2023 Healthfirst Plans
Healthfirst has released affordable new 2023 plans for NY small businesses and not a moment too soon. The only non-profit Health Insurer owned by hospitals has kept market low rates with a modest 7% INCREASE for 2023. By integrating a Hospital/Provider medical approach Healthfirst has been successfully delivering value for the 5 boroughs.
About HealthFirst
Healthfirst had entered the small business market on Jan 1, 2017. Healthfirst is a provider-sponsored health insurance company that serves more than 1.4 million members in downstate New York and Nassau county. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NYS of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.
Value–Based Care Model
Providers are paid based on the quality and value of care they provide.
Value-based payments require providers to show that they’re meeting quality standards and benefiting patients.
Examples of Quality Standards
•Medication Adherence and Use
•Preventative Care and Cancer Screenings
•Avoiding Admission and Readmission to ER
•Member Satisfaction Measures
This model incentivizes providers to deliver quality care. Providers work together to make sure members receive the care they need when they need it, and from the provider best suited to provide it. Members are the focus.
The Healthfirst options include four Pro EPO plans with comprehensive benefits and pediatric dental and vision coverage that span all the metal tiers (Bronze, Silver, Gold, and Platinum). With Healthfirst plans, employees will have access to key features, including preventive and wellness visits (including annual checkups, vaccinations, and mammograms); a multilingual member services team; access to telemedicine via Teladoc; a robust choice of in-network doctors, specialists, hospitals, and urgent care centers; behavioral health and substance abuse services; coverage for acupuncture visits; and a user-friendly member portal that enables members to proactively manage their care.
Rate Trend 
2018: +4.8%
2019: +6.4%
2020: -4.7%
2021: +1.2%
2022: +4.1%
Value
- Members have access to a broad network of providers and dozens of industry-leading hospitals.
- Community locations throughout New York City, Long Island, and parts of Westchester.
- Dental and vision coverage, 24/7 telemedicine access, acupuncture, exercise reward programs.
All Metal Levels will be included for all size groups including 1-99 market. Referrals are not needed to visit a Specialist MD but one must select a Primary Care Physician on the enrollment form.
Network Overview:
Healthfirst will expand into Westchester and Rockland counties, effective January 1, 2023.
Healthfirst EPO Pro Network – Provider count expanded to 37,000 from 20,000 2 years ago. Geographic network coverage for NYC 5 Boroughs, Nassau/Suffolk, and Southern Westchester. 136+ Urgent Care locations and 60+ hospitals included. Examples:
| Hospital for Special Surgery | City MD Urgent Care |
| NY Columbia Presbyterian | Modern MD |
| NYU Langone | Urgent Care |
| Mt Sinai Health System | Northwell Go-Health |
| Montefiore | PM Pediatrics |
| Westchester Medical Center | Midtown NY Doctors |
| Maimonides | |
| NEW** Memorial-Sloan Kettering | Cure Urgent Care |
| Staten Island University Hospital | Riverdale Urgent Care |
| SUNY Stoneybrook | Throgs Neck Urgent Care |
| Northwell Health (formerly North Shore LIJ) | Statcare |
| Winthrop | Rapid MD |
| LI Health Network | Express Medical Care |
| Bon Secours | Excel Urgent Care |
Stats:
•60%of current groups are based in NYC and 39% are in Long Island
•Number of Long Island-based groups has increased by 63%over the past year
•Nassau (25%) and Manhattan (22%) are the counties with a higher proportion of active groups
•Suffolk has seen the highest growth in groups (139%) over the past year
60% of current groups are in the Professional and Business Services, Healthcare and Social Assistance, and Retail and Wholesale Trade sectors
Additional Features:
- Free 24/7 Telemedicine via Teladoc: Members can speak to a doctor anytime, anywhere, with a $0 copay. Telemedicine is accessed via phone call or video chat.
- Gym Reimbursement: Annual $400/member and $200/spouse reimbursement
- Acupuncture Covered Benefit
- CVS/Caremark: 7,998 CVS and 22,302 Local Pharmacies. †2X copay for Mail Order 90 days supply.
- Free Flu Vaccine
- Free HSA Account. Healthfirst will pay for set-up and monthly maintenance.
- Pro Plus EPO plans Option
- Dental – Preventive Care covering Dental Exam, X-Rays, Fillings †& Cleaning †every 6 months. Emergency Dental. Major Dental covering periodontal services, endodontic services plus 6 months follow-up care, and limited orthodontia.
- Vision – Exams, Lenses, Frames, or Contacts covered every 12 months
- Urgent Care: City MD, GoHealth, PM Pediatrics, ProHealthcare
- SHOP Credits: SMB groups can enroll in tax credit program directly with our Brokerage
- A business must have fewer than 25 employees
- Average salary must be less than $53,000 per year Health insurance coverage must be offered to all full-time employees *Based on the New York State of Health Small Business Health Options Program eligibility nystateofhealth.ny.gov/employer
DOCTOR SEARCH: CLICK HERE
2023 HEALTHFIRST PROVIDER NETWORK
2023 Healthfirst 1Q Rates