Healthfirst Signature Plans (Medicare Only, without Medicaid)
| Benefits | Signature HMO | Signature PPO |
| Service Area | NYC, Nassau, Westchester, Orange, Rockland & Sullivan |
NYC, Westchester, Rockland, Nassau and Suffolk |
| Premium | $0 | $0 |
| MOOP | $6,700 | $5,000 IN/$8,000 Comb. |
| Medical Deductible | $0 | $0 |
| PCP | $0 copay | $0 copay IN/$50 copay OON |
| Specialist | $40 | $45 copay IN/$60 copay OON |
| Over the Counter | $70/quarter OTC* | Not covered |
| Flex Card | Not covered | $700/year Flex Card (For dental, vision & hearing) |
| Dental: Preventive and Comprehensive | $2500 annual max No deductible |
$1500 annual max No deductible, OON copays |
| Eyewear | $250/2 years | $250/2 years |
| Hearing | $0-$1,475 copays | $0-$1,475 copays |
| Acupuncture | $0 copay 12 visits |
$0 copay 12 visits |
| Transportation (Supplemental) | 25 one-way trips* | Not covered |
| Part D Deductible | $250 (Tier 4 & Tier 5) | $250 (Tier 4 & Tier 5) |
| Low-Cost 90-Day Fills | Yes | Yes |
| Low-Cost Insulin | Yes | Yes |
| Supplemental Drug Coverage | Yes | Yes |
| US Traveler Benefit | Not covered | Yes Florida only |
2023 第一保健紅藍卡Flex計劃 Phone # (適用於上州，紐約市，Nassau，Suffolk)
管理式保健計劃 (Signature) HMO- 福利與承保範圍摘要（中文）適用於紐約郡、NYC、上州, Nassau, Suffolk（英文）
無需轉介
專科醫生專注於某一方面的範疇，例如：泌尿科醫生（泌尿科醫生）、心髒病科醫生（心臟科醫生）、耳鼻喉科醫生（耳鼻喉科醫生）或皮膚科醫生（皮膚科醫生）。 第一保健紅藍卡優勢計劃成員可以直接前往網絡內專科醫生處，而無需前往 PCP家庭醫生進行轉診。 我們的目標是增加我們會員獲得護理的機會。
緊急護理網絡
通過我們的緊急護理網絡，會員有更多的護理選擇。 緊急護理中心提供深夜和周末服務，以及比無需預約的急診室成本更低的服務。 當他們的 PCP 辦公室關閉時，他們可以訪問網絡內緊急護理中心以獲得非緊急情況的幫助，例如耳痛、胃部不適、扭傷、縫線等。
管理式保健計劃 (Signature) PPO- 福利與承保範圍摘要（中文）適用於紐約市、Nassau、佛羅里達 （英文）
2023 第一保健紅藍白卡LIP計劃 (適用於上州，紐約市，Nassau，Suffolk)
生活改善計劃(Life Improvement Plan) – 福利與承保範圍摘要（中文）適用於紐約市、Nassau、上州、（英文）
2023 第一保健紅藍卡Signature計劃 (適用於上州，紐約市，Nassau，Suffolk)
第一保健MA 計劃的功能和優勢摘要
護士幫助熱線
第一保健護士幫助熱線免費提供給 第一保健紅藍卡優勢 計劃成員尋求健康相關問題的答案。 通過為遇到非緊急醫療問題的成年人提供快速獲得高質量醫療服務的機會，護士幫助熱線可以幫助減少非緊急情況下急診室就診的頻率，並大大提高會員的滿意度
護士幫助熱線不能替代他們的初級保健提供者家庭醫生。家庭醫生應始終是他們護理和定期就診的首選。
針灸
經過數千年的實踐，針灸是一種行之有效的治療方法，可以治療與各種疾病和病症相關的疼痛和不適。 第一保健幫助支付針灸的費用，以便我們的會員可以獲得最適合他們需求的治療方案。
2023第一保健紅藍卡優勢計劃針灸福利
| 第一保健生活改善計劃 (LIP) | 第一保健Signature福利計劃 (HMO) | 第一保健Signature福利計劃 (PPO) |
|---|---|---|
| 每年 20 次 腰痛就診 無需copay ($0)每年 20 次 補充訪問的 無需copay ($0) | 每年 20 次 腰痛就診 無需copay ($0)每年 12 次 補充訪問的 無需copay ($0) | – |
交通接送福利
第一保健紅藍卡優勢計劃將安排到經批准的提供者地點或藥房的汽車服務。 會員必須在就診前至少兩個工作日致電第一保健會員服務部，他們的第一保健計劃將安排通過經批准的汽車服務接送他們。 對於公共交通以外的未經 第一保健計劃預先授權的交通費用，他們將不予報銷。
除非醫療上有必要並且得到 Healthfirst 的事先授權（例如，當網絡提供者不可用或沒有網絡提供者能夠提供所需級別或類型的護理時），否則不承保到網絡外提供者的交通服務。
2023第一保健紅藍卡優勢計劃交通接送福利
| 特選專享計劃 (HMO) | 生活改善計劃 (LIP) | 增進福利計劃 (IBP) | 加強福利保健計劃 (65+) |
|---|---|---|---|
| *如果被選為 Choice Extra，則每年 12 次單程交通接送 | $0 交通費 往返診所/藥房。 每年最多 28 次單程交通接送 |
$0 交通費 往返醫生/藥房。 每年最多 40 次單程交通接送 |
不覆蓋 |
Dental
Did you know that tooth decay is one of the most common chronic diseases in the United States? Oral health is essential to overall health and well-being – and crucial to be able to eat and speak. At Healthfirst, we want members to take advantage of their preventive dental care coverage. Now, Healthfirst Medicare Advantage members can call Dentaquest for help finding an in-network dentist and also scheduling a dental appointment. Healthfirst Medicare Advantage members may call DentaQuest at 1-800-508-2047 for help finding a dentist and scheduling an appointment.
Acupuncture
Practiced for thousands of years, acupuncture is a proven and effective treatment option for pain and discomfort associated with a variety of illnesses and conditions. Healthfirst helps cover the cost of acupuncture so our members can have access to the treatment options that best fit their needs.
The 2024 acupuncture benefit for Healthfirst Medicare Advantage plans are:
| Life Improvement Plan (LIP) | Increased Benefit Plan (IBP) | 65 Plus Plan (65+) |
|---|---|---|
| $0 copay for up to 12 visits for lower back pain every year
$0 copay for up to 12 supplemental visits every year |
$0 copay for up to 20 visits for lower back pain every year
$0 copay for up to 12 supplemental visits every year |
$0 copay for up to 20 visits for lower back pain every year
$0 copay for up to 12 supplemental visits per year |
Transportation
Healthfirst Medicare Advantage Plans will arrange for car service to approved provider locations or Pharmacies. Members must call Healthfirst Member Services at least two business days in advance of their office visit and their Healthfirst plan will arrange to have them transported by an approved car service. They will not be reimbursed for the cost of transportation which is not pre-authorized by Healthfirst plan other than public transportation.
Transportation to out-of-network providers is not covered unless it is medically necessary and prior authorization is granted by Healthfirst (for example, when network providers are unavailable or no network providers are able to offer the level or type of care needed).
The 2024 transportation benefit for Healthfirst Medicare Advantage plans are:
| Signature (HMO) | Life Improvement Plan (LIP) | Increased Benefit Plan (IBP) | 65 Plus Plan (65+) |
|---|---|---|---|
| *If selected as a Choice Extra, 12 one-way trips per year | $0 transportation to/from doctor or pharmacy. Up to 28 one-way trips per year |
$0 transportation to/from doctor or pharmacy. Up to 40 one-way trips per year |
No coverage |
Additional Advantages of Healthfirst MA Plans for 2024
Teladoc provides access to a doctor either by phone, secure video through a personal computer, or mobile device, 24 hours a day, 7 days a week. Doctors can diagnose symptoms, prescribe medication and send prescriptions to a selected pharmacy.
This benefit covers up to 84 meals, 3 per day, delivered to a member’s home for up to 28 days after a hospital stay greater than two days. The benefit can be used immediately following an inpatient hospital stay if recommended by a provider. This benefit requires prior authorization.
This benefit provides access to network fitness facilities to all basic amenities plus group exercise classes. SilverSneakers FLEX classes are held at parks and community locations. At-home kits are offered for members who want to work out at home or for those who can’t get to a fitness location.
My Advocate
My Advocate is additional resources for your Healthfirst Medicare Advantage patients who might need financial assistance. We know how hard it can be for some of your Healthfirst Medicare Advantage patients to keep up with all of the costs in their life—whether it’s paying for rent, food, electricity, or medical bills. That’s why we’re pleased to tell you about My Advocate, a program open to all Healthfirst Medicare Advantage members who may need financial help.
With My Advocate, your Healthfirst Medicare Advantage patients get connected to local health and financial programs that offer:
- Medicine discounts
- Help with copays and Medicare Part B premiums
- Transportation discounts
- Meals and other food options
- Reduced rates for energy bills
- And more
Your Healthfirst Medicare Advantage members may call My Advocate at 1-866-620-4995 (TTY 1-855-368-9643), Monday to Friday, 9am–6pm, or visit My Advocate at www.myadvocatehelps.com to find out which programs may be right for them. My Advocate will ask your patients questions about their finances to determine which programs they might be eligible to receive. All information will be kept private and confidential.
第一保健紅藍卡/紅藍白卡如何查找醫生？
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