Affinity Health Plan

    • QHP Members

      Renew your health plan today!

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

    • maternity program

      Healthy Choices = Healthy Babies

      Announcing "Healthy Beginnings," Affinity's special program offering helpful tools and support for mothers-to-be.

    • Best Hospitals 2014

      Affinity Network Hospitals Named Best in the Nation

      NY Presbyterian, NYU Langone and Mt. Sinai get high marks on US News and World Report’s 2014-2015 Best Hospitals List.

    • Healthy Streets Summer 2014

      The new edition of Healthy Streets is out!

      Find health tips, plus plan updates, in Affinity's member newsletter. El boletín para miembros de Affinity, ¡también en español!

    • Dentaquest slider

      Affinity gets a "dental makeover"

      Starting June 1, 2014, our new dental provider is DentaQuest, a leading provider of dental and orthodontic services.

  • 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 - 6:00 PM EST

    • Key Enrollment Dates More

      • November 15, 2014: Open enrollment for 2015 starts
      • December 15, 2014: The last day to enroll and have coverage begin on January 1, 2015
      • December 31, 2014: Health care coverage ends for this year
      • January 1, 2015: The first day when 2015 coverage starts
      • January 15, 2015: The last day to enroll and have coverage begin on February 1, 2015
      • February 14, 2015: Open enrollment ends for the year, except under special circumstances

    • Renew Your Coverage More

      If you signed up to an Affinity Qualified Health Plan last year, your current coverage will be automatically renewed on January 1, 2015, 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

      2014 Plans 

      2015 Plans:


      For our AffinityAccess Direct Members who have purchased 2015 coverage directly through Affinity at AffinityOnlineStore.com, you can find your AffinityAccess Direct Schedule of Benefits here:

    • 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:

      By mail
      Send a check or money order to:
      Affinity Health Plan
      P.O. Box 417993
      Boston, MA 02241-7993

      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 888-543-6973. We are available Monday through Friday, 8am-6pm EST.

      Online
      For 2015 plans you can make your monthly payment with your credit or debit Visa, Mastercard, or Discover card 24 hours a day, 7 days a week by clicking here. (Unfortunately, we cannot accept premium payments for 2014 bills online.)

      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 state. 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

      For 2015 Plans


      For our AffinityAccess Direct Members who have purchased 2015 coverage directly through Affinity at AffinityOnlineStore.com, you can find your AffinityAccess Direct Subscriber Contract here:

       
      For 2014 Plans

    • 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 8:30am - 6pm (Eastern Time)

      Customer Service
      Phone: (888) 543-6973; Mon-Fri 8am - 6pm (Eastern Time)

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

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

      Medical Emergency: 911

      Hospitalizations: (888) 543-9074

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

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

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

      Block Vision:  www.blockvision.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:
      Affinity Health Plan
      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

    • Fitness Rewards Program More

      We know that staying with an exercise routine isn’t always easy. To encourage you to get fit and stay healthy, Affinity Health Plan provides partial reimbursement to the Subscriber and the Subscriber’s Covered Spouse for exercise facility fees or membership fees. It’s simple! Click here to learn more about Affinity Health Plan Fitness Rewards.

    • 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 2015 coverage starts on Nov. 15, 2014 and ends Feb. 15, 2015. However, if any of the above events happen to you after the deadline, you will still be able to apply for health insurance. With nearly 26,000 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