New York

New York (Plan 100A and 100B)

Medical Homes—Healthcare Centered on You!

Our Health Fund

275 Seventh Avenue,
Suite 1504
New York, NY 10001

(866) 261-5676 or (212) 957-9241

Phone Hours:
9:00am to 5:30pm Eastern Time

$0 Copays at our Medical Homes

Where our primary care is always FREE!

Check out locations in each New York City Borough, and Long Island.  (Copays will apply to all other services such as lab, x-ray, physical therapy, etc.)

Medical Homes

What is a patient-centered medical home (PCMH)? They’re basically health centers where doctors, nurses, patient advocates, social workers, health coaches, and pharmacists talk to each other and coordinate the care you receive. Think of it as your “home base” when it comes to your healthcare. It’s really how healthcare should be!

Advantages:

   • Same-day visits, when available
   • Closer relationships with doctors, specialists and nurses who will work together to keep you get and stay healthy
   • A better understanding of your illness and treatment plan
   • Instructions about your future treatment plans
   • People who take the time to listen to your questions and concerns.

Find a medical home close to you

Call us with your questions: (866) 261-5676

Take control of your health with Better Living

Designed by Stanford University for people with ongoing health conditions, Better Living is a FREE program that meets once a week for six weeks. Each workshop lasts 2½ hours. Watch this video and learn more.

Call us to see if you qualify for this FREE program:
(646) 676-9353 or (929) 226-7161

2015 Better Living Report

Find a Doctor or Urgent Care

If you need special care or something not available at our Health Center, call these helpful phone numbers to find a doctor in network. Check out some of these other links too for help.

Find a doctor or urgent care center
Call (800) 553-9603 or visit Empire Blue Cross Blue Shield 

Find an eye doctor
Call (800) 999-5431 or visit Davis Vision

Find a dentist
Call (212) 501-4444 or visit EmblemHealth

Find a dentist (outside of NY Area):
Call (800) 624-2414

 

 

 

 

Benefits

Good health starts with knowing your benefits!

There are two versions of the New York Plan: 100A and 100B. Call us if you need help figuring out which plan you have: (866) 261-5676

New York Plan A (100A)

Download a copy of your “Benefits at a Glance.” 
This is an overview of your benefits, but some information may have changed.

Call us to double-check: (866) 261-5676

New York Plan B (100B)

Download a copy of your “Benefits at a Glance.” 
This is an overview of your benefits, but some information may have changed.

Call us to double-check: (866) 261-5676

 

View your SPDs here: Plan APlan B

After each SPD is published, certain changes may have been made to your benefits. These changes are reflected in a Summary of Material Modifications (SMM) that are mailed to each member. View these SMMs on our library page. (Click your plan button under "New York Region".)

Pharmacy

Hospitality Rx now manages your pharmacy benefits! Please view their website for more details.

Copays

  What you pay
When you use a network or mail order pharmacy
Certain preventive drugs/supplies $0
Generic drugs $1 copay
Preferred brand name drugs $15 copay
Non-preferred brand name drugs $30 copay
Specialty brand or biosimilar drugs (effective June 1, 2016) 25% coinsurance
($30 max copay)
Existing out-of-pocket limits continue to apply. Remember, Class II pharmacy benefits are limited to certain preventive drugs/supplies only.

Forms

Here are some forms you may want to print and fill out before you visit us in the Fund office. You may also mail some of them.

Call us if you need help understanding these forms: (866) 261-5676

Claim FormCoordination of Benefits

EnrollmentLife Insurance Beneficiary

 

Pharmacy forms

Appeal FormMail Order Form

Prior Authorization Initiation FormReimbursement Claim Form