PLAN BENEFITS

Image Source: NY State of Health

Hospital

Over 150 hospitals covered throughout New York State.

Doctor

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

Emergency

Emergency Services (given in an emergency room of urgent care facility). Ambulances are also covered.

Prescription Drugs

Covers all medically necessary drugs if: your doctor or other prescriber says you need them to get better or stay healthy, and
you fill the prescription at a UnitedHealthcare Community Plan network pharmacy.

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 basi

Vaccines

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.

Recommendations:
HPV; Covid-19 Vaccine and Boosters; MMR; TDAP.

Physical Examinations

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.

Mental Health

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

Vision Care

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.

Dental Care

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, etc.

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.