Affinity Health Plan

    • 2016 HepC Treatment

      Hepatitis C Coverage Expansion

      Affinity Health Plan has recently expanded coverage of Hepatitis C treatment.

    • QHP Welcome Banner - Young Woman at Coffee Shop

      Welcome New Members!

      Thank you for choosing Affinity. Now that you’ve enrolled in an AffinityAccess Plan, here’s what you will need to know.

    • QHP Members

      Renew your health plan today!

      Make sure your health coverage continues without a break. New this year: lower premiums & a larger network!

    • 2017 Rate Change

      2017 QHP Premium Rate Change

      Due to the rising cost of providing our members’ care

    • Learn About Your Urgent Care Options: You Have Choices

      When an Urgent Care Center is Best

      Urgent Care Centers are faster and less expensive than Emergency Rooms. But, when is Urgent Care a better choice? Learn what makes sense.

  • Customer Service

    Have a question about how your plan works? Don’t see what you’re looking for? We’re here to help!

    Call Us:
    (888) 543-6973 | Fax: (718) 536-3386
    TTY/TDD: (800) 662-1220

    Mon-Fri: 8:00 AM - 7:00 PM EST

    Sat: 8:00 AM - 4:30 PM EST

    Visit an Affinity Community Service Centers (CSC)

    Access Your Account Online

    Set up and manage your personal account options, including:

    • View/pay your monthly bill
    • Schedule automatic payments
    • Select/change your PCP
    • Print a temporary ID card
    • Review your benefits
    Log in or create an account
    Payment Options
  • Healthy Streets Spring/Summer 2015

    Member News & Alerts

    • Hepatitis C Treatment

      Expanded coverage for Hepatitis C Treatment Learn More

    • Affinity Blog

      Get the latest health information and tips on healthy living. Read the latest post

    • Key Enrollment Dates More

      • November 1, 2016: Open enrollment starts for 2017 coverage
      • December 15, 2016: The last day to enroll and have coverage begins on January 1, 2017
      • December 31, 2016: Health care coverage ends for 2016 plan year
      • January 1, 2017: The first day when 2017 coverage starts if payment is received by January 10,2017
      • January 15, 2017: The last day to enroll and have coverage begin on February 1, 2017
      • January 31, 2017: Open enrollment ends for the year, except under special circumstances

    • Renew Your Coverage More

      If you signed up to an AffinityAccess Qualified Health Plan last year though affinitystoreonline.com, your current coverage will be automatically renewed on January 1, 2017, as long as you continue to be eligible for coverage. However, you do have the option to choose another policy. Click here for information on renewing your plan.

    • Schedule of Benefits More

      For AffinityAccess and AffinityAccess Direct Members

      2017 AffinityAccess Plans:

      *For members who are 65 and older, AND ineligible for Medicare, AND ineligible for Essential Plan

      2017 AffinityAccess 2.0 Plans:

      *For members who are 65 and older, AND ineligible for Medicare, AND ineligible for Essential Plan

      2016 AffinityAccess Plans:

      *For members who are 65 and older, AND ineligible for Medicare, AND ineligible for Essential Plan

      2016 AffinityAccess 2.0 Plans:

      *For members who are 65 and older, AND ineligible for Medicare, AND ineligible for Essential Plan

    • Member Handbooks More

      Click below for information on how your AffinityAccess Qualified Health Plan works. Find out how to get care when you need it, what services are covered, or who to talk to when you have a question, so you can get the most out of your coverage.

      2017

      • English (Coming Soon)

      2016

    • Treatment Cost Calculator More

      This Treatment Cost Calculator will help you better understand the potential costs of obtaining health care services when you need treatment. In English | En Español

    • Payment Instructions More

      Now that you have confirmed your Affinity Qualified Health Plan selection, you can begin submitting your payments to us in the following ways:

      Online Payments (Fastest and Easiest Method)

      For 2017 plans, you can make your monthly payment online, right now, by check, credit or debit Visa, MasterCard, or Discover, 24 hours a day, 7 days a week.

      Other Methods of Payment

      By mail:
      Send a check or money order to:
      Affinity Health Plan
      P.O. Box 417993
      Boston, MA 02241-7993
      Please include your member ID number in the memo area of your check.

      By phone:
      Pay with your credit/debit card or eCheck (a payment you make directly from your bank account)

      Call our customer service department at (866) 247-5678. We are available Monday through Friday, 8:00am - 7:00pm EST; Saturday, 8:00am - 4:30pm.

      You can also access our Automated Payment Line at the same number 24 hours a day, 7 days a week.

      Maintaining Coverage

      When you first enroll in your plan, there is a 10-day grace period for your first payment. This means that you will have until the 10th day of the month your coverage begins to make your first payment. If your first payment is not received within 10 days, your plan may be cancelled. For all other months your payment is due by the 1st of every month.

      Enrollment is not effective until Affinity receives your first premium payment and sends a confirmation to the New York State of Health (NYSoH). The date when both actions are complete will be considered your "Coverage Effective Date."

      If you fail to make your monthly premium payments during the plan year, your coverage may be terminated retroactively to the last date to which a payment applies.

    • Member Forms More
    • Subscriber Contracts More
    • Important Numbers and Contacts More

      Call, write, fax or follow the Web links to get answers from Affinity regarding our Qualified Health Plans (QHP):

      To Research or Buy a Plan
      Phone: (866) 731-8001; Mon-Fri 8:30 am – 6:00 pm (Eastern Time)

      Customer Service
      Phone: (888) 543-6973; Mon-Fri 8:00 am – 7:00 pm (Eastern Time); Sat 8:00 am - 4:30 pm (Eastern Time)

      Claims
      Phone: (888) 543-6973; Mon-Fri 8:00 am – 6:00 pm (Eastern Time)

      Pre-authorization
      Phone: (888) 543-9074; Mon-Fri 8:30 am – 5:00 pm (Eastern Time)

      Medical Emergency: 911

      Hospitalizations: (888) 543-9074

      Beacon Health options:www.beaconhealthstrategies.com
      Phone: (888) 438-1914

      Dental:www.dentaquest.com
      Phone: (866) 731-8004

      LabCorp Laboratory Services:www.labcorp.com
      Phone: (888) LABCORP (888-522-2677, ext. 3)

      Superior Vision:www.superiorvision.com
      Phone: (866) 810-3312

      CVS Caremark Pharmacy:www.caremark.com
      Phone: (855) 722-6228 (Customer Care)
      (877) 432-6793 (Authorization)
      (888) 543-9069 (Appeals)

      Paper Claims:
      AffinityAccess Claim Unit
      PO Box 981650
      El Paso, TX 79998-1650

      Claims by Telephone
      Phone: (888) 543-6973; Fax: (718) 536-3386

      Complaint, Grievance & Appeal Unit (CGA) Including Expedited
      Phone: (888) 543-9069; Fax: (718) 536-3358

    • Wellness Programs More

      Exercise Facility Reimbursement
      We will partially reimburse the Subscriber and the Subscriber’s covered Spouse for certain exercise facility fees or membership fees but only if such fees are paid to exercise facilities that we have an agreement with and which maintain equipment and programs that promote cardiovascular wellness.

      Memberships in tennis clubs, country clubs, weight loss clinics, spas or any other similar facilities will not be reimbursed. Lifetime memberships are not eligible for reimbursement. Reimbursement is limited to actual workout visits. We will not provide reimbursement for equipment, clothing, vitamins or other services that may be offered by the facility (e.g., massages, etc.).

      In order to be eligible for reimbursement, You must:

      • Be an active member of the exercise facility; and
      • Complete 50 visits in a six (6)-month period

      In order to obtain reimbursement, at the end of the six (6)-month period, You must submit:

      • Documentation of the visits from the facility. Each time You visit the exercise facility, a facility representative must sign and date the documentation of the visits
      • A copy of Your current facility bill which shows the fee paid for Your membership

      Once We receive documentation of the visits and the bill, You will be reimbursed the lesser of $200 for the Subscriber and $100 for the Subscriber’s covered Spouse or the actual cost of the membership per six-month period. Reimbursement must be requested within 120 days of the end of the six (6)-month period. Reimbursement will be issued only after You have completed each six (6)-month period even if 50 visits are completed sooner.

    • Special Enrollment Period More

      There are some special situations under which you, your spouse or child can still enroll for health care coverage. They include:

      • You lose health coverage – for example, your current plan expires, or you lose job-based coverage, or your COBRA ends
      • You get married, or get divorced
      • You are having a baby or adopting
      • You move to New York, or from one county to another within New York
      • You become a US citizen
      • Your income changes and your eligibility for advance payments of the premium tax credits is affected
      • See others here or watch this video

      Open enrollment for 2017 coverage runs from Nov. 1, 2016 to January 31, 2017. However, if any of the above events happen to you after the deadline, you will still be able to apply for health insurance. With more than 40,000 doctors and over 85 of the area’s best hospitals, Affinity is the right choice. And depending on your income, you may be able to get premium tax credits or lower out-of-pocket costs that reduce how much your coverage costs.

      Find out if you qualify

      Call (866) 731-8001, email us or visit us in person at one of our neighborhood retail stores. Click here to find a location near you.

      For Medicaid and CHP plans, enrollment is open year-round. To see if you qualify, contact us at (866) 247-5678 or email us.

    • Terms To Know More

      Premium

      Monthly fees paid for coverage of medical benefits during a specific time period (in most cases this is one year). Premiums can be paid by employers, unions, employees; or shared by both the insured individual and the plan sponsor (employers, union).

      Deductible

      A fixed dollar amount during the benefit period - usually a year - that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both per individual and per family deductibles.

      Co-pay or Co-payment

      A fixed dollar amount made by you (the insured person) when a medical service is received, such as for a doctor’s office visit.

      Co-insurance 

      Similar to a co-pay, however, in this case you (the insured person) would pay a percentage of the cost of care that you receive; the plan would cover the rest; after your deductible has been met.

    • Additional Resources More