HealthFirst insurance Income between $19,320 and $25,760††

The Essential Plan

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.Summary of Benefits and Coverage (PDF)

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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, 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

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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

• Women’s Preventive Services
• Full List of Approved Preventive Services

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

*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

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  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.

  *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).

 
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  Active & Fit Direct

  Healthfirst makes working out affordable too! For just $25/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.

 
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  ExerciseRewards™ Program

  Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! 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. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.