Individual & Family Plans Personal Wellness Plan

Personal Wellness Plan is for Medicaid Managed Care members who may benefit from extra behavioral health or substance abuse services. It offers all the benefits of Medicaid, plus extra services like Community Support, Education and Employment, Peer and Family Supports, and Managing Crises.

Did you receive a letter from New York State about joining HARP? If you have questions about the letter you received, or need additional information about this plan, please call 1-855-725-3344

Plan highlights

  • Individual and group counseling
  • Crisis intervention services
  • Substance use disorder services
  • Continuing day treatment
  • Personalized recovery services
  • Assertive community treatment services
  • Access to home- and community-based services
  • 24/7 access to care with telemedicine (Teladoc)*

Costs and plan details

Premium
$0
Deductible (individual)
$0
Eligible Age
21 to 64
Eligible Service Areas
Within New York City's five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), on Long Island, and in Westchester, Orange, Rockland, and Sullivan counties
Other Eligibility Requirements
Enrolled in a Medicaid Managed Care plan
Identified by New York State as eligible for a Health and Recovery Plan
Maximum Out-of-Pocket (individual)
$0
For maximum out-of-pocket pharmacy copay information, visit NYRx, the Medicaid Pharmacy Program
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay
Maternity Care
$0 copay
Dental Cleanings
$0 copay
Vision Exams
$0 copay
Telemedicine (Teladoc)
$0 copay
Specialist Visit
$0 copay
Retail Health Clinic
$0 copay
Urgent Care
$0 copay
Emergency Room
$0 copay
Ambulance
$0 copay
Surgeon
$0 copay
Outpatient Facility
$0 copay
Inpatient Hospital Stay
$0 copay per admission

Additional benefits

24/7 access to telemedicine with Teladoc®

Talk to a doctor any time—for a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.

See better with Healthfirst vision benefits

Taking care of your eyes doesn’t just mean having clear vision. An annual eye exam can help detect a number of health risks, such as diabetes, thyroid disease, high blood pressure, and other conditions. Healthfirst has made it easy for our members to take advantage of this often overlooked preventive service by providing access to comprehensive vision care.

Dental care that keeps you smiling

Healthfirst believes that providing you with good dental care is important to your overall healthcare. Covered services include regular and routine dental services such as preventive dental checkups, cleanings, X-rays, fillings, and other services to check for any changes or abnormalities that may require treatment and/or follow-up care for you. You do not need a referral from your PCP to see a dentist.

In Lieu of Services (ILS)

ILS are services or settings that are not covered by Medicaid but are medically appropriate substitutes for covered services or settings.

Covered ILS Benefit: Psychiatric Admissions

You have covered care options than can be used instead of Inpatient Psychiatric services available in some hospitals.

The alternative care option is a short-term intensive stay in a private Institution for Mental Disease (IMD) licensed by OMH, available only at the following four facilities in the Healthfirst service area:

  • Four Winds Hospital (Westchester)
  • Gracie Square Hospital (NYC)
  • Brunswick Hospital Center (Long Island)
  • South Oaks Hospital (Long Island)

Plan documents

General plan information

•
  • Covered Services
Full list of approved preventive services

Prescription drug information

Medicaid NYRx drug look-up Medicaid NYRx benefits and coverage See all plan documents Find member forms

Helpful resources

Behavioral health resources NY State of Health Vaccine recommendations Women's preventive services guidelines Learn about Social Care Networks
  • Fairness Hearing Notice for Class Action Against the State Regarding CDPAP

Frequently asked questions

You may be eligible for Personal Wellness Plan—Healthfirst’s Health and Recovery Plan (HARP)—if you are:

  • 21 or older
  • Insured only by Medicaid
  • Eligible for Medicaid Managed Care

If you’re eligible for HARP, you’ll receive a letter from New York State or New York Medicaid Choice.

HARP is for Medicaid Managed Care members who may benefit from extra behavioral health or substance abuse services. It offers all the benefits of Medicaid, plus extra services like:

  • Community support
  • Education and employment
  • Peer and family supports
  • Managing crises

New York State will send you a letter if you’re eligible for Personal Wellness Plan. You have 30 days to opt out or choose a different HARP. After 30 days, you’ll be enrolled in Personal Wellness Plan.

Disclaimers

The benefit information provided is a brief summary, not a complete description, of benefits. For more information, contact the plan.

Coverage is provided by Healthfirst PHSP, Inc.
Plans contain exclusions and limitations.

ATENCIÓN: Dispone de servicios de asistencia lingüística y otras ayudas, gratis. Llame al 1-866-305-0408 (TTY: 1-888-867-4132).

请注意：您可以免费获得语言协助服务和其他辅助服务。请致电 1-866-305-0408 (TTY: 1‑888‑542‑3821)。

*Telemedicine (Teladoc) isn't a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).

Learn about enrollment

Call to speak with a sales representative
1-844-434-7785

TTY English: 1-888-542-3821

TTY Español: 1-888-867-4132

Monday to Friday, 9am–6pm

Request a call

Our sales team will call you within one business day.

Request a call
Schedule an appointment

We can help you enroll by phone, video chat, or in person.

Schedule an appointment

Looking for in-person help?

Visit a neighborhood Community Office near you to talk to us in person, and take care of your health insurance needs.

You can also go to the NY State of Health website to view your choices, or call the NY State of Health customer service center at 1-855-355-5777.

Questions? Ready to enroll?
Let's talk

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