Health Plan Forms and Documents | Healthfirst

Forms & Documents

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Medicare & Managed Long Term Care Plans

* = managed long-term care plan

Plan Documents

Member Resources
65 Plus Plan (HMO)
CompleteCare (HMO SNP)*
Coordinated Benefits Plan (HMO)
Increased Benefits Plan (HMO)
Life Improvement Plan (HMO SNP)
Signature (HMO)
Medicare Part D Resources
Medicare Advantage Plan Enrollment Resources
Privacy, Protected Health Information (PHI), and Non-Discrimination

General Forms, Documents, and Resources

Member Resources
65 Plus Plan (HMO)
CompleteCare (HMO SNP)*
Coordinated Benefits Plan (HMO)
Increased Benefits Plan (HMO)
Life Improvement Plan (HMO SNP)
Senior Health Partners*
Signature (HMO)
Medicare Part D Resources
Medicare Advantage Plan Enrollment Resources
Privacy, Protected Health Information (PHI), and Non-Discrimination

Medicare Advantage Members:

Premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

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

Healthfirst Health Plan, Inc. offers HMO plans that contract with the Federal Government. Healthfirst Medicare Plan has a contract with New York State Medicaid for Healthfirst CompleteCare (HMO SNP) and a Coordination of Benefits Agreement with the New York State Department of Health for the Healthfirst Life Improvement Plan (HMO SNP). Enrollment in Healthfirst Medicare Plan depends on contract renewal.

Healthfirst Medicare Plan, Inc. 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).

Last update April 8, 2021 @ 3:33 pm

Y0147_MKT21_46 1226-20_2021

Medicaid Plans

Plan Documents

Essential Plan 1
Medicaid Managed Care
Personal Wellness Plan
Child Health Plus
Member Resources
Privacy and Protected Health Information (PHI)
Essential Plan 2
Essential Plan 3
Essential Plan 4
Platinum
Gold
Silver
Bronze
Green

General Forms, Documents, and Resources

Essential Plan 1
Medicaid Managed Care
Personal Wellness Plan
Child Health Plus
Member Resources
Privacy and Protected Health Information (PHI)
Essential Plan 2
Essential Plan 3
Essential Plan 4
Platinum
Gold
Silver
Bronze
Green

Essential Plans

Plan Documents

Essential Plan 1
Medicaid Managed Care
Personal Wellness Plan
Child Health Plus
Member Resources
Privacy and Protected Health Information (PHI)
Essential Plan 2
Essential Plan 3
Essential Plan 4
Platinum
Gold
Silver
Bronze
Green

General Forms, Documents, and Resources

Essential Plan 1
Medicaid Managed Care
Personal Wellness Plan
Child Health Plus
Member Resources
Privacy and Protected Health Information (PHI)
Essential Plan 2
Essential Plan 3
Essential Plan 4
Platinum
Gold
Silver
Bronze
Green