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Healthfirst Health Insurance Review – Rates, Forms, Doctors & Benefits [2020/21 for NYC & Long Island]

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Healthfirst Health Insurance Review – 2020 & Beyond (Constantly Updated)

“Is HealthFirst good?”;

“Is HealthFirst Medicaid?”;

“What kind of insurance is the First Health network?”;

“Does HealthFirst cover braces or implant?”

We will try to use this article to provide the most accurate answer to all your Healthfirst Insurance related questions & concerns.

Most importantly, we want you to get the maximum benefits from your insurance plan.

If you have any additional question, feel free to comment below or email us at

First Health (Coventry) or HealthFirst or Health First?

What kind of insurance is the First Health? or What is First Health network, stop here, you are looking at a similar name but unrelated company.

The First Health with a heart shape logo company, this is a company that was acquired by Coventry, which later got acquired by Aetna in 2013.

If you are looking for Health First with space in between, click here instead.

This article is about HealthFirst insurance, based in New York.

Healthfirst is a provider-sponsored health insurance company that serves more than 1.4 million members in downstate New York & Long Island.

Healthfirst offers top-quality MedicaidMedicare Advantage, Child Health Plus, Managed Long Term Care plans.

Healthfirst offers Leaf individual health plan and Essential Plan on the NY State of Health Exchange Marketplace. (Both of these plans are subsidized by NY State)

Healthfirst Total plan is an unsubsidized full cost EPO insurance for individuals.

Healthfirst Pro and Pro Plus (Inclusive of Dental) EPO plans for small-business owners and their employees.

This article is about Healthfirst Pro & Pro Plus plan.

  • Is HealtFirst good or suitable for you?
  • Healthfirst’s pro & cons,
  • Healthfirst’s EPO Pro plan specific coverage details
  • What is the difference between the leave plan, EPO & EPO Plus Plan
  • how to Make Payment online or over the phone,
  • it’s Frequently Used Forms,
  • links to locate or Find a Doctor (click “Search Providers”)and many more.

Healthfirst Health Insurance Review


Healthfirst Health Insurance Rate Proposed Increase of 5% in 2021

2021 Proposed Group Rate Increase

* Based on Downstate Metro NYC and Long Island

2020 2nd Quarter Group Health Insurance (w/o Doctor Deductibles)
[Scroll down for 3rd Quarter (Jul, Aug, Sep) 2020 Rate]

Click Each Company Logo to Learn More AboutClick below to see if your doctor is inWhat we recommend forClick Any Price to See Full Rate Sheets
Hello How are you?Emblem Doctor NetworkHMO Select (NYC)$517.55$608.56$710.57$894.18
Hello How are you?Emblem Doctor NetworkHMO Select (L.I.)$588.71$692.23$808.26$1017.11
Hello How are you?Emblem Doctor NetworkHMO Prime (NYC)$605.85$711.56$830.08$1043.37
Hello How are you?Emblem Doctor NetworkHMO Prime (L.I.)$689.14$809.39$944.19$1186.82
oxford-group-health-insuranceOxford Doctor NetworkEPO$551.86$653.68$786.02$935.14
Healthfirst-insuranceHealthfirst Doctor NetworkEPO$502.50$617.52$709.07$868.00
Healthfirst-insuranceHealthfirst Doctor NetworkPro Plus(Dental) EPO$520.09$639.14$733.88$898.38
oscar-group-health-insuranceOscar Doctor NetworkEPO$563.29$754.37$856.83$966.72
empire-bcbs-insuranceEmpire Doctor NetworkEPO$742.89$884.70$1083.57$1252.20
empire-bcbs-insuranceEmpire Doctor NetworkPPON/A$1061.98$1225.28$1582.32
empire-bcbs-insuranceOxford Doctor NetworkPPO$708.70$904.42$1103.74$1317.97
empire-bcbs-insuranceAetna Doctor NetworkEPO$650.92$715.27$878.61N/A

2020 3rd Quarter Group Health Insurance (w/o Doctor Deductibles)

Click Each Company Logo to Learn More AboutClick below to see if your doctor is inWhat we recommend forClick Any Price to See Full Rate Sheets
Hello How are you?Emblem Doctor NetworkHMO Millennium (NYC)$526.35$618.91$722.65$909.38
Hello How are you?Emblem Doctor NetworkHMO Millennium (L.I.)$598.72$704.00$822.00$1,034.40
Hello How are you?Emblem Doctor NetworkHMO Prime (NYC)$616.15$723.66$844.19$1,061.11
Hello How are you?Emblem Doctor NetworkHMO Prime (L.I.)$700.86$823.15$960.24$1,207.00
oxford-group-health-insuranceOxford Doctor NetworkEPO$565.43$669.75$805.35$958.14
Healthfirst-insuranceHealthfirst Doctor NetworkEPO$510.54$627.40$720.42$881.89
Healthfirst-insuranceHealthfirst Doctor NetworkPro Plus(Dental) EPO$528.41$649.37$745.62$912.75
oscar-group-health-insuranceOscar Doctor NetworkEPO$570.45$763.95$867.71$979.00
empire-bcbs-insuranceEmpire Doctor NetworkEPO$757.75$902.39$1,105.24$1,277.24
empire-bcbs-insuranceEmpire Doctor NetworkPPON/A$1,083.22$1,249.79$1,613.96
empire-bcbs-insuranceOxford Doctor Network PPO$726.13$926.65$1,130.88$1,350.38
empire-bcbs-insuranceAetna Doctor NetworkEPO$670.22$736.48$904.66N/A

HealthFirst Rate Increase/Decrease Trend

Yes, decrease. Healthfirst actually reduced it’s Small Group health insurance premium rate by 4.7 in 2020.

Hence, it is the most competitively priced insurance carrier in the entire New York.

2018:  +4.8%

2019:  +6.4%

2020:  -4.7%

2021:  +5.5% (Pending Request with NY DFS)

Healthfirst is not suitable for (Upstate NY & maybe Suffolk County residents) …

Healthfirst network is limited to NY downstate. – The 5 Boroughs, (i.e. Manhattan, Brooklyn, Queens, Bronx & Staten Island) plus Nassau County.

Healthfirst partnership with Northwell, aka (NSLIJ or CareConnect) in Nassau County. 

Hence, it made them one of the best value insurance providers for Nassau County Residents. (Click to check your hospital/doctors) is in-network. This is very important as all of HealthFirst insurance plans are EPO, hence, not out of network coverages. (If you need to know more about the different types of insurance plans, click here.)

In Suffolk county,  hospital/doctor networks are only limited to the 5 hospitals in Suffolk County. 

The 5 in-network hospitals of NSLIJ/Northwell are (as of 6/10/2020):

If HealthFirst added more Suffolk doctors & notably hospital networks in the future, we will surely update it here.

The biggest missing piece (i.e. the largest Healthcare providers network) in Suffolk County is the Stoney Brook Medicine group.

Hence, if your doctor is within that group, please don’t consider HealthFirst unless you are willing to switch doctors.

Now, we got the uglier part of the way,  we can see if it is right for you?

Is HealthFirst Health Insurance Good?

What is the definition of Good? It really depends. 

As all HealthFirst plans are EPO, hence, it is obviously not as good as the PPO plan. (Only UHC/Empire BCBS has PPO plans in NY & the entire USA).

However, if all your doctors are in-network, and you don’t travel much, given the reasonable 5.5% requested increase for 2021, HealthFirst insurance seems like a good choice to save some money.

We all know that COVID-19 has done terrible things to NY state, but I still don’t want to pay for a 21.1% (OSCAR) increase my insurance premium.  Emblem (HIP)’s 20.9% & Aetna 19.6% request sure makes Healthfirst look good.


The background of the company & why it matters to you?

HF-Is-medicaid-Initially-Medicaid -Provider

HF started off Initially as a Medicaid Provider

For most people, if you just type Healthfirst into a Google search bar, you will see that the first thing Google suggested is, about their Medicaid plan, as Healthfirst, is original, a Medicaid provider. 

Healthfirst Medicaid & Essential Plan which we don’t represent…

I am sorry to inform you that, Healthfirst may be a very good Medicaid & Essential plan provider, but, it is not something we have the right to represent, so I can only ask you to click on the link about to find more about the plan yourself. The company has grown about 5 fold in terms of membership count to 1.2 million members in downstate New York since their CEO Pat Wang told the helm from 2008.

Pat Wang (Healthfirst CEO)

Healthfirst Plan Highlights

All Plans of Healthfirst

Healthfirst 2020 SBC (2021 version expected to be the same)

Platinum Pro EPO

Gold Pro EPO

Gold 20/50/0 Pro EPO

Silver Pro EPO

Silver 40/75/4700 Pro EPO

Bronze Pro EPO

Bronze Pro 6650 EPO

Bronze Pro 8150 EPO

Click below image for all of Health First Services Center

Healthfirst is well known in offering Medicaid, Child Health Plus, and Managed Long Term Care aka Medicare/Medicaid plans.

It is traditionally a strong player in the low-income market. Healthfirst has expanded to Nassau county through partnering with Greatneck based Northwell Health, or what used to be known as NSLIJ.

Click Here For Chinese Version 點擊此處閱讀中文版

Healthfirst Group Insurance Payment Address

Healthfirst Pay Online (Group)

Please click the link above and call Healthfirst to access your Online Payment Account.

Monday to Friday, 9 am-5 pm

We suggest you issue a month schedule payment directly from your Bank, most larger banks (i.e. Chase, City, TD &, etc) have that service for free.

It is better off to set up a monthly recurring payment online, (with the below address & your Group ID). That way, you can track all your expenses from one place.

Healthfirst Insurance Company
PO Box 13831
Philadelphia, PA 19101-3831

Pay By Phone

It can be done by calling Employer Service: Call 1-855-949-3668 to pay over the phone directly

Or you can mail the check to :

Healthfirst Insurance Company
PO Box 13831
Philadelphia, PA 19101-3831

Healthfirst Bill/Invoice

Healthfirst doesn’t send bills through emails.

They will need to register for an employer portal with their email address in order to access online billing and see their invoices.

Here is the registration link –

Healthfirst Pay Online (Individual)

For healthfirst individual payment, click the link above

Chinatown Locations, Harlem?

Does the Healthfirst service center location scream immigrants to you? It does. they are traditionally a very strong player in the lower-income segment.

In fact, there are very well known in the Medicaid & Medicare/Medicaid plans to offer. In fact, being 5 stars in Medicare Healthfirst started from Medicaid managed care & eventually expanded to Medicare and has been getting rave reviews from doctors & even users alike.

Since about 2 years ago, there have started also selling full-price commercial insurance for groups.

Their commercial group plan offering is relatively new.

Healthfirst started offering commercial plans starting in 2017. I have met many clients who didn’t know about this. The plans offered are Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.

Healthfirst’s Pro & Con.

The pro is, if you are an immigrant, Healthfirst is very immigrant-friendly with many doctors speaking a second language.

Healthfirst Pro.  Healthfirst is the NY minority population preferred insurance provider?

If you don’t know, the majority of the NY population is the minority. So Healthfirst is as famous as Metro Plus, which is an insurance company specializing in low-income insurance.

After CEO Pat Wang took office (2008-2018, he also an immigrant), the company’s business grew five times.
You can see Healthfirst service is getting worse and worse (Five-star rate is 1-2 years before).
Maybe it is because most of their clients are individual or just walking in or contact them via phone, and the staffs are lack of experience, so they did not give the customer satisfaction service.
We searched & was very surprised to find out that there are no Japanese Doctors within the Zip Code.
On the contrary, we can get 11 pages of Japanese Doctor by searching another carrier doctor with Cigna 
Healthfirst has a very good relationship with doctors. From what I know, So doctors like this company. But policies often change.
So even if the clients convert the insurance company, they still need us. Because we are the bridge between clients and the insurance company.
I believe that most of you who read these articles are interested in an individual health plan. Perhaps most people don’t know Healthfirst also selling the group health plan.
Just like a restaurant, when it is just opened, both the service and the product are good, but after a long time, the quality may be difficult to guarantee. Just like the group plan of Healthfirst. So far it good, but it is hard to say later. And the above comments are all about the individual plan.

Healthfirst Review

Let’s review Healthfirst from three places:

BBB Reviews

Rating from BBB itself is questionable.  (click to read why?).

You really need to read the real user reviews, it wasn’t good really due to the fact that those are review left from people mostly on their Medicaid, Medicare, or Dual Plans.

As I mentioned earlier, HealthFirst was a traditional Medicaid provider. Hence, it is uncommon for the employee to not treat their clients on Medicaid with full respect.

However, that is beyond what I can say. From many of my clients who have been on the plans for about 2 years now, there are very happy with their treatment and reimbursement issue.

Yelp reviews (1-2 stars?)

Yelp reviews also have been around for a good while, hence, many or most of their negative reviews are also from their legacy Medicaid, Medicare & Dual product lines.
The 2019 review we are providing here for their Group plan, hence, wait for it, for our final review in the end.

Yelp’s review does bring up a very valid point. Healthfirst has been expanding so quickly and in fact, just this last week, we have a meeting with Healthfirst management and was being told that there are upgrading the system backend. Hence… see below. (See a screen capture from our interaction with Healthfirst)
Our Client Dr. Yu, who is one of our Heallthfirst Groupp plan client that has been been using their plan for a while told us that one of the employee is missing from the group renew list.

Our Client Dr. Yu, one of our Healthfirst Group plan client told us that one of the employees is missing from the group renew list.

I do foresee technical error to plague them for a little while longer. Do bookmark this page so that you will receive the most current updates.
For complete reviews of Healthfirst from Yelp, click on the link below

Google MyBusiness Reviews

Last but not least, Google My Business review. Click below to get an understanding of how Google’s doing review services.

Google base their review on each local office. Hence, when you click on the link above, you will see there are varying reviews from better to worst. We took the review from Healthfirst Corp Office.

Click to read more
Healthfirst Health Insurance Google Review
Healthfirst Health Insurance Review


Healthfirst Infertility Treatment

We Cover services for the diagnosis and treatment (surgical and medical) of infertility when such infertility is the result of malformation, disease or dysfunction. Such Coverage is available as follows:

1. Basic Infertility Services. Basic infertility services will be provided to a Member who is an appropriate candidate for infertility treatment.

In order to determine eligibility, We will use guidelines established by the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, and the State of New York.

However, Members must be between the ages of 21 and 44 (inclusive) in order to be considered a candidate for these services.

Basic infertility services include:

• Initial evaluation;

• Semen analysis;

• Laboratory evaluation;

• Evaluation of ovulatory function;

• Postcoital test;

• Endometrial biopsy;

• Pelvic ultrasound;

• Hysterosalpingogram;

• Sono-histogram;

• Testis biopsy;

• Blood tests; and

• Medically appropriate treatment of ovulatory dysfunction.

Additional tests may be Covered if the tests are determined to be Medically Necessary.

2. Comprehensive Infertility Services. If the basic infertility services do not result in increased fertility, We Cover comprehensive infertility services.

Comprehensive infertility services include:

• Ovulation induction and monitoring;

• Pelvic ultrasound;

• Artificial insemination;

• Hysteroscopy;

• Laparoscopy; and

• Laparotomy.

3. Exclusions and Limitations. We do not cover:

• In vitro fertilization, gamete intrafallopian tube transfers or zygote intrafallopian tube transfers;

• Costs for an ovum donor or donor sperm;

• Sperm storage costs;

• Cryopreservation and storage of embryos;

• Ovulation predictor kits;

• Reversal of tubal ligations;

• Reversal of vasectomies;

• Costs for and relating to surrogate motherhood (maternity services are Covered for Members acting as surrogate mothers);

• Cloning; or

• Medical and surgical procedures that are experimental or investigational, unless Our denial is overturned by an External Appeal Agent.

All services must be provided by Providers who are qualified to provide such services in accordance with the guidelines established and adopted by the American Society for Reproductive Medicine.

L. Infusion Therapy.

We Cover infusion therapy which is the administration of drugs using specialized delivery systems that otherwise would have required You to be hospitalized.

Drugs or nutrients administered directly into the veins are considered infusion therapy. Drugs taken by mouth or self-injected are not considered infusion therapy.

The services must be ordered by a physician or other authorized Health Care Professional and provided in an office or by an agency licensed or certified to provide infusion therapy. Any visits for home infusion therapy count toward Your home health care visit limit.

Healthfirst Acupuncture and Physical Therapy

Acupuncture: unlimited and no deductible

Physical Therapy is 60 visits as indicated on all of our small group plan Summary Benefit Coverage.

Please click the button below for more information about:

Healthfirst Login

Healthfirst Medicaid

Healthfirst Pay Online (Please call Healthfirst to access your Online Payment Account)

Pay By Phone (It can be done by calling Employer Service): Call 1-855-949-3668 to pay over the phone directly

Or you can mail the check to :

Healthfirst Insurance Company
PO Box 13831
Philadelphia, PA 19101-3831

How do I contact Healthfirst Health Insurance?

Healthfirst is here for you, with multiple resources to answer your questions. The fastest way to get the answers you need is usually online, but we’re also available to talk to you over the phone or in-person at Healthfirst Community Offices.


Other Healthfirst Websites (For general information) (Login to your secure Healthfirst account; pay your bill) (Find a doctor, specialist, or hospital) (Check the cost of a service or procedure) (View a list of our locations)

To make payment by Mail to Healthfirst & other correspondence

General Member Correspondence
Healthfirst Insurance Company P.O. Box 1566
New York, NY 10274-1566
Medical Claims
Healthfirst Claims Department P.O. Box 958438
Lake Mary, FL 32795-8438
To Request an External Appeal Application
New York State Department of Financial Services One Commerce Plaza
Albany, NY 12257 1-800-400-8882,
CVS Pharmacy Mail Order Prescription Service (only)
P.O. Box 2110, Pittsburgh, PA 15230-2110


Healthfirst Group Member Services (Medical, dental, vision, and behavioral health benefits)
Monday to Friday, 8 am–6 pm English TTY 1-855-779-1033 Spanish TTY 1-855-779-1034
Healthfirst Individual Care Management Department
Monday to Friday, 8 am–6 pm English TTY 1-855-779-1033
Healthfirst General Pharmacy Services
(For help with your prescriptions)
CVS Pharmacy Mail Order Prescriptions Service (only)
Monday to Friday, 8 am–8:30 pm
Exercise Rewards – Gym Reimbursement
Monday to Friday, 8 am–9 pm
Active&Fit Direct – Gym Membership
Monday to Friday, 8 am–9 pm
Chiropractic Services
Monday to Friday, 8 am–9 pm
Teladoc – Telemedicine
1-800-Teladoc (835-2362) 24/7 Service

Healthfirst Health Insurance 2020 Underwriting

It’s an abbreviated version of our full underwriting guidelines that lets you easily look up key elements of our plans, including:

  • Accepted tax forms
  • Renewal deadline/requirements
  • Enrollment/termination rules
  • Audit requirements
  • Member add/term billing rules
  • And more

Click for 2020 Underwriting Guidelines Quick Reference Guide (PDF)

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