|
Benefit Package
The Healthy NY benefit packages, which are streamlined, consist of health benefits that cover essential health needs including:
inpatient and outpatient hospital services, physician services, maternity care, preventive health services, diagnostic and x-ray services, and
emergency services. Applicants may choose a benefit package with or without a limited prescription benefit.
Keep in mind....
- Even though Healthy NY benefit packages are the same, the health plans may charge different premium rates
- Once you have chosen which type of benefit package you want - with or without the prescription drug benefit - you will not be able to
change your choice of benefit package until your annual recertification or if your premium rate changes
- Covered services are subject to a copayment. All benefits are provided "in-network" only, except for emergency services or where care
is not available through a health care plan’s providers. Otherwise, you must use a health care plan’s network of providers
Covered Services Include the Following:
- New! Diagnostic screening for prostate cancer for men
- New! Coverage for home health care for up to 40 post-hospital or post-surgical visits in a calendar year
- New! Coverage for 30 post-hospital or post-surgical visits per calendar year for physical therapy
- Inpatient hospital services consisting of daily room and board, general nursing care, special diets
and miscellaneous hospital services and supplies
- Outpatient hospital services consisting of diagnostic and treatment services
- Physician services consisting of diagnostic and treatment services, consultant and referral services, surgical services
(including breast reconstruction surgery after a mastectomy), anesthesia services, second surgical opinion, and a second opinion
for cancer treatment
- Outpatient surgical facility charges related to a covered surgical procedure
- Pre-admission testing
- Maternity care
- Adult preventive services consisting of mammography screening, cervical cytology screening, periodic physical examinations no more than
once every three years, and adult immunizations
- Preventive and primary health care services for dependent children including routine well-child visits and necessary immunizations
- Equipment, supplies and self-management education for the treatment of diabetes
- Diagnostic x-ray and laboratory services
- Therapeutic services consisting of radiological services, chemotherapy and hemodialysis
- Blood and blood products furnished in connection with surgery or inpatient hospital services
If the prescription drug benefit is selected:
- Prescription drugs obtained at a participating pharmacy ($3,000 maximum per person, per year)
Copayments and Deductibles
If you choose the benefit that includes prescription drug coverage, there is a $100 annual deductible for prescription drugs.
This deductible amount is the same for each health plan.
If you enroll in the Healthy NY High Deductible Health Plan Option, any money that you spend on copayments for preventive
services cannot be applied towards your plan deductible. If you enroll in the Healthy NY High Deductible Health Plan Option and you
choose the prescription drug benefit, then the $100 prescription drug deductible does not apply.
|