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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


Summary of Benefits and Coverage


Subscriber Contracts


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



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

Claim Form

Prior Authorization form

Pharmacy Mail Order Form

Pharmacy Reimbursement Claim Form

Sample ID card


Benefits Assistance

Important Numbers and Contacts

Call, write, fax or follow the Web links to get answers:


Grievance and Appeals (GA), including expedition
Fax: 718.536.3358

Monday - Friday, 8:00 A.M. – 6:00 P.M. (ET)

Medical Services

Medical Emergency
Phone: 911


Beacon Health Options (Mental Health program)
Phone: 888.438.1914

Phone: 866.731.8004

Superior Vision
Phone: 866.810.3312

CVS Caremark Pharmacy
Phone: 855.722.6228

  • 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

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:


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.



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 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

Feedback Survey

Visit their Web site at 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 forumsvolunteer activities, and community organizations.



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 or contact them at 866.810.3312.



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, or contact them at:


CVS Caremark Pharmacy

Phone: 855.722.6228

877.775.5623 (Customer Care)

800.294.5979 (Authorization)

888.543.9069 (Appeals)



DentaQuest provides dental services to Members in the Essential Plan through their network of contracted providers. Visit their Web site at or contact them at 866.731.8004.



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