H5989 Plan Documents


Annual Notice of Change

(ANOC)

Summary of Benefits

(SB)

Evidence of Coverage

(EOC)

Low Income Subsidy (LIS) Premium Table

Multi-Language Interpreter Services

Medicare Plan Ratings

Appeal/Redetermination Request Form

Coverage Determination Request

Prior Authorization Criteria

Direct Member Reimbursement RX Claim Form

Personal Medication List

Contact Us:

Toll-Free: 1.888.201.4342 

TTY: 711

Mailing Address:

Health Pointe of New York

810 Seventh Avenue - Suite 801

New York, New York 10019

Please contact our Member Services number at 1-888-201-4342 for additional information. (TTY users should call 711.) From October 1 to March 31, we are open 7 days a week, from 8 a.m. to 8 p.m. EST. From April 1 to September 30, we are open Monday through Friday, from 8 a.m. to 8 p.m. EST.

We do not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, sex, gender identity, age or disability in our health programs and activities.

ATENCION: Si habla español, tiene a su diposicion servicios gratuitos de assistencia linguistica. Llame a 1.888.201.4342 / TTY: 711

Health Pointe Direct Complete Plan (HMO I-SNP) is a Health Plan with a Medicare Contract. Enrollment in Health Pointe HMO I-SNP depends on contract renewal.

CMS Material ID: H5989_HPweb2019 | Last updated 12/10/2019

Health Pointe of New York COVID-19 Statement – H1711

Health Pointe of New York is closely monitoring the COVID-19 (Coronavirus) outbreak.

Click on the following links for the most up-to-date information from NYC.gov and The New York State Department of Health websites.

If you have any questions, please call Member Services at 844-269-3442.

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