Affinity Health Plan

  • Deciding on a New Plan

    Call the insurer or visit the insurer’s website to make sure your doctor and other health care providers will be in the plan network next year.

    Check to make sure any prescription medications you or your family take will be covered.

    If you are totally disabled at the time your existing Affinity coverage terminates, you may be eligible for a limited extension of your benefits for covered care or treatment of the condition causing your disability. Only care or treatment related to your disabling condition is eligible for this extension of benefits. If you develop a new condition or if you have an accidental injury after your coverage terminates, then that condition or injury will not be covered. Contact Affinity to learn more about this benefit.

    If you are either: a) in an ongoing course of treatment with a provider for a life- threatening or a degenerative and disabling condition or disease; or b) in the second or third trimester of a pregnancy when your new coverage becomes effective, then you may be able to continue to receive care from your provider for up to 60 days from the date of your new enrollment (or through your pregnancy) under your new health insurance policy, even if your provider does not participate in your new health insurer’s network.

    To receive this transitional care, your provider must agree to accept as payment your new health insurer’s reimbursement for such services and to certain other conditions of providing care under the new policy. If your provider agrees, you will receive the services as if they were being provided by a participating provider and you will only pay for any applicable in-network cost-sharing. You, your representative or your provider should contact your new health insurer to determine if you are eligible for transitional care.

    Please note: This transitional care benefit is not available to Medicare enrollees who move to a Medicare Supplemental insurance policy, a Medicare Advantage plan or a Medicare Part D prescription drug plan.  

    Special information for Medicare enrollees:

    If you are currently a Medicare enrollee, you cannot purchase an individual health insurance policy from another insurer due to federal rules. However, you can supplement your Medicare benefits by purchasing a Medicare Supplement insurance policy and/or a Medicare Part D prescription drug plan. You may also purchase a Medicare Advantage Plan. You may purchase a Medicare Supplement insurance policy at any time during the year. The annual open enrollment period for Medicare Advantage plans and Medicare Part D prescription drug plans starts on October 15, 2017 and ends on December 7, 2017, so you can enroll in coverage effective January 1, 2018 at that time. To avoid a gap in coverage, you should enroll in Medicare Advantage or Medicare Part D with an effective date of January 1, 2018.

    You can purchase Medicare Supplement, Medicare Advantage or Medicare Part D products from any health plan in New York State that issues these products. Although Affinity does not offer Medicare Supplement policies or Medicare Part D prescription drug plans; Affinity offers comprehensive Medicare Advantage plans. If you would like to purchase a Medicare Advantage Plan, you can contact us toll-free at 1-877-234-4499.