care for all Affinity Members. Visit their Web site at www.superiorvision.com or contact them at 866.810.3312.
Pharmacy
CVS Caremark is Affinity's pharmacy benefits manager for Medicaid. Members in these programs can get prescription drugs not only at CVS pharmacies, but all the other chain and independent pharmacies that participate in their network. Visit their Web site at www.caremark.com, or contact them at:
CVS Caremark Pharmacy
Phone: 855.722.6228
877.775.5623 (Customer Care)
800.294.5979 (Authorization)
888.543.9069 (Appeals)
Dental
DentaQuest provides dental services to Members in the Essential Plan through their network of contracted providers. Visit their Web site at www.dentaquest.com or contact them at 866.731.8004.
Chiropractic
Chiropractic services are not covered by Medicaid.
Transportation Services
Non-emergency transportation services which includes personal vehicle, bus, taxi, ambulete, and public transportation to medical appointments are now administered through New York State. You or your provider must call the vendor listed below to arrange transportation:
- NYC (Bronx, Brooklyn, Manhattan, Queens, Staten Island): Logisticare - 877.564.5922
- Long Island (Nassau and Suffolk): Logisticare - 844.678.1103
- All other counties: Medical Answering Services - 800.850.5340
You can access this information online.
If possible, you or your provider should call the vendor at least three days before your medical appointment and provide your appointment date and time, its address, and the doctor you are seeing.
Treatment Cost Calculator
This Treatment Cost Calculator will help you better understand the potential costs of obtaining health care services when you need treatment. English | Español