- Social Security
- Supplemental Security Income (SSI)
- Veterans’ Benefits (VA)
- Retirement
- Rent receipt
- Mortgage statement
- Mail with your address on it
When can I sign up for coverage?
You can sign up for health insurance coverage during Open Enrollment. Please note that certain plans have specific enrollment periods to sign up or switch plans.
However, you can enroll outside the Open Enrollment Period if you’ve had a Qualifying Life Event (QLE). These include:
- A change in family size (birth or adoption)
- Marital status change (marriage, annulment, legal separation, divorce, death of a spouse)
- Job loss or change
- Losing your insurance or more
Need help signing up for a health insurance plan? Contact us for more information.
When will I receive my member ID card?
- For any plan with a premium, your Member ID card will be mailed after the initial payment (known as a binder payment) has been made
- For any plan without a premium, your Member ID card will be mailed upon enrollment
- You can also print a temporary Member ID card from your secure Healthfirst account
Is my doctor part of the Healthfirst Network?
Healthfirst has a large network that includes thousands of doctors and specialists. Visit HFDocFinder to find an in-network Healthfirst provider.
How can I find a pharmacy participating with my plan?
Finding a new participating pharmacy is easy. You can:
- Use our Find a Pharmacy search tool to locate one near you
- Call the Healthfirst Member Services phone number on the back of your Member ID card. We’ll help you check if your pharmacy is in our plan network.
- Stop by a Healthfirst Community Office and let us help you look up the participating pharmacies in your community
How do I use my coverage at the pharmacy?
Pharmacy benefits are different for each Healthfirst health insurance plan. Please check your plan’s formulary for more information on which pharmacy medicines and other items are covered.
Healthfirst has partnered with CVS Caremark to bring you a personal prescription drug account that will give you 24/7 access to important drug benefit information and tools that will make getting your prescription drugs easier. Click here to create your account or log in.
How can I find a Healthfirst doctor, hospital, or pharmacy?
Healthfirst has a large network that includes thousands of doctors and specialists. Visit HFDocFinder to find a participating Healthfirst doctor or hospital and use our Find a Pharmacy tool to locate a pharmacy near you.
How can I choose a new doctor?
You can choose a new Primary Care Provider (PCP) at any time. To make the change, you can log into your secure Healthfirst account* or call us.
*Please note: To create a secure online account, you must be a member of a Healthfirst health insurance plan.
Will I have to change any of my doctors or other providers if I switch plans?
Some of our plans share a provider network, but not all of them do. To make sure your doctor is in-network, please visit HFDocFinder.
If my Primary Care Provider (PCP) leaves, can I keep seeing them?
If your doctor leaves Healthfirst, we’ll let you know within 15 days of the doctor informing us. We can then help you find a new Primary Care Provider (PCP). There are some circumstances where you may be able to keep your PCP. These include:
- If you’re more than three months pregnant, or if you’re receiving ongoing treatment for a health condition, Healthfirst may cover that doctor’s costs for a short time
- If you’re pregnant, you may continue to see your doctor for up to 60 days after your baby is born
- If you’re seeing a doctor for an ongoing condition, you may continue seeing him or her for up to 90 days.† You’ll then need to see a Healthfirst doctor for treatment. Please talk to your current doctor about the best way to change to a Healthfirst doctor.
If any of these conditions apply to you, or if you have other questions, check with your PCP or contact us. We’re here to help.
† Your current PCP must agree to work with Healthfirst during this 90-day period.
Will my plan cover transportation?
Depending on the Healthfirst plan you have, you may be eligible to receive free transportation to and from medical appointments and select non-medical appointments. Please refer to your Member Handbook or call the Member Services phone number on your Member ID card for details.
What happens if I need care when I am on vacation?
If you need coverage outside our network and/or service area, please confirm your plan’s service area in your summary of benefits. Such coverage will be treated as an out-of-network service, meaning you will be responsible for the full cost.
In certain instances, you can petition to receive out-of-network coverage at in-network prices, but this approval must be obtained before receiving services. Please note that emergency care is always covered.
How do I request my health records?
For a copy of the health records that Healthfirst maintains about you, send a request specifying the records you’re seeking to:
Healthfirst Member Services
P.O. Box 5165, New York, NY 10274-5165
Fax: 1-212-801-3250
You can also make a request over the phone by calling Member Services at 1-844-347-5816, Monday to Friday, 8am—8pm or sending an email to
Forms@healthfirst.org.
To ask Healthfirst to share a copy of your electronic health records with an entity or another individual:
Complete the authorization form located here.
Send the completed authorization form and all relevant documentation to:
Healthfirst Member Services
P.O. Box 5165, New York, NY 10274-5165
Fax: 1-212-801-3250
Phone: 1-844-347-5816
You can also make a request over the phone by calling Member Services at 1-844-347-5816, Monday to Friday, 8am—8pm or sending an email to
Forms@healthfirst.org.
For additional information about the health records that Healthfirst maintains about you, please see the Notice of Privacy.
Does my plan cover over-the-counter (OTC) in-home COVID-19 tests?
On January 10, 2022, the Biden-Harris Administration issued guidance requiring health insurance companies to cover the cost of over-the-counter (OTC) in-home COVID-19 tests for their members. Healthfirst is complying with that guidance: coverage began on January 15, 2022. For more information, visit hfcovidtests.org.
What should I know about COVID-19 if I have Medicaid?
View this fact sheet if you have Medicaid and need information about COVID-19 vaccines, tests, and treatment.
I submitted my renewal. Why did I lose my coverage?
You may have not submitted required documentation or missed the deadline, or you may no longer be eligible for your selected plan. Please contact us and we can help you regain coverage.
I haven’t had to renew Medicaid, Child Health Plus, Essential Plan, or Personal Wellness Plan coverage in a few years. Does that mean I don’t have to renew coverage each year?
No. Once the Covid-19 Public Health Emergency (PHE) ends, you’ll need to renew coverage every year. The New York State of Health (NYSOH) and Healthfirst will contact you when it’s time to renew. Learn more about renewing your coverage here.
When should I renew my plan?
Certain plans have different renewal times, but we’ll reach out to make sure you have all the information you need. You can also use our online renewal guide or contact us for more information.
Do I need to renew my insurance plan every year?
Unless you are enrolled in a Healthfirst Medicare plan, you’ll need to renew your insurance every year. You’ll get a reminder ahead of time asking you to renew your insurance plan. To renew your insurance, you can:
- Contact us. We can help you over the phone or make an appointment to visit you in your home or another location convenient to you.
- Visit one of our many Healthfirst Community Offices, where a representative will help you understand your health plan options
How do I renew my Healthfirst insurance plan?
The easiest and fastest way to renew your plan is to contact us.
What documents do I need to renew my coverage?
Required documentation for renewal varies from person to person. You’ll likely need:
- Proof of income
- Proof of address if your address has changed
- Proof of immigration status if your immigration status has changed or been renewed
Will I be notified before my coverage expires?
No matter your Healthfirst plan, we’ll send a reminder when it’s time to renew. If you’re a Medicaid, Child Health Plus, Personal Wellness Plan, Essential Plan, Leaf or Leaf Premier member, you’ll also receive a notice from either NY State of Health (NYSOH), the Human Resources Administration (HRA), or your Local Department of Social Services (LDSS) before your anniversary date.
Make sure you open and read any renewal notices you receive to get the details about renewing your health insurance plan. Your coverage will be cancelled if you don’t renew when you are required to or don’t return documents by the requested date.
What happens if I don’t renew?
Unless you are enrolled in a Healthfirst Medicare plan, your healthcare coverage will expire and you’ll be without health insurance. If you get sick or injured, you won’t have health coverage—even in an emergency—and you’ll have to pay for any care received.
What if I have additional questions about surprise bills and Independent Dispute Resolution?
If you have additional questions, please call 1-800-342-3736, or email your questions to surprisemedicalbills@dfs.ny.gov.
As a member, what are my rights and protections against surprise medical bills and balance billing?
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance, and/or deductible.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other healthcare provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You’re protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or hospital, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in a stable condition.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, and intensivist services. Providers of these services can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections. You can’t give up your protections for these other services if they are a surprise bill. Surprise bills are when you’re at an in-network hospital or ambulatory surgical facility and a participating doctor was not available, a non-participating doctor provided services without your knowledge, or unforeseen medical services were provided.
Services referred by your in-network doctor
Surprise bills include when your in-network doctor refers you to an out-of-network provider without your consent (including lab and pathology services). These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. You may need to sign a form (available on the Department of Financial Services’ website at www.dfs.ny.gov) for the full balance billing protection to apply.
You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have these protections:
- You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
- Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.
