Personal Wellness Plan

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The Healthfirst Personal Wellness Plan is for Medicaid Managed Care members who may benefit from extra behavioral health or substance abuse services. It offers all of the benefits in Medicaid, plus extra services like community support Education and Employment, Peer and Family Supports, and Managing Crises.

Did you receive a letter from New York State about joining HARP? If you have questions about the letter you received, or need additional information about this plan, please call 1-855-725-3344

Plan Highlights:

  • All your current Medicaid benefits
  • Individual and group counseling
  • Crisis intervention services
  • Substance use disorder services
  • Continuing day treatment
  • Personalized recovery services
  • Assertive community treatment services
  • Access to home- and community-based services
  • NEW - Institution for Mental Disease (IMD) In Lieu of Service (ILS)
  • 24/7 access to care with telemedicine (Teladoc)*
  • 2022
  • 2021
Personal Wellness Plan
Summary of Benefits and Coverage (PDF)
Comprehensive Formulary
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
Enrolled in a Medicaid Managed Care plan
Identified by New York State as eligible for a Health and Recovery Plan
Dental Cleanings
$0 copay
Vision Exams
$0 copay
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Contact Us Tier
Personal Wellness Plan
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)
$1 copay
Brand Name Non-Preferred (Tier 3)
$3 copay
Over-the-Counter (OTC) Nonprescription Drugs
$0.50 copay
Covered Prescription Drugs (Formulary) English
Personal Wellness Plan
Summary of Benefits and Coverage (PDF)
Comprehensive Formulary
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
Enrolled in a Medicaid Managed Care plan
Identified by New York State as eligible for a Health and Recovery Plan
Dental Cleanings
$0 copay
Vision Exams
$0 copay
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Contact Us Tier
Personal Wellness Plan
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)
$1 copay
Brand Name Non-Preferred (Tier 3)
$3 copay
Over-the-Counter (OTC) Nonprescription Drugs
$0.50 copay
Covered Prescription Drugs (Formulary) English

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

  • 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

    See Better with Healthfirst Vision Benefits

    Taking care of your eyes doesn’t just mean having clear vision. An annual eye exam can help detect a number of health risks, such as diabetes, thyroid disease, high blood pressure, and other conditions. Healthfirst has made it easy for our members to take advantage of this often overlooked preventive service by providing access to comprehensive vision care.

  • Additional benefit image

    Dental Care That Keeps You Smiling

    Healthfirst believes that providing you with good dental care is important to your overall healthcare. Covered services include regular and routine dental services such as preventive dental checkups, cleanings, X-rays, fillings, and other services to check for any changes or abnormalities that may require treatment and/or follow-up care for you. You do not need a referral from your PCP to see a dentist.

Additional Benefits

  • 24/7 Access to Telemedicine with Teladoc*

    Additional benefits dropdown arrow
  • See Better with Healthfirst Vision Benefits

    Additional benefits dropdown arrow
  • Dental Care That Keeps You Smiling

    Additional benefits dropdown arrow

Frequently Asked
Questions

See All
  • Who is eligible to enroll? FAQ dropdown arrow
  • Why should I choose Healthfirst? FAQ dropdown arrow
  • How can I enroll? FAQ dropdown arrow

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

1-855-659-5971

7 days a week, 24 hours a day

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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