Hospitals covered throughout New York State
Emergency Services (given in an emergency room of urgent care facility).
We cover medically necessary prescription drugs that, except as specifically provided otherwise, can be dispensed only pursuant to a prescription and are:
• Required by law to bear the legend “Caution — Federal Law prohibits dispensing without a prescription”;
• FDA approved;
• Ordered by a Provider authorized to prescribe and within the Provider’s scope of practice;
• Prescribed within the approved FDA administration and dosing guidelines; and
• Dispensed by a licensed pharmacy.
We cover inpatient hospital services for acute care or treatment given or ordered by a health care professional for an illness, injury or disease of a severity that must be treated on an inpatient basis
We cover adult immunizations as recommended by ACIP. This benefit is not subject to copayments or coinsurance when provided in accordance with the recommendations of ACIP.
June 2019 Meeting Recommendations*
Hepatitis A Vaccines
Serogroup B Meningococcal (MenB) Vaccines
You are eligible for a physical examination once every calendar year, regardless of whether or
not 365 days have passed since the previous physical examination visit. This benefIt is not subject to Copayments, or Coinsurance when provided in accordance with the comprehensive guidelines supported by HRSA and items or services with an “A” or “B” rating from USPSTF.
Mental health service and drug or alcohol addiction treatment (treated as any other medical illness).
In addition, your vision care benefits include:
One annual eye exam per year
Other diagnostic exams performed by an eye doctor
Lenses or contacts once a year (more often if medically necessary
Frame one time per year unless there is a medical need.
There is an additional cost for the Essential Plan Plus ranging from $30 to $46 per month per person.
Dental coverage is both for preventative care and routine care. If you sign up for the plus plan your oral care benefits include:
Two Cleanings per year
Oral Exams including X-rays
*Only free for Essential Plan 3 and 4
Gym membership. You can get reimbursed up to $400 per plan year. That’s $200 for each six-month enrollment period when you attend the gym at least 50 times.