Healthfirst Health Insurance Review - Rates, Doctors & Benefits NY 2020

This article is about HealthFirst insurance which is based in New York. Specifically, the company is related to small group health insurance with non-subsidized insurance plans starting at $500/month.

We are also authorized to represent individuals over 65 as Medicare/Medicaid or Dual plan members, but Medicare related material has some serious mumbo jumbo laws governing them. If you are over 65, feel free to call us at 1-212-484-6888 ,or if you are looking for free Medicaid insurance, stop right here and call 1-844-708-3699.

Healthfirst Health Insurance Review – 2022 & Beyond (Constantly Updated)

點擊此處閱讀中文版

“Is HealthFirst good?”

“Is HealthFirst Medicaid?”

“What kind of insurance is First Health?”;

“Does HealthFirst cover braces or implants?”

“Does Healthfirst cover Infertility Treatment?”

Healthfirst covers 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 investigation, unless our denial is overturned by an External Appeal Agent.

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

I. Infusion Therapy.

We cover infusion therapy, the administration of drugs using specialized delivery systems that otherwise would have required hospitalization.

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 healthcare professional and provided in an office or by an agency licensed or certified to provide infusion therapy. Any visits for in-home infusion therapy count toward your home health care visit limit.

Does HealthFirst Group Insurance cover abortion?

Yes, it’s a NY State law. All plans cover elective abortion (2020 plan documents). Independent Health (21): All plans cover elective abortion.

Unlike Oxford Health, the most popular group health insurance carrier in New York state, HealthFirst has so many types of plans within their Healthy NY Plans.

All of HealthFirst’s group plans have the same benefits as Oxford Health, and you can add on an elective Dental & Vision coverage with the ProPlus plan.

Healthfirst Acupuncture and Physical Therapy

Both Acupuncture and chiropractic are covered benefits. There is actually NO restriction on number of times.

Acupuncture: unlimited with no deductible

Physical Therapy is covered up to 60 visits as indicated on the Benefits summary of all of our small group plans.

At Healthfirst, we do things differently by actually outlining everything that is or is not covered by the policy.

The rationale is that if a plan doesn’t cover the most important things you need, this plan is worthless no matter how cheap it is.

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

If you have any additional questions, feel free to comment below or email us at [email protected]

HealthFirst’s Past and Future Rates

To put things into perspective, Healthfirst insurance decreased their rates by 5% in 2020 and have maintained this decrease throughout the COVID-19 pandemic when others saw the opportunity to increase in price.

Futhermore, 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)

The Story of Healthfirst

Healthfirst Inc. was established as a not-for-profit, managed care organization by a coalition of hospitals under the Greater New York Hospital Association in 1993.

The GNYHA VP that was tasked with this grassroots effort was none other than Pat Wang, the current CEO leading Healthfirst.

In little more than 25 years, it has grown to be New York’s largest not-for-profit health insurer.

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

The Background of the Company & Why It Matters

Healthfirst has grown 5 fold in membership to over 1.2 million members in downstate New York since their CEO Pat Wang has held the helm in 2008.

Healthfirst is not suitable for Upstate NY & maybe Suffolk County residents..

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

Healthfirst partners with Northwell, aka NSLIJ or CareConnect, to work in Nassau County.

Healthfirst is recognized as one of the best value insurance providers for Nassau County Residents. Click here to check if your hospital/doctors are in-network. This is very important as all of HealthFirst insurance plans are EPO, therefore, there is no out-of-network coverage. (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 and 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.

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

Now that the uglier part is out of the way, let’s see if HealthFirst is right for you.

Memorial Sloan Kettering (MSK) Hospital is in-network

Is HealthFirst Health Insurance Good?

What is the definition of Good? It really depends.

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

However, if all of your doctors are in-network, and you don’t travel much, given the reasonable 5.5% requested increase for 2022, 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‘s 19.6% increase requests sure make Healthfirst look good.

Healthfirst Plan Highlights

All Plans of Healthfirst

Healthfirst 2020 SBC (2022 version expected to be the same)

Silver 40/75/4700 Pro EPO

Bronze Pro EPO

Bronze Pro 6650 EPO

Bronze Pro 8150 EPO

HealthFirst service centers updates (yes, all are still closed)

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

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

As a broker for HealthFirst, we can only help sign up a new account for their group plans & individual Medicare clients.

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

Healthfirst Formularies

Click here to check Healthfirst formularies

Healthfirst Group/Individual Insurance Payment

Healthfirst Pay Online (Group)

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

Employers:
1-855-949-3668
Monday to Friday, 9 am-5 pm

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

It is better 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

Healthfirst Pay By Phone (Group)

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

Healthfirst Pay By Mail (Group)

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

Healthfirst Bill/Invoice (Group)

Healthfirst does not send bills through emails.

They will need you to register for an employer portal with your email address to access online billing and see invoices.

Here is the registration link – https://www.myhfgroup.org/registration

Healthfirst Pay Online (Individual)

Please wait until you receive the confirmation letter from NYSOH.

If you want to make payment before you receive the letter, please call 888-250-2220 to get your member ID.

You need to register for a new account to make payment.

Healthfirst Pay By Phone (Individual)

It can be done by calling Employer Service: Call 1-844-347-5815 to pay over the phone directly

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, they are very well-known because of the Medicaid & Medicare/Medicaid plans they offer. Healthfirst was rated 5 stars in Medicaid managed care, eventually expanding to Medicare and has been getting rave reviews from doctors & even users alike.

Since about 2 years ago, they’ve also started selling full-price group commercial insurance.

HealthFirst’s Commercial Group Plans

Healthfirst started offering commercial plans 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 Pros and Cons

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

Healthfirst is Preferred by Minorities

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

After CEO Pat Wang took office (2008-2018, also an immigrant), the company’s business grew five times.

Recently, Healthfirst has received poorer ratings than before.

Maybe it is because most of their clients are individuals or just walking in or contact them via phone, and the staff may lack of experience, so they did not give the customer satisfactory service.

We searched and were 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 Doctors by searching another carrier doctor with Cigna

Healthfirst has a very good relationship with doctors. From what I know, 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 that Healthfirst is 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’s good, but it is hard to predict the future. The below comments are all about the individual plan.

Healthfirst Review

Let’s review Healthfirst from three places:

BBB Reviews

Ratings from the BBB itself are questionable. (click to read why?).

You really need to read the real user reviews which weren’t completely accurate as the reviews were left from people mostly on 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, they are very happy with their treatment and reimbursement issue.

I do foresee technical errors that may continue to plague them for a little while longer. Bookmark this page so that you receive the most current updates.

For complete reviews of Healthfirst from Yelp, click on the link below:

Google Business Reviews

Last but not least, Google Business reviews should be considered in this commentary. Click below to get an understanding of how Google does reviewing services.

Google bases 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

Online

Other Healthfirst Websites

healthfirst.org (For general information)

MyHFNY.org (Login to your secure Healthfirst account; pay your bill)

HFDocFinder.org (Find a doctor, specialist, or hospital)

HFCostLookUp.org (Check the cost of a service or procedure)

healthfirst.org/community-offices (View a list of our locations)

To Make a 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, dfs.ny.gov

CVS Pharmacy Mail Order Prescription Service (only)

P.O. Box 2110, Pittsburgh, PA 15230-2110

Phone

Healthfirst Group Member Services (Medical, dental, vision, and behavioral health benefits)

1-855-949-3668
Monday to Friday, 8 am–6 pm English TTY 1-855-779-1033 Spanish TTY 1-855-779-1034

Healthfirst Individual Care Management Department

1-855-789-3668
Monday to Friday, 8 am–6 pm English TTY 1-855-779-1033

Healthfirst General Pharmacy Services
(For help with your prescriptions)

1-800-364-6331

CVS Pharmacy Mail Order Prescriptions Service (only)

1-800-378-5697
Monday to Friday, 8 am–8:30 pm

Exercise Rewards – Gym Reimbursement

1-877-810-2746
Monday to Friday, 8 am–9 pm

Active&Fit Direct – Gym Membership

1-877-810-2746
Monday to Friday, 8 am–9 pm

Chiropractic Services

1-800-678-9133
Monday to Friday, 8 am–9 pm

Teladoc – Telemedicine

1-800-Teladoc (835-2362) 24/7 Service

Healthfirst Health Insurance 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)

HealthFirst or First Health (Coventry) or Health First?