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​Plan benefits:

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Hospital

Over 150 hospitals covered throughout New York State

vaccination
Vaccine

We cover adult immunizations as recommended by ACIP. This benefit is not subject to copayments or coinsurance when provided in accordance with the recommendations of ACIP.

​June 2019 Meeting Recommendations*

  • HPV 

  • Pneumococcal Vaccines

  • Influenza Vaccines

  • Hepatitis A Vaccines

  • Serogroup B Meningococcal (MenB) Vaccines

vision, eye exam, glasses
Vision

In addition, your vision care benefits include:

  • One annual eye exam per year

  • Other diagnostic exams performed by an eye doctor

  • Lenses or contacts once a year (more often if medically necessary

  • Frame one time per year unless there is a medical need.

free mental health care
Mental Health

Mental health service and drug or alcohol addiction treatment (treated as any other medical illness).

In-network physicians, primary care physicians, general practitioners
Doctor

Primary care physicians and general practitioners are covered under the Essential Plan.

preventive care
Physical Examination

You are eligible for a physical examination once every calendar year, regardless of whether or
not 365 days have passed since the previous physical examination visit. This benefIt is not subject to Copayments, or Coinsurance when provided in accordance with the comprehensive guidelines supported by HRSA and items or services with an “A” or “B” rating from USPSTF.

 

teeth, dental, dentist
Dental

Dental coverage is both for preventative care and routine care. Your oral care benefits include:

  • Two Cleanings per year

  • Oral Exams including X-rays

  • Fillings

  • Extractions

  • Emergency care

  • Dentures

  • Fixed bridge

ambulance fee
Emergency

Emergency Services (given in an emergency room of urgent care facility).

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Prescription ​Drugs

We cover medically necessary prescription drugs that, except as specifically provided otherwise, can be dispensed only pursuant to a prescription and are:

• Required by law to bear the legend “Caution — Federal Law prohibits dispensing without a prescription”;

• FDA approved;
• Ordered by a Provider authorized to prescribe and within the Provider’s scope of practice;
• Prescribed within the approved FDA administration and dosing guidelines; and

• Dispensed by a licensed pharmacy.

gym reinbursement
Free Gym
​Membership

Gym membership. You can get reimbursed up to $400 per plan year. That’s $200 for each six-month enrollment period when you attend the gym at least 50 times.

free hospitalization
​Inpatient

We cover inpatient hospital services for acute care or treatment given or ordered by a health care professional for an illness, injury or disease of a severity that must be treated on an inpatient basis 

​hospitals across NY:

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For additional benefit details:
Should any discrepancies exist between information provided by NYWPG Partners and the NY State of Health, please consult the official nystateofhealth site. Please review the benefit summary for greatest accuracy in plan benefit details. NYWPG Partners is not liable for any misjudgments of plan benefits.