Affinity Health Plan

    • 2016 HepC Treatment

      Hepatitis C Coverage Expansion

      Affinity Health Plan has recently expanded coverage of Hepatitis C treatment.

    • Urgent Care slide

      When an Urgent Care Center is Best

      Urgent Care Centers are faster and less expensive than Emergency Rooms. But, when is Urgent Care a better choice? Learn what makes sense.

    • Member Rights and Responsibilities More

      As a Member of Affinity Health Plan you will have the right to...

      1. Get quality health services with care and respect no matter what your race, color, religion, sex, age, homeland, sexual orientation, physical or emotional state.

      2.  Get information that is clear, complete, and in your language from your Primary Care Physician (PCP) and other doctors. It will say what is wrong, and what can be done for you.

      3.  Get a second opinion about your care and treatment.

      4.  Name someone to decide about your care, if you are too sick to know what to do.

      5.  Know what is to be done in any surgery, and have the chance to agree to it before anything is started.

      6.  Say no to treatment when the law allows, and be told clearly what will happen if you do so.

      7.  Get a copy of your health record and talk about it with your doctor.

      8.  Have your treatment and records kept private (except as the law or a contract may call for).

      9.  Get thoughtful and respectful care in a clean and safe setting free of unwanted restraints.

      10. Say your views to Affinity Health Plan staff, including any complaints you may have, and get a thoughtful, helpful answer.

      11. Make a written or spoken complaint to Affinity Health Plan at any time.

      12. Make a written or spoken complaint to the New York State Department of Health or your Local Department of Social Services.

      13. Use the State Fair Hearing process.


      As a Member of Affinity Health Plan, you have the responsibility to...

      1.  Use the hospital Emergency Room only for real emergencies that might cause death or lasting harm.

      2.  Keep your medical appointment. And to call if you are either going to be late or must can cancel your appointment.

      3.  Talk over your health care needs with your Affinity doctor and follow the care you both agree on.

      4.  Listen to your PCP’s advice and ask questions when you’re in doubt.

      5.  Call or go back to your PCP if you do not get better, or ask for a second opinion.

      6.  Call your PCP or Affinity Health Plan if you need care at night or on the weekend.

      7.  Tell us if you have problems with any health care staff. Call Customer Service.

      8   Tell Affinity Health Plan if your address and/or phone number changes.

      9.  Learn how your health care system works.

      10. Follow the rules in your Member Handbook.

      11. Tell Affinity if you become eligible for Medicare or get other insurance coverage.

      12. Let Affinity Health Plan staff know if your rights have not been honored.

    • Maintaining Coverage More

      In order to make sure your coverage continues without a break, you will need to pay your premiums monthly.

      For Child Health Plus
      Payment is due before the 1st of every month. You may pay either by mail, or by phone at (866) 247-5678 Monday through Friday, from 8:30 am to 6:00 pm. View more payment options here.

      For Qualified Health Plans
      When you first enroll in your plan, there is a 10-day grace period before your first payment is due. This means that you will have until the 10th day of the month your coverage begins to make your first payment. If your first payment is not received within 10 days, your plan may be cancelled. For all other months your payment is due by the 1st of every month. Payments can be submitted online via AffinityOnlineStore.com. View more payment options here. If you fail to make your monthly premium payments during the plan year, your coverage may be terminated retroactively to the last date to which a payment applies.

    • Enrollment Periods More

       Essential Plan, Child Health Plus & Medicaid Plans

      No enrollment period exists. Theses plans are available at anytime of year.

      Qualified Health Plans

      • November 1, 2016: Open enrollment starts for 2017 coverage
      • December 15, 2016: The last day to enroll and have coverage begins on January 1, 2017
      • December 31, 2016: Health care coverage ends for 2016 plan year
      • January 1, 2017: The first day when 2017 coverage starts if payment is received by January 10,2017
      • January 15, 2017: The last day to enroll and have coverage begin on February 1, 2017
      • January 31, 2017: Open enrollment ends for the year, except under special circumstances


      Special Enrollment Period for Qualified Health Plans

      Special situations exist that allow you, your spouse or child to enroll for health care coverage at anytime. The circumstances are listed below:

      • You lose health coverage – for example, your current plan expires, or you lose job-based coverage, or your COBRA ends
      • You get married, or get divorced
      • You are having a baby or adopting
      • You move to New York, or from one county to another within New York
      • You become a US citizen
      • Your income changes and your eligibility for advance payments of the premium tax credits is affected
      • See others here or watch this video


       Medicare

      • October 15, 2016: Open enrollment for 2017 begins
      • December 7, 2016: Last day to enroll and have coverage in 2017
    • Important Phone Numbers More

      Call, write, fax or follow the Web links below to get answers from Affinity regarding your plan:

      To Research or Buy a plan
      866.731.8001; Mon-Fri 8:30am - 6:00pm (Eastern)

      Member Customer Service
      Child Health Plus and Medicaid: 866.247.5678; Mon-Fri 8:00am - 6:00pm (Eastern)
      Qualified Health Plans: 866.543.6973; Mon-Fri 8:00am - 6:00pm (Eastern)

      Pre-authorizations and Hospitalizations
      (This is the number your provider will have to call for authorization)
      866.543.9074; Mon-Fri 8:30am - 5:00pm (Eastern)

      Medical Emergency: 911

      Beacon Health Strategies Behavioral Health: www.beaconhealthstrategies.com
      (for psychological or psychiatric care) 
      888.438.1914

      Dental: www.dentaquest.com
      866.731.8004

      Laboratory Services

      BioReference Laboratories: 800.229.5227
      GeneDX: 888.729.1206
      GenPath Women’s Health: 800.633.4522
      GenPath Oncology: 800.627.1479

      Empire City Laboratories, Inc.: 718.788.3840

      LabCorp: 888.522.2677
      Integrated Oncology: 800.710.1800
      Dianon Systems, Inc.: 800.328.2666
      Integrated Genetics: 800.848.4436
      Litholink Corporation: 800.338.4333
      MedTox Laboratories, Inc.: 800.832.3244
      Monogram Biosciences, Inc.: 800.777.0177

      Lenco Diagnostic Lab: 855.870.0097

      Spectra (including Shiel Medical Lab): 800.553.0873

      Sunrise Medical Laboratories: 800.782.0282

      Xeron Clinical Laboratories: 718.762.3310

      Quest Diagnostics, Inc.: (coming soon)

      Superior Vision: www.superiorvision.com
      866.810.3312

      CareCore: www.CareCore.com
      (for X-rays, CAT scans, MRIs, MRAs, PET scans, and CTAs)
      866.242.5615

      CVS Caremark Pharmacy: www.caremark.com
      855.722.6228 (Customer Care)
      877.432.6793 (Authorization)
      888.543.9069 (Appeals)

      Complaint, Grievance & Appeal Unit (CGA)
      Child Health Plus and Medicaid: 866.247.5678
      Qualified Health Plans: 888.543.6973

    • Claims More

      For Qualified Health Plans

      Reimbursement Claim Form for Prescriptions

      For Child Health Plus and Medicaid

      Call 866.247.5678 from Mon. to Fri. 8:00 am to 6:00 pm (Eastern Time) or Fax: 718.794.7809.

      CHP Claim Form: Child Health Plus Members should use this form if you paid out-of-pocket for a drug covered by your pharmacy benefit for which you would like to be considered for reimbursement.

    • Treatment Cost Calculator More

      This Treatment Cost Calculator will help you better understand the potential costs of obtaining health care services when you need treatment. In English | En Español

    • Terms to Know More

      Premium

      Monthly fees paid for coverage of medical benefits during a specific time period (in most cases this is one year). Premiums can be paid by employers, unions, employees; or shared by both the insured individual and the plan sponsor (employers, union).

      Deductible

      A fixed dollar amount during the benefit period - usually a year - that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both per individual and per family deductibles.

      Co-pay or Co-payment

      A fixed dollar amount made by you (the insured person) when a medical service is received, such as for a doctor’s office visit.

      Co-insurance 

      Similar to a co-pay, however, in this case you (the insured person) would pay a percentage of the cost of care that you receive; the plan would cover the rest; after your deductible has been met.

    • Additional Resources More