The Essential Plan

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Plans with access to essential health benefits like doctor visits, lab tests, prescription drugs, hospitalization, urgent care, emergency care, vision, dental, and more—all for a $0 monthly plan premium. These plans are for qualified individuals ages 19–64.

Plan Highlights:

  • No-cost annual checkups
  • Hospital, emergency room and urgent care visits
  • Lab tests and X-rays
  • Prescription drug coverage
  • Maternity and newborn coverage
  • No-cost dental and vision coverage*
  • 24/7 access to care with telemedicine (Teladoc)**
  • Physical, occupational, and speech therapy
  • Annual gym membership reimbursement
  • 2022
  • 2021
Tier
Essential Plan 1
Essential Plan 1 Plus Dental & Vision
Summary of Benefits and Coverage (PDF)
English
English
Premium
$0
Eligible Age
19 to 64
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester, Orange, Rockland, and Sullivan counties
Other Eligibility Requirements
Income between $19,320 and $25,760††
Dental Cleanings
$0 copay
$0 copay
Vision Exams
$0 copay
$0 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Essential Plan 1
Essential Plan 1 Plus Dental & Vision
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$2,000
$2,000
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$15 copay
$15 copay
Specialist Visit
$25 copay
$25 copay
Retail Health Clinic
$25 copay
$25 copay
Urgent Care
$25 copay
$25 copay
Emergency Room
$75 copay
$75 copay
Ambulance
$75 copay
$75 copay
Surgeon
$50 copay
$50 copay
Outpatient Facility
$50 copay
$50 copay
Inpatient Hospital Stay
$150 copay per admission
$150 copay per admission
Prescriptions
Generic Drugs (Tier 1)
$6 copay
$6 copay
Brand Name Preferred (Tier 2)
$15 copay
$15 copay
Brand Name Non-Preferred (Tier 3)
$30 copay
$30 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$15 copay
$15 copay
Covered Prescription Drugs (Formulary) English
Tier
Essential Plan 2
Essential Plan 2 Plus Dental & Vision
Summary of Benefits and Coverage (PDF)
English
English
Premium
$0
Eligible Age
19 to 64
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester, Orange, Rockland, and Sullivan counties
Other Eligibility Requirements
Income between $17,774 and $19,320††
Dental Cleanings
$0 copay
$0 copay
Vision Exams
$0 copay
$0 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Contact Us Tier
Essential Plan 2
Essential Plan 2 Plus Dental & Vision
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$200
$200
Your Annual Checkup (Preventive Care)
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
$0 copay
Specialist Visit
$0 copay
$0 copay
Retail Health Clinic
$0 copay
$0 copay
Urgent Care
$0 copay
$0 copay
Emergency Room
$0 copay
$0 copay
Ambulance
$0 copay
$0 copay
Surgeon
$0 copay
$0 copay
Outpatient Facility
$0 copay
$0 copay
Inpatient Hospital Stay
$0 copay per admission
$0 copay per admission
Prescriptions
Generic Drugs (Tier 1)
$1 copay
$1 copay
Brand Name Preferred (Tier 2)
$3 copay
$3 copay
Brand Name Non-Preferred (Tier 3)
$3 copay
$3 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$2.50 copay
$2.50 copay
Covered Prescription Drugs (Formulary) English
Tier
Essential Plan 3
Summary of Benefits and Coverage (PDF)
English
Premium
$0
Eligible Age
21 to 64
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester, Orange, Rockland, and Sullivan counties
Other Eligibility Requirements
Income between $12,880 and $17,774††
Requires legal U.S. residency for less than five years. Learn more about your legal status here.
Dental Cleanings
$0 copay
Vision Exams
$0 copay
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Contact Us Tier
Essential Plan 3
Deductible (Individual)
$0
Maximum Out-of-Pocket (Individual)
$200
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$0 copay
Retail Health Clinic
$0 copay
Urgent Care
$0 copay
Emergency Room
$0 copay
Ambulance
$0 copay
Surgeon
$0 copay
Outpatient Facility
$0 copay
Inpatient Hospital Stay
$0 copay per admission
Prescriptions
Generic Drugs (Tier 1)
$1 copay
Brand Name Preferred (Tier 2)
$3 copay
Brand Name Non-Preferred (Tier 3)
$3 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$2.50 copay
Covered Prescription Drugs (Formulary) English
Tier
Essential Plan 4
Summary of Benefits and Coverage (PDF)
English
Premium
$0
Eligible Age
21 to 64
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester, Orange, Rockland, and Sullivan counties
Other Eligibility Requirements
Income less than $12,880††
Requires legal U.S. residency for less than five years. Learn more about your legal status here.
Dental Cleanings
$0 copay
Vision Exams
$0 copay
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Contact Us Tier
Essential Plan 4
Deductible (Individual)
$0
Maximum Out-of-Pocket (Individual)
$0
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$0 copay
Retail Health Clinic
$0 copay
Urgent Care
$0 copay
Emergency Room
$0 copay
Ambulance
$0 copay
Surgeon
$0 copay
Outpatient Facility
$0 copay
Inpatient Hospital Stay
$0 copay per admission
Prescriptions
Generic Drugs (Tier 1)
$0 copay
Brand Name Preferred (Tier 2)
$0 copay
Brand Name Non-Preferred (Tier 3)
$0 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$0 copay
Covered Prescription Drugs (Formulary) English
Tier
Essential Plan 1
Summary of Benefits and Coverage (PDF)
English
Premium
$0
Eligible Age
19 to 64
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester, Orange, Rockland, and Sullivan counties
Other Eligibility Requirements
Income between $19,320 and $25,760††
Dental Cleanings
$0 copay
Vision Exams
$0 copay
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Contact Us Tier
Essential Plan 1
Deductible (Individual)
$0
Maximum Out-of-Pocket (Individual)
$2,000
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
$15 copay
Specialist Visit
$25 copay
Retail Health Clinic
$25 copay
Urgent Care
$25 copay
Emergency Room
$75 copay
Ambulance
$75 copay
Surgeon
$50 copay
Outpatient Facility
$50 copay
Inpatient Hospital Stay
$150 copay per admission
Prescriptions
Generic Drugs (Tier 1)
$6 copay
Brand Name Preferred (Tier 2)
$15 copay
Brand Name Non-Preferred (Tier 3)
$30 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$15 copay
Covered Prescription Drugs (Formulary) English
Tier
Essential Plan 2
Summary of Benefits and Coverage (PDF)
English
Premium
$0
Eligible Age
19 to 64
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester, Orange, Rockland, and Sullivan counties
Other Eligibility Requirements
Income between $17,775 and $19,320††
Dental Cleanings
$0 copay
Vision Exams
$0 copay
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Contact Us Tier
Essential Plan 2
Deductible (Individual)
$0
Maximum Out-of-Pocket (Individual)
$200
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$0 copay
Retail Health Clinic
$0 copay
Urgent Care
$0 copay
Emergency Room
$0 copay
Ambulance
$0 copay
Surgeon
$0 copay
Outpatient Facility
$0 copay
Inpatient Hospital Stay
$0 copay per admission
Prescriptions
Generic Drugs (Tier 1)
$1 copay
Brand Name Preferred (Tier 2)
$3 copay
Brand Name Non-Preferred (Tier 3)
$3 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$2.50 copay
Covered Prescription Drugs (Formulary) English
Tier
Essential Plan 3
Summary of Benefits and Coverage (PDF)
English
Premium
$0
Eligible Age
21 to 64
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester, Orange, Rockland, and Sullivan counties
Other Eligibility Requirements
Income between $12,880 and $17,775††
Requires legal U.S. residency for less than five years. Learn more about your legal status here.
Dental Cleanings
$0 copay
Vision Exams
$0 copay
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Contact Us Tier
Essential Plan 3
Deductible (Individual)
$0
Maximum Out-of-Pocket (Individual)
$200
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$0 copay
Retail Health Clinic
$0 copay
Urgent Care
$0 copay
Emergency Room
$0 copay
Ambulance
$0 copay
Surgeon
$0 copay
Outpatient Facility
$0 copay
Inpatient Hospital Stay
$0 copay per admission
Prescriptions
Generic Drugs (Tier 1)
$1 copay
Brand Name Preferred (Tier 2)
$3 copay
Brand Name Non-Preferred (Tier 3)
$3 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$2.50 copay
Covered Prescription Drugs (Formulary) English
Tier
Essential Plan 4
Summary of Benefits and Coverage (PDF)
English
Premium
$0
Eligible Age
21 to 64
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester, Orange, Rockland, and Sullivan counties
Other Eligibility Requirements
Income less than $12,880††
Requires legal U.S. residency for less than five years. Learn more about your legal status here.
Dental Cleanings
$0 copay
Vision Exams
$0 copay
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Contact Us Tier
Essential Plan 4
Deductible (Individual)
$0
Maximum Out-of-Pocket (Individual)
$0
Your Annual Checkup (Preventive Care)
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Specialist Visit
$0 copay
Retail Health Clinic
$0 copay
Urgent Care
$0 copay
Emergency Room
$0 copay
Ambulance
$0 copay
Surgeon
$0 copay
Outpatient Facility
$0 copay
Inpatient Hospital Stay
$0 copay per admission
Prescriptions
Generic Drugs (Tier 1)
$0 copay
Brand Name Preferred (Tier 2)
$0 copay
Brand Name Non-Preferred (Tier 3)
$0 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$0 copay
Covered Prescription Drugs (Formulary) English

Note: Due to changes in New York State regulation, as of June 1, 2021:
• Essential Plan 1 and Essential Plan 1 Plus Dental & Vision cost-sharing and benefits are the same.
• Essential Plan 2 and Essential Plan 2 Plus Dental & Vision cost-sharing and benefits are the same.

*Dental services must be medically necessary to be covered; limitations apply.

**Telemedicine 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).

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

††Based on 2020 earnings. The income ranges shown are for individuals only. The income ranges may increase based on the eligible members in your household. To learn more, talk to a Healthfirst representative.

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 PHSP, Inc. Plans contain exclusions and limitations.

Additional Benefits

  • Additional benefit image

    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.

  • Additional benefit image

    Active & Fit Direct

    Working out just got cheaper. For just $25/month plus a one-time enrollment fee of $25, you can get a standard membership to a fitness center in your area. Track your activity, monitor your progress, achieve your fitness goals, and so much more. (Note: a three-month membership commitment is required up front.)

    Call Active&Fit Direct at 1-877-810-2746, Monday to Friday, 8am—9pm, to learn more and find out how you can join.

  • Additional benefit image

    Rewards for Working Out

    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. Your covered spouse or domestic partner can also get rewarded $100 every six months for going to the gym 50 days or more.  Visit ActiveandFit.com or talk to an Active&Fit ExerciseRewards representative at 1-877-810-2746, Monday to Friday, 8am—9pm.

Additional Benefits

  • 24/7 Access to Telemedicine with Teladoc*

    Additional benefits dropdown arrow
  • Active & Fit Direct

    Additional benefits dropdown arrow
  • Rewards for Working Out

    Additional benefits dropdown arrow

Frequently Asked
Questions

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Support When You Need It

We're happy to answer your questions.

Learn about enrollment

1-844-488-1486

Monday to Friday, 9am–8pm

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

Member Services

1-888-250-2220

Monday to Friday, 8am—8pm

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

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.

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

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