Affinity Health Plan

    • What is a PCP?

      The letters "PCP" stand for "primary care provider." The PCP is a doctor or nurse practitioner who you choose for all of your regular care. Here are a few other things your PCP can do for you:

      • help keep you healthy and treat you when you are ill.
      • arrange for you to have lab tests and x-rays.
      • arrange for you to see a specialist, or go into the hospital, if needed.

    • How do I make a payment for my Affinity qualified health plan (QHP) that I purchased on the State Health Plan Marketplace?

      In order to continue coverage, your premiums payments must be made on a monthly basis. Valid payment types include personal checks, bank checks or money orders. You also have the option of paying by credit or debit card.  Click here for more detailed payment instructions.

    • Should everyone in my family have the same PCP?

      Each family member can have a different PCP. Or, you can choose one PCP for the whole family. There are different types of PCPs:

      • A Family Medicine doctor can treat the whole family.
      • A Pediatrician is a doctor who treats children.
      • An Internal Medicine doctor treats mostly adults.

      The choice is yours. If you need help deciding which PCP is right for you and your family, call Customer Service toll free at 1-866-247-5678.

    • I am a new Affinity Health Plan Member. Can I keep seeing my old doctor who is not in the Affinity network, or do I have to switch to an Affinity doctor right away?

      You may keep seeing your old non-Affinity doctor for up to 60 days after the date you joined us, but only for special reasons. For example:

      • If you are being treated for a life-threatening, or other serious conditions.
      • If you are three or more months pregnant when you join Affinity. You can keep seeing your non-Affinity doctor for your pregnancy until your baby is born and you have your follow up care.

    • I am going to have a baby. What happens when my baby is born? Will my baby be signed up for Affinity Health Plan?

      If you have Medicaid, your baby will be enrolled in Affinity Health Plan on the day he or she is born. But your newborn baby will not be signed up for our program if,

      • the baby weighs less than 1200 grams (about 2 1/2 pounds) at birth, or
      • the baby has full private health insurance, or
      • you are in prison at the time of birth.

      If you have Child Health Plus or Family Health Plus, call Customer Service at 1-866-247-5678 for your baby's health care coverage.

    • What happens if my doctor leaves Affinity Health Plan's provider network?

      Within 15 days after we learn that your doctor is leaving our network, we will let you know so you can choose a new PCP from our network. If the doctor who is leaving is treating you for a health problem, you can keep using that doctor for up to 90 days before you have to choose a new Affinity doctor.

    • How do I change PCPs?

      Sometimes, you or a family member may need to choose a different PCP. For example, your PCP may move to a new location that is not convenient for you. Or, you may just want to try a different PCP for personal reasons. That's OK. You can change your PCP at any time. Call Customer Service and ask for help in selecting another PCP. Please note that the change to your new PCP will take place on the first day of the month after the change was requested.

    • How do I get specialty care that my PCP cannot give?

      Your PCP will refer you to a specialist if you need specialty care. We have over 5,000 specialists. These are doctors with special training in conditions such as heart disease, cancer, or asthma. If we do not have a specialist in our provider network that can give you the care you need, we will get you one from outside the network.

    • What should I do if I become ill or a family member becomes ill?

      If you have an emergency, you should go to the nearest hospital emergency room. If the sickness or injury is not urgent, call your PCP - even when your PCP's office is closed. There is always a doctor on call to help you. The telephone number for your PCP's office is printed on your Affinity ID Card. You can call at any time, 24 hours a day, seven days a week. When you call, tell the operator your name, the name of your PCP, your Affinity Health Plan ID number, and the reason for your call. Your PCP - or another doctor who works with your PCP - will handle your call.

    • What should I do if I get a bill from a doctor?

      We pay for all of the services covered by your Affinity Health Plan program. If a doctor bills you for a covered service, send that bill to us and we will take care of it.

    • What should I do if I have a problem with the service I get from Affinity or its doctors?

      We take our motto, Dedicated to Excellence, seriously. We try to serve you and your family well all the time. But, if you have a problem with our service or the services you get from an Affinity doctor, please call or write to Customer Service. We will do our best to solve the problem. If you are not satisfied and need to file a complaint, please do so. We will not make things hard for you. We will not take any action against you for filing a complaint. In fact, our Customer Service staff can help you prepare your complaint if you are unable to do so due to hearing, vision or translation problems.

    • What if I don't agree with Affinity's finding on my complaint?

      If you are not satisfied with our decision on your complaint, you can appeal. We have the steps to file an appeal in your Member Handbook. Our Customer Service can also explain how you can file an appeal.

    • Where do I go to fill my prescriptions?

      Members can fill their prescriptions at any pharmacy that is in the CVS/Caremark network. If you are a member with questions or need assistance, please call the specific number for your plan:

      • Medicaid, Child Health Plus or Family Health Plus: 1-855-465-0031 
      • Medicare Part D: 1-866-362-4002
      • Affinity Essential: 1-855-722-6228

    • What is an advanced directive and why do I need one?

      It’s hard to think about being so sick that you cannot decide what health care you want. But it is important for everyone to get ready if that time comes.

      Advanced Directives are forms you sign. You can name someone to make medical decisions for you if in the future you are unable to make these decisions yourself. They tell what health care you want or don’t want, in case you cannot make your own choices. You can also say what treatment you want and what medical treatment you don’t want if in the future you’re unable to make your wishes know.

      There are a number of types of advanced directives:

      Living Will
      A paper that spells out the medical treatments you would want if you were very sick. Some kinds of treatments that you may choose to have or not have are:

      • Tube feeding
      • ƒMachines that breathe for you
      • ƒCPR (Cardiopulmonary Resuscitation)

      Health Care Proxy
      You may hear this called a durable power of attorney (DPA) or a medical power of attorney (POA). A Health Care Proxy names the person you have chosen to make health care choices for you if you cannot make them yourself. Your doctor will decide when that time is. Choose someone you trust. Talk to that person honestly about treatments you would want and ones you wouldn’t want.

      DNR (Do Not Resuscitate)
      A DNR order says that you do not want to have CPR if your heart stops or if you stop breathing.

      We feel strongly that you must talk to your family and doctor about having an advanced directive. Your doctor can give you the forms and can answer any questions that you have.

      If you want any more facts on advance directives, call Social Work Department at

      Click here for pdf version

    • Who is LogistiCare?

      LogistiCare is the vendor that Affinity Health Plan has contracted with to manage non-emergent transportation services.

    • What are non-emergent transportation services?

      • Ambulette
      • Livery/Taxi
      • Metrocard

    • When does LogistiCare take over managing non-emergent transportation services?

      11/09/2009 for Medicaid members only (excluding members in Orange and Rockland Counties-their services are covered through their local Dept. of Social Services).  Medicare members will begin on 01/01/10.

    • When can Members begin to call LogistiCare to schedule transportation?

      Medicaid Members and/or providers may call LogistiCare on or after10/26/2009 to schedule transportation services for dates of service after11/09/2009.

    • What is the phone number (for Members)?

      (866) 475-5749 (toll free) (reservation line)

      (866) 418-9810 (toll free) ("where's my ride" line) (urgent transportation line)

    • What is the phone number (for providers)?

      (866) 428-2351 Provider/Facility line

    • How far in advance may Members order transportation?

      Members can order trips up to 30 days in advance (as long as they are eligible).

    • Is there a deadline for ordering routine (non-urgent) transportation?

      Members must give 72 hours (3 days) notice when ordering routine transportation appointments.

    • Can Members order transportation for urgent appointments?

      Yes. The appointment will be confirmed by the ordering provider, and transportation will be provided same day via taxi.  Providers will receive phone calls from LogistiCare customer service staff to confirm all urgent appointments.

    • What if a Member calls to complain that their ride is late?

      Members may call (866) 418-9810 (toll free) if their scheduled transportation has not arrived.  They (and providers) may also use this number to set up return transportation from an appointment, especially if they did not schedule a round trip because they were unsure of when their appointment would be over.

    • What are LogistiCare's business hours?

      8:00 a.m. - 5:00 p.m. Monday through Friday.  The Ride Assistance line is open 24/7.

    • What if a Member needs transportation on Saturday or Sunday?

      Routine transportation for Saturday and Sunday should be ordered during normal business hours.  Urgent Saturday and Sunday transportation can be handled through the Ride Assistance line.

    • What information will a Member be asked when they call LogistiCare?

      Members will need to have the following information ready when they call LogistiCare: 

      • Affinity ID number Date and time of appointment
      • Date of Birth
      • Name and telephone number of the doctor/health center/etc.
      • Pick up time and location