Plan Documents


Thank You for being a Member of Health Pointe Direct Complete Plan (HMO I-SNP)

Appointment of Representative

Evidence of Coverage

HIPAA Privacy

HP Enrollment Form

Multi-Language Insert

Non-Discrimination

Summary of Benefits

Provider Directory

Annual Notice of Change

Prior Authorization

Criteria

Step Therapy

Criteria

Pharmacy Directory

Low Income Subsidy Premium Summary Table

Appeal Request Online Submission

Coverage Determination Request Online Submission

Direct Member Reimbursement

Rx Claim Form

Personal Medication List

Contact Us:

Toll-Free: 1.844.269.3442 

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 1-844-269-3442 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 1.844.269.3442 / TTY: 711

Health Pointe of New York is an HMO I-SNP with a Medicare Contract. Enrollment in Health Pointe of New York depends on contract renewal.

CMS Material ID: H1722_HPweb2019 | Last updated 01/17/2020

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