Metroplus gold coverage. … Offered by MetroPlus Health Plan MetroPlus.

Metroplus gold coverage New York, NY 10004] This Certificate of Coverage (“Certificate”); explains the benefits available to You under a Group Contract between GOLD CERTIFICATE OF COVERAGE Metro Plus Health . MetroPlus Health Plan has a contract with New York State Medicaid for MetroPlusHealth UltraCare (HMO-DSNP) and a Coordination of Benefits Welcome to MetroPlus Gold! This Guide describes the comprehensive benefi ts you receive as a MetroPlus Gold member. To search our provider network for our Marketplace Participating dental providers for all our health plans, excluding MetroPlusHealth Gold and GoldCare. Please take the time to read them both carefully. 9626 (TTY 711) 1. NOTE: Information about the cost of this plan (called the As a MetroPlusHealth Gold member, we want to help you stay healthy. WHO QUALIFIES FOR METROPLUS GOLD. If there is a discrepancy between this guidelines and a member’s benefits program, MetroPlus Essential Plan 1; MetroPlus Essential Plan 2; MetroPlus Essential Plan 3; MetroPlus Essential Plan 4; Essential Plan 200-250; MedPlus, BronzePlus, SilverPlus, GoldPlus, PlatinumPlus; MetroPlus Medicare Advantage Plan; MetroPlus Medicare Platinum Plan; MetroPlus Gold; MetroPlus Gold Care; MetroPlus Health Ultracare (MAP); Approval Date: 3/30/18 LOB: Medicaid, HIV SNP, MetroPlus Gold, Goldcare I&II, Essential, HARP Effective Date: 3/30/18 Policy Number: UM-MP228 Review Date: 6/27/2024 Cross Reference Number: Retired Date: Page 2 of 10 . Find A Specialist Find A METROPLUS HEALTH GOLD The MetroPlusHealth Gold Plan is available to all employees of the City of New York, non-Medicare eligible retirees, their spouses or qualified domestic partners, and eligible dependents. 32 Details for the MetroPlusHealth Gold Plan (Optional Rider) are listed below: Please refer to the Certificate of Coverage for additional details that apply to this optional prescription rider. For individuals receiving mastectomy- related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the MetroPlusHealth has updated the MetroPlus Platinum Plan (HMO) Summary of Benefits, Evidence of Coverage, and Annual Notice of Changes for 2024 with 2024 Medicare Part A coinsurance amounts. NOTE: Information about the cost of this plan (called the premium) will be provided Please note MetroPlusHealth members never pay a fee to renew Medicaid, Child Health Plus, or Essential Plan coverage. Essential Plan Fitness Reimbursement: $200 every 6 months for members Marketplace Plans Fitness Reimbursement: $200 every 6 months for members and $100 GOLD PLAN CERTIFICATE OF COVERAGE. All verified permanent and non-administrative employees who work in an Administration for Children’s Services/Agency for Child Development (ACS/ACD) funded Day Care and/or Family Day Care Centers Online: metroplus. NOTE: Information about the cost of this plan (called the premium) will be provided Please (For MetroPlus Gold, this is only covered with a prescription rider. or • MetroPlus Gold Standard Rx plan (For Group 11 & unions who do not provide Prescription Coverage) or • Buy-out Waiver . New York, NY 10004] This Certificate of Coverage (“Certificate”); explains the benefits available to You under a Group Contract between Renew My Coverage; For Providers; For Brokers; 866. or • Waive. HEALTH MAINTENANCE ORGANIZATION . org By Phone: 1. ; If you’re pregnant, make From reading other folks posts, it seems that Metro Plus Gold is the absolute cheapest, but limits you bc it's an HMO, and seems not to have any mental/behavioral health component at all (right?). RESPONSIBLE PARTIES: HIV SNP, CHP, MetroPlus Gold, Gold Care I&II, Market Plus, Essential, HARP Effective Date: 8/14/17 Policy Number: UM -MP214 Review Date: 07/22/2024 Cross Reference Number: Retired Date: Page 5 of 12 . If you need a referral, remind your doctor what insurance coverage you have, and ask him or her to refer you to a specialist in that plan. 855. Individual + Should MetroPlus request additional information in order to adjudicate the claims, please submit the requested information within 30 days from the requested date. 3795 or TTY 711. GOLD PLAN CERTIFICATE OF COVERAGE (BASIC PLAN) 1 MBR 24. See the “Adult Health” section for more care that’s recommended for all adults. Port Richmond 238A Port Richmond Avenue Staten Island, NY 10302 Monday – Friday | 9 AM – 5PM Saturday | 9 AM – 1 PM. If you need assistance because you are hearing impaired and / or speech impaired, please Please be sure to tell us which Certificate of Coverage – for example, GoldPlus G1 – you need. Vanderbilt Staten Island Hospital 165 Vanderbilt Avenue Staten Island, NY 10304 Monday – 8:30am -4:30pm Tuesday – 8:30am – 7:00pm Renew My Coverage; For Providers; For Brokers; 866. * Tagalog; Tiếng Việt; Skip Navigation Find a Doctor; Renew My Coverage; For Providers; For Brokers; 866. Learn how to protect yourself from health insurance scammers. PROCEDURE: MRgFUS unilateral thalamotomy is considered medically reasonable and necessary in METROPLUS ADVANTAGE PLAN (HMO D-SNP) METROPLUS PLATINUM PLAN (HMO) METROPLUS ULTRACARE (HMO D-SNP) 20242024 MEDICARE FORMULARY LIST OF COVERED DRUGS PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS your Evidence of Coverage. (EP), Gold & GoldCare members will now have access to coverage for Human Donor Milk in Outpatient Settings. Rights and Responsibilities Upon Disenrollment MetroPlusHealth kicked off open enrollment for its Gold Health plan with a “Champion Gold Room Celebration” at its headquarters at 50 Water Street in Lower Manhattan on Nov. Members and their dependents get: Lab tests and X-rays. NOTE: Information about the cost of this plan (called the premium) will be provided Please note Coverage also includes examinations for diagnosis and treatment for visual defects and/or eye disease. MetroPlusHealth [50 Water Street . Find a Home Choosing Your Health Plan Your Costs Choosing Your Healthcare Provider Dental Coverage Understanding Your Bill Your Rights Surprise Billing Resources Costs Locate Providers Insurance Appeals and Assistance Quality of Care, Literacy and Reform Wellness Dental/ Oral Health Disability and Condition-Specific Palliative Care By State Beginning on October 1, 2019, members of the MetroPlus Medicaid Plan will have expanded coverage for infertility drugs. We offer our members many extras to help make getting health care easier and more convenient, including online appointment MetroPlus Gold: MetroPlus Health Plan Coverage Period: 7/1/2021-6/30/2022 Coverage for: Individual + Family | Plan Type: HMO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. MetroPlusHealth has updated the MetroPlus Platinum Plan (HMO) Summary of Benefits, Evidence of Coverage, and Annual Notice of Changes for 2022 with 2022 Medicare Part A coinsurance amounts. MetroPlusHealth GoldCare I; MetroPlusHealth GoldCare II; MetroPlusHealth members never pay a fee to renew Medicaid, Child Health Plus, or Essential Plan coverage. MetroPlus Gold, Goldcare I&II, Market Plus, Essential, HARP Effective Date: 12/17/2021 Policy Number: UM-MP326 Review Date: 1/31/2023 Cross Reference Number: Retired Date: Page 1 of 6 . The SBC shows you how you and the plan (called the premium) will be provided separately. With MetroPlusHealth Gold, you get $0 premiums, deductibles, copays, unlimited telehealth visits, unlimited mental health care, and more. GHI is the norm, and seems to work fine, but still not great for mental/behavioral health, is that right? I'm torn between these two and the DC37 health plan (which seems like it is pretty Browse our extensive directory of the best MetroPlus Health Plan Therapists, MetroPlus Health Plan Psychologists and MetroPlus Health Plan Counselors near you. B. Aetna EPO Basic Plan. Learn how to protect yourself from health But, you may be eligible for COBRA continuation coverage, which allows you to stay in the plan for a time by paying the full cost of coverage yourself. This benefit can be combined with your Medicaid benefits to provide coverage for additional eyewear, or to purchase eyewear beyond the Medicaid spending limit. waived family coverage is $1,000 and waived individual coverage is $500. Read more . 6636 Explore Plans. For Members. 2 Not to worry— There will be no changes to coverage, benefits, and services providing you take appropriate steps to MetroPlus Health Plan Retention Department- Medicaid: 1-212-908-3300: MetroPlus Health Plan GoldPlus (G3): MetroPlus Health Plan Coverage for: Child Only | Plan Type: HMO. 496. Make the switch today. Additionally, MetroPlus Managed Medicaid, Partnership in Care (PIC), and Enhanced (two) test kits per week are covered at no cost from any in-network pharmacy without a prescription. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Special health education and care programs, and lots To take advantage of all the benefits this plan offers, you need to see providers in the MetroPlus network. Find a Plan . GoldPlus (G1): MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO. If there is a discrepancy between this . 5777 or contact us at Renew My Coverage; For Providers; For Brokers; 866. GoldCare Health News is for MetroPlusHealth GoldCare members. In addition, coverage may be mandated by MetroPlus Health Plan today announced the start of the annual fall open enrollment period for its MetroPlus Gold health plan – available exclusively to MetroPlusHealth members never pay a fee to renew Medicaid, Child Health Plus, or Essential Plan coverage. 219 This is Your . MetroPlusHealth has offered low-cost, quality health care for New Yorkers for more than 35 years. Beginning on October 1, 2019, members of the MetroPlus Medicaid Plan will have expanded coverage for infertility drugs. is a wholly-owned subsidiary of NYC Health + Hospitals MetroPlus. NYC HEALTH + HOSPITALS FACILITIES. You can also choose from more than 34,000 top providers and sites. The plan will help you pay for your healthcare. e. deductible, I chose metro plus gold because all of the doctors I see are in the H+H system and there are no copays for most things. 4. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. If there is a discrepancy between this guidelines and a member’s benefits program, the benefits program will govern. Find A Specialist Find A As a MetroPlus Gold member, we want to help you stay healthy. Get all the details, and give it a try above. New Drug Discount Program: Over 100 medications available at NO COST to ALL MPH Gold Plan MetroPlus Gold: MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO MBR 19. GoldPlus (G3): MetroPlus Health Plan Coverage for: Child Only | Plan Type: HMO. This Guide is an important supplement to the MetroPlus Gold Certifi cate of Coverage. For Enrollment in MetroPlus Health Plan, Inc. Locations for finding a MetroPlus Health Plan Facilitated Enroller (FE) can be found here (PDF). Find a Pharmacy MetroPlus Gold: MetroPlus Health Plan Coverage Period: 10/1/2023-9/30/2024 Coverage for: Individual + Family | Plan Type: HMO Important Questions Answers Why This Matters: What is the overall deductible? $0 See the Common Medical Events chart below for your costs for services this plan covers. MetroPlus Gold: MetroPlus Health Plan Coverage Period: 10/1/2023-9/30/2024 Coverage for: Individual + Family | Plan Type: HMO Important Questions Answers Why This Matters: What is the overall deductible? $0 See the Common Medical Events chart below for your costs for services this plan covers. ; If you are insured, take advantage of free preventive services, especially those for women. Spouse or domestic partner. MetroPlusHealth Gold & GoldCare I and GoldCare II . CERTIFICATE OF COVERAGE . If You need foreign language assistance to understand this Certificate, You andor paid for by MetroPlus Health Plan, as some programs exclude coverage for services or supplies that MetroPlus Health Plan considers medically necessary. If you have trouble finding your drug in the list, turn to the Index that begins on Eligibility. For Market Place and Gold/GoldCare Plan members, 2 (two) tests or 1 (one) test kit per week is covered at no cost from any in-network pharmacy without a prescription. 221 This is Your . For individuals receiving mastectomy- related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the Beginning January 1st, 2025, MetroPlusHealth’s Qualified Health Plan (QHP), Essential Plan (EP), Gold & GoldCare (applicable only to members with Pharmacy Rider) members will have coverage for prenatal vitamins in the same way other similar supplements are covered. 6636 MPH GOLD Portal •Special Leave of Absence Coverage (SLOAC) •Other Types of Leave •Retirement Savings Plans (NYCERS, VDC, TDA 403B, 457, NYCE IRA) •Additional Savings Plan •Transit Benefit •Direct Deposit • MetroPlus Gold Basic . Gold First, find the type of MetroPlusHealth coverage plan you have, then the borough you live in (or need a provider in). For individuals receiving mastectomy - If you would like more information on WHCRA benefits, call MetroPlus at 1877- -475-3795 (TTY: 711) for more MPH GOLD Portal (Benefit Administrators) Search for: Popular Content . This Certificate of Coverage (“Certificate”) explains the benefits available to You under a Group Contract between MetroPlus Health Plan (hereinafter referred to as “We”, “Us” or MetroPlus Health Plan President & Chief Executive Officer . NOTE: Information about the cost of MetroPlusHealth members never pay a fee to renew Medicaid, Child Health Plus, or Essential Plan coverage. Individual + Family Plans Renew My Coverage; For Providers; For Brokers; 866. org. (See In-Network and Out-of-Network Care. 303. is an HMO, HMO D-SNP plan with a Medicare contract. Find A Doctor Find A Doctor . For Metroplus gold is free also and you don’t need referrals and most visits are $0 co pay Reply PracticeSalt1539 Health Coverage. Don’t assume that your PCP knows the details of your plan. NOTE: Information about the cost of this plan (called the CHP, MetroPlus Gold, Goldcare I&II, Market Plus, Essential, HARP Effective Date: 7/20/17 Policy Number: UM-MP202 Review Date: 9/1/21 Cross Reference Number: Retired Date: Page 1 of 12 1. Simply call MetroPlus Gold Member Services at 877. 17 Complete an enrollment form, select MetroPlus Gold and submit the form to Human Resources For current members, contact MetroPlus Gold MetroPlusHealth members never pay a fee to renew Medicaid, Child Health Plus, or Essential Plan coverage. Examinations for refraction are limited to every two (2) years unless otherwise justified as medically necessary. Better yet, check out our online search tool. 6636 866. Buy Your Own If you aren’t covered through your job or a family member’s job, you can buy coverage directly from an insurance company, or through special marketplaces set up through the Affordable Care Act. Individual + Family Plans; NYC Employee Plans; Medicare and Dual-Eligible Plans; Special Needs and Long Term Care; Explore Plans MetroPlusHealth has offered low-cost, quality health care for New Yorkers for more than 35 years. You can get covered services from any provider within this network. *Find A Dentist: Participating dental providers for all our health plans, excluding MetroPlusHealth Gold and GoldCare. Any interventional treatment that uses equipment or MetroPlus Gold: MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO MBR 19. Learn Coverage Period: 1/1/2025-12/31/2025 . 24/7 telehealth, prescription drug coverage, and prepackaged medications. This service is provided by NYC Health + Hospitals / ExpressCare and is available as part of your MetroPlusHealth GOLD CERTIFICATE OF COVERAGE Metro Plus Health . You can access the New York State of Health website at nystateofhealth. Find a plan that's right for Approval Date: LOB: MetroPlus Gold, Goldcare I&II, MarketPlace, SHOP, Essential Effective Date: 1/1/2020 Policy Number: UM-MP271 Review Date: 6/27/2022 Cross Reference Number: Retired Date: Page 5 of 21 at least 6 months. We will also cover services If you have any questions about this benefit, or a member’s eligibility, please contact MetroPlus by calling 1 MetroPlus Gold: MetroPlus Health Plan Coverage Period: 10/1/2023-9/30/2024 Coverage for: Individual + Family | Plan Type: HMO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO. has over 17,000 MetroPlus Gold members and more than half a million members across our nearly 90 product lines. stica. You can use it to pay for care before meeting your deductible, and for copays and coinsurance afterward. MetroPlus Gold . 50 Water Street, 7th Floor New York, NY 10004. Please review the updated documents for more information. 9626 (TTY: 711) In Person: Visit one of our Community Offices (go to metroplus. exclude coverage for services or supplies that MetroPlus Health Plan considers medically necessary. Individual + Family Plans; NYC Employee Plans; Medicare and Dual-Eligible Plans; Special Needs and Long Term Care; Title: Clinical Trial Coverage of Routine Care Division: Medical Management Department: Utilization Management Approval Date: 11/29/2022 LOB: Medicaid, HIV SNP, CHP, MetroPlus Gold, Goldcare I&II, Market Plus, Essential, HARP Effective Date: 11/29/2022 Policy Number: UM-MP343 Review Date: 10/31/2023 Cross Reference Number: Retired Date: Page 1 of 6 1. Eligible dependents. The Summary of Benefits and Coverage (SBC) document will help you choose a health . 355. Find A Specialist Find A Specialist . Learn how to protect yourself from health insurance CERTIFICATE OF COVERAGE . MetroPlus Health Plan has a contract with New York State Medicaid for MetroPlusHealth UltraCare (HMO-DSNP) and a Coordination of Benefits Agreement with the New York State Department of Health for the MetroPlus Advantage Plan (HMO-DNSP). In an HMO, you get all of your care from doctors, hospitals and other providers in your plan’s network. ) When you join, you choose a primary care physician (PCP) who Summary of Benefits and Coverage (SBC) Listed below are pdfs of summaries for each non-Medicare Health Plan offered by the New York City Health Benefits Program to its employees and non-Medicare retirees. We offer our members many extras to help make getting health care easier and more convenient, including online GoldPlus (G1): MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO. MetroPlusHealth will kick off its Gold Plan enrollment with a “Champion Gold Room Celebration” on November 2, 2023, from 10:00 AM to 2:00 PM, at 50 Water Street. GOLD CERTIFICATE OF COVERAGE Metro Plus Health . Over 34,000 doctors and specialists, 40 hospitals Ready to enroll in a 2025 MetroPlus Advantage Plan (HMO D-SNP)? Call us at 833-965-1526 (TTY:711) now. Find a Additional perks include up to $1,000 for fitness activities and reimbursements towards weight loss. For a full list of exclusions, please review your Certificate of Coverage. Find a Doctor; Renew My Coverage Participating dental providers for all our health plans, excluding MetroPlusHealth Coverage Period: 1/1/2025-12/31/2025 . If you have had or are going to have a mastectomy, you may be entitled to certainbenefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). Bi-Weekly Rate Individual Coverage: $65. plan. You can add on a low-cost prescription drug benefit to the basic Gold plan to cover drugs for you and your family. excluding MetroPlusHealth Gold and GoldCare. Employees who enroll remain in the Buy-out MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO. * MetroPlusHealth members never pay a fee to renew Medicaid, Child Health Plus, or Essential Plan coverage. How do I obtain the reimbursement? A 6-month claim period must be completed EMAIL: mph_reimbursements@metroplus. Flexible spending plans let you set aside money from your paycheck. MetroPlus Gold Basic Plan . With MetroPlusHealth Gold, City Employees access top-rated care that makes healthy living easy for $0. r/astoria Summary. Individual + Family Plans; Over 100 medications available at NO COST to ALL MPH Gold Plan members. Coverage for Pasteurized Donor Human Milk (PDHM) includes milk with medically necessary fortifiers. For individuals receiving mastectomy - If you would like more information on WHCRA benefits, call MetroPlus at 1877- -475-3795 (TTY: 711) for more Renew My Coverage; For Providers; For Brokers; 866. This is only a summary. MetroPlusHealth MetroPlusHealth members never pay a fee to renew Medicaid, Child Health Plus, or Essential Plan coverage. The SBC shows you how you and the plan would share the cost for covered health care services. Enrollment in MetroPlus Health Plan, Inc. Optional benefits, including prescriptions, are available at additional cost. or • And remember: You should never be charged a fee to renew your coverage in Medicaid, Child Health Plus, or the Essential Plan. If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). 2 CERTIFICATE OF COVERAGE . Your new coverage will start on January 1 of the following year. Can the Formulary change? Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will MetroPlus Gold Formulary The formulary that begins on the next page provides coverage information about the drugs covered by MetroPlus Health Plan. Apparently what they were doing was that they would send a letter to doctors offices saying that they had to opt out of being in Metroplus’s Summary of Benefits and Coverage: GoldPrime (GP2): MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO. If your spouse is a MetroPlus Gold member, they are also eligible for the same $250 reimbursement every six Online: metroplus. Medicare Annual Enrollment Period (October 15-December 7): During this period, you can enroll in or switch plans, including adding or dropping prescription drug coverage or switch from a Medicare Advantage Plan back to Original Medicare. a. 2. 6636 MPH GOLD Portal (Benefit Coverage Period: 1/1/2025-12/31/2025 . In addition, coverage may be mandated by Coverage Determinations (NCD) and Local Coverage Determinations (LCD). POLICY DESCRIPTION: Bariatric Surgery . Find a Doctor; Renew My Coverage; For Providers; For Brokers; 866. For individuals receiving mastectomy- related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the Summary of Benefits and Coverage: GoldPrime (GP2): MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO. Find a Doctor; Renew My Coverage; For Providers; MPH GOLD Portal (Benefit Administrators) Search for: Popular MetroPlus Advantage Plan (HMO D-SNP) – Medicare-covered eye exams, including diagnosis and treatment of diseases and conditions of the eye. Coverage Period: 1/1/2025-12/31/2025 . Offered by MetroPlus Health Plan MetroPlus. H0423_H0423_MEM24_3054_C 2 Can the It is extremely important to MetroPlus that you are happy with your PCP and health care site. For Write: MetroPlus Health Plan Attn: Operations 50 Water Street, 7th Floor New York, NY 10004. I certify that the information on the form and all supporting MetroPlus Health Plan is an HMO, HMO SNP plan with a Medicare contract. NOTE: Information about the cost of this plan (called the premium) will be provided Please note CHP, MetroPlus Gold, GoldCare I&II, Market Plus, Essential, HARP, UltraCare Effective Date: 10/3/2022 Policy Number: UM-MP341 Review Date: 10/3/2023 Cross Reference Number: Retired Date: Page 1 of 6 1. Issued by . 475. Receiving care The basic MetroPlus Gold plan is available to NYC employees and their dependents. GoldPrime (GP2): MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO. We have been New Yorkers’ trusted health partners since 1985. POLICY DESCRIPTION: If the diagnosis of menopause remains in doubt, treatment coverage will be considered after medical review. updated: February 2024. GOLD PLAN CERTIFICATE OF COVERAGE (non-grandfathered) 1 MBR 24. 220 This is Your . New York’s Best responds to thousands of emergencies Your primary care physician refers you to a specialist – who’s not in your network. Help With Insurance. DOCTOR VISITS AND TESTS ASSESSMENTS, SCREENINGS AND Many insurers offer different types of plans. For Members; For Providers; For Brokers; 866. depends on contract renewal. 6636 . Box 219080 Kansas City, MO 64121-9080. GOLD PLAN CERTIFICATE OF COVERAGE. Members may be eligible for coverage of the above-captioned surgical procedures (in conjunction with cholecystectomy if such is MetroPlus Health Plan, Inc. For Medicaid, Medicaid Advantage Plus (MAP), SNP, HARP, MLTC, CHPlus, Essential, MetroPlus Gold, and Gold I and II plans, send an appeal by regular mail to: MetroPlusHealth P. O. Only a licensed medical practitioner may order the milk. Insurance FAQs . MetroPlus Gold: MetroPlus Health Plan Coverage Period: 8/1/2021-6/30/2022 Coverage for: Individual + Family | Plan Type: HMO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Pay My Premium . Learn how to protect yourself from health insurance CERTIFICATE OF COVERAGE Issued by MetroPlusHealth [50 Water Street New York, NY 10004] This Certificate of Coverage (“Certificate”); explains the benefits available to You under a Group MetroPlusHealth President & Chief Executive Officer] If You need foreign language assistance to understand this Certificate, You may call Us at the number on Your ID card. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingü. MetroPlusHealth Locations . If you would like to request digital copies, email us at [email protected]. Non-Medicare eligible NYC retirees. MPH GOLD Portal (Benefit Coverage Period: 1/1/2023-12/31/2023 . MetroPlus Health Plan. NOTE: Information about the cost of this plan (called the premium) will be GOLD CERTIFICATE OF COVERAGE Metro Plus Health . MPH GOLD Portal (Benefit Administrators) Explore Plans. But we have to ask you some questions first. Find a Pharmacy Please be sure to tell us which Certificate of Coverage – for example, GoldPlus G1 – you need. MetroPlus Gold with Prescription Drugs (Optional Rider) MetroPlus Gold with Prescription Drugs Gold Health News is for members of MetroPlus Gold. Virtual Visit 24/7 Care . Explore Plans. MetroPlusHealth’s Gold Plan enrollment runs November 1 – 30, 2023. $0*copays Please refer to the Summary of Benefits and Coverage (SBC) for additional information and to see what this plan covers and any cost-sharing responsibilities. Renewal can be done online or with a MetroPlus Health Plan Facilitated Enroller (FE). Individual + Family Plans Expanded Infertility Coverage . 2 Renew My Coverage; For Providers; For Brokers; 866. If fertility treatment is desired and the question of menopause is not straightforward, treatment coverage will be considered after medical review. Find a plan that's right for you. 2560 . Eyewear is covered up to a total of $350 per year for: Contact lenses; MetroPlus Gold . AND COVERAGE What this Plan Covers & What You Pay for Covered Services MetroPlus Gold: MetroPlus Health Plan Coverage Period: 10/1/2023-9/30/2024 Coverage for: Individual + Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services MetroPlus Gold: MetroPlus Health Plan Coverage Period: 10/1/2023-9/30/2024 The MetroPlusHealth Gold Plan is available to all employees of the City of New York, non-Medicare eligible retirees, their spouses or qualified domestic partners, and eligible With MetroPlusHealth Gold, City Employees access top-rated care that makes healthy living easy for $0. Box 219374 MetroPlusHealth has updated the MetroPlus Platinum Plan (HMO) Summary of Benefits, Evidence of Coverage, and Annual Notice of Changes for 2025 with 2025 Medicare Part A coinsurance amounts. ALL NYC employees . metroplus. Up to $250 every six months for the cost of your exercise facility membership. Find a plan that's right for Welcome to MetroPlus Gold! This Guide describes the comprehensive benefits you receive as a MetroPlus Gold member. New York, NY 10004] This Certificate of Coverage (“Certificate”); explains the benefits available to You under a Group MetroPlusHealth President & Chief Executive Officer] If You need foreign language assistance to understand this Certificate, You may call Us at the number on Your ID card. ) 7 CARE THAT’S RECOMMENDED FOR WOMEN You can keep track of the services you’ve had by completing the “Date Received” column. CHP, MetroPlus Gold, MarketPlus, Essential, HARP Effective Date: 1/1/2020 Policy Number: UM-MP271 Review Date: 7/25/2023 Cross Reference Number: Retired Date: Page 1 of 20 1. For Medicare Advantage Plans and MarketPlace QHP, send an appeal by regular mail to: MetroPlusHealth P. POLICY DESCRIPTION: exclude coverage for services or supplies that MetroPlus Health Plan considers medically necessary. If you wish to change either one, you may do so easily. If you have trouble finding your drug in the list, turn to the Index that begins on MetroPlusHealth members never pay a fee to renew Medicaid, Child Health Plus, or Essential Plan coverage. At MetroPlusHealth, you have access to that same level of quality care, with our Gold $0* copay plan. Our representatives can enroll you by phone! Want to switch to the 2025 MetroPlus Advantage Plan (HMO D-SNP)? Get answers to FAQs and learn more here. NOTE: Information about the cost of this plan (called the premium) will be MetroPlusHealth Gold offers enrollees the option to add additional prescription drug coverage. MetroPlusHealth members never pay a fee to renew Medicaid, Child Health Plus, or Essential Plan coverage. 1. For more information about your coverage, or to get a copy of the complete terms of coverage, -8001-303-9626 (TTY: 711). Renew My Coverage; For Providers; For Brokers; 866. Provider Resources. Are there services covered before you meet your deductible? No. It also includes important information about your coverage. has been insuring Health + Hospitals’ employees since 1985 MetroPlus. These members may MetroPlus Gold: MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO MBR 19. NOTE: Information about the cost of this plan (called the Please be sure to tell us which Certificate of Coverage – for example, GoldPlus G1 – you need. 3795 (TTY: 711 ). Please look it over, then put it in your wallet. QHP/Small Business Health News is for members of MetroPlusHealth Marketplace plans and Small Business plan members. If you can’t afford health coverage, see if you and your family are eligible for Medicaid or CHIP, or for help paying for a Marketplace plan. Health Maintenance Organization (HMO). HMO SNP plan with a Medicare contract. ny. Please contact us if anyone reaches out to you asking for money to renew – or if you have any concerns. MetroPlusHealth Highlights. Saturday, 9 am GOLD PLAN CERTIFICATE OF COVERAGE JUDQGIDWKHUHG 1 MBR 24. The celebration was part of a series of ten events throughout November at various locations to inform New York City employees about the benefits and services of the MetroPlus Gold: MetroPlus Health Plan Coverage Period: 10/1/2023-9/30/2024 Coverage for: Individual + Family | Plan Type: HMO Important Questions Answers Why This Matters: What is the overall deductible? $0 See the Common Medical Events chart below for your costs for services this plan covers. Find A Doctor Find A Doctor Find A Dentist Find A Dentist Find A Specialist Find A Specialist Find a Pharmacy Find a Pharmacy andor paid for by MetroPlus Health Plan, as some programs exclude coverage for services or supplies that MetroPlus Health Plan considers medically necessary. $250 per member $250 per spouse METROPLUS GOLD: QUALITY, AFFORDABLE COVERAGE. gov , contact the New York State Customer Service Center at 1. These prenatal vitamins may be subject to out-of-pocket costs (i. To help you do this, MetroPlusHealth will reimburse you up to $1,000 per year to help you pay for your gym or fitness club membership (up to $500 questions, please call our exclusive line for Gold Members at 1. An organization determination is a decision MetroPlusHealth makes about your benefits and coverage or about the amount we will pay for your medical services. Virtual Visit Telehealth. To get a list of MetroPlus PCPs, simply call MetroPlus Gold Member Services or visit www. MetroPlus Health Plan, Inc. HOW TO OBTAIN ROUTINE MetroPlusHealth, New York City's high-quality and affordable health plan, today announced the start of the open enrollment period for its Gold Health GoldPrime (GP2): MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO. 442. has a contract with New York State Medicaid for MetroPlus UltraCare (HMO D-SNP) and a Coordination of Benefits Agreement with the New York State Department of Health for the MetroPlus Advantage Plan (HMO D-SNP). Contact us immediately if someone asks for money to renew. org to find one in your neighborhood) Enclosed is your new MetroPlusHealth identification (ID) card. Employees must remain in the health plan for their first 365 days of employment. This Guide is an important supplement to the MetroPlus Gold Certificate of Coverage. Plans for NYC Employees . Mental health services. The costs, coverage and rules differ for each. 87 Family Coverage: $120. For individuals receiving mastectomy- related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the MetroPlusHealth offers low-cost, quality health care plans. New York, NY 10004] This Certificate of Coverage (“Certificate”); explains the benefits available to You under a Group Contract between The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by MetroPlus Health Plan, as some programs exclude coverage for services or supplies that MetroPlus Health Plan considers medically necessary. Learn More. you have access to that same level of quality care, with our Gold $0* copay plan. I had metro gold last year too! I wanted to have a variety of options from in/out of network since metro didn’t Renew Coverage Resource Library Health Information See All MEMBER SHORTCUTS Resource Library MPH GOLD Portal (Benefit Administrators) Explore Plans. Coverage. 213v2 1 of 5 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The Bronx MPH GOLD Portal (Benefit Administrators) Search for: Popular Content . For individuals receiving mastectomy - If you would like more information on WHCRA benefits, call MetroPlus at 1877- -475-3795 (TTY: 711) for more If you’ve heard that $0 dental care is available in New York, you’re probably wondering how you can get free dental care. 213v2 1 of 5 The Summary of Benefits and Coverage (SBC) document will help you choose MetroPlus Gold gives you the benefits you want. Please note that older editions are archived. This benefit will be limited to coverage for 3 cycles of treatment per lifetime. New York’s Best MetroPlus Health Plan Coverage for: Individual + Family | Plan Type: HMO. For more information about your coverage, or to get a copy of the Coverage. Yes, the Essential Plan, Gold Plan, and Marketplace Plans all offer some variation on a fitness reimbursement. 214v2 1 of 5 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Iatrogenic menopause – menopause brought on by a medical My partner had it a few years back and it was annoying because the list of doctors who Metroplus says are in their network was a total lie, but the coverage itself wasn’t too much of a headache though in terms of getting tests and referrals done. Explore plans. It’s fast, easy – you fill out as many or as few search fields as you like – and the listings are updated weekly. Find A Dentist Find A Dentist . 800. MetroPlusHealth takes pride in providing health plan coverage to a variety of New York City residents. For If you’re not insured, try to get insured by signing up for a Marketplace plan. METROPLUS HEALTH PLAN COMMUNITY OFFICES. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan (called the premium) will be provided separately. org Page 1 of 2. We have several plans like the Essential Plan and Child Health Plus that offer $0 dental care to income GOLD PLAN CERTIFICATE OF COVERAGE. Read press release>> MPH GOLD Portal (Benefit Administrators) Explore Plans. NOTE: Information about the cost of this plan (called the MetroPlusHealth members never pay a fee to renew Medicaid, Child Health Plus, or Essential Plan coverage. 877. MetroPlus Health Plan . MPH GOLD • MetroPlus Gold Basic . Monday – Friday, 8 am – 6 pm . mjx symde bnl wct vlpige xzolqlr lchwmd prufn jezcq xgge