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Plan Documents

Select a Healthfirst plan below to see its Summary of Benefits, Evidence of Coverage, Member Handbook, and other important documents.

If you’re a Healthfirst member, log in to the Member Portal to see your plan benefits and more helpful information.

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Find the Healthfirst Member Form you need here.

Choose Plan Year

Medicare & Managed Long-Term Care Plans

*=Managed Long-Term Care Plans

Plan Documents

Comprehensive Formulary
Healthfirst 65 Plus Plan Formulary Search Tool
Annual Notice of Changes
Evidence of Coverage
Summary of Benefits
Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Comprehensive Formulary
Healthfirst CompleteCare Formulary Search Tool
Annual Notice of Changes
Evidence of Coverage
Summary of Benefits
Member Handbook
Member Handbook Insert - Appeals and Grievances Update
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Comprehensive Formulary
Healthfirst Connection Plan Formulary Search Tool
Annual Notice of Changes
Annual Notice of Changes for Life Improvement Plan to Connection Plan Crosswalk Members
Evidence of Coverage
Summary of Benefits
Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Comprehensive Formulary
Healthfirst Increased Benefits Plan Formulary Search Tool
Annual Notice of Changes
Evidence of Coverage
Summary of Benefits
Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Comprehensive Formulary
Healthfirst Life Improvement Plan Formulary Search Tool
Annual Notice of Changes
Evidence of Coverage
Summary of Benefits
Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Comprehensive Formulary
Healthfirst Signature Formulary Search Tool
Annual Notice of Changes (NYC)
Annual Notice of Changes (Lower Hudson Valley)
Evidence of Coverage (NYC)
Evidence of Coverage (Lower Hudson Valley)
Summary of Benefits
Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Comprehensive Formulary
Healthfirst Signature Formulary Search Tool
Evidence of Coverage
Summary of Benefits
Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy

Additional Resources

Pre-Enrollment Checklist
Medicare Part B Step Therapy Information
Regulation 194 - Disclosure
Low Income Subsidy Premium Pricing - 65 Plus, CompleteCare, Connection, Increased Benefit, and Life Improvement Plans
Low Income Subsidy Premium Pricing - Signature HMO
Low Income Subsidy Premium Pricing - Signature PPO
Accessing Clinical Guidelines for Medicare Basic Services
Healthfirst Clinical Guidelines Quick Reference Guide
Advance Directives

Medicare Advantage Members:

*Healthy foods and home utilities are special supplemental benefits for members enrolled in a Healthfirst dual-eligible special needs plan. To be eligible, you must have a chronic condition such as cardiovascular disorder, disabling mental health condition, diabetes, lung disorders, obesity, or another eligible condition not listed. Benefit eligibility is not based on your chronic condition alone.

Premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Healthfirst Medicare Plan has HMO and PPO plans with a Medicare contract. Our SNPs also have contracts with the NY State Medicaid program. Enrollment in Healthfirst Medicare Plan depends on contract renewal.

ATENCIÓN: Dispone de servicios de asistencia lingüística y otras ayudas, gratis. Llame al 1-866-305-0408 (TTY: 1-888-867-4132).

请注意：您可以免费获得语言协助服务和其他辅助服务。请致电 1-866-305-0408 (TTY: 1‑888‑542‑3821)。

Y0147_GEN26_17 5173-25_C

Last update October 1, 2025 @ 6:31 am

Y0147_MKT26_54 5319-25_M

Choose Plan Type

Medicare & Managed Long Term Care Plans

*=Managed Long-Term Care Plans

Plan Documents

Comprehensive Formulary
Healthfirst 65 Plus Plan Formulary Search Tool
65 Plus Plan Monthly Formulary Changes
Annual Notice of Changes
Evidence of Coverage
Summary of Benefits
2025 Star Ratings

Every year, Medicare evaluates plans based on a 5-star rating system.

Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Comprehensive Formulary
Healthfirst CompleteCare Formulary Search Tool
CompleteCare Monthly Formulary Changes
Annual Notice of Changes
Evidence of Coverage
Summary of Benefits
2025 Star Ratings

Every year, Medicare evaluates plans based on a 5-star rating system.

Member Handbook
Member Handbook Insert - Appeals and Grievances Update
Member Handbook Insert - Social Care Network (SCN)
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Comprehensive Formulary
Healthfirst Connection Plan Formulary Search Tool
Connection Plan Monthly Formulary Changes
Annual Notice of Changes
Evidence of Coverage
Summary of Benefits
2025 Star Ratings

Every year, Medicare evaluates plans based on a 5-star rating system.

Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Comprehensive Formulary
Healthfirst Increased Benefits Plan Formulary Search Tool
Increased Benefits Plan Monthly Formulary Changes
Annual Notice of Changes
Evidence of Coverage
Summary of Benefits
2025 Star Ratings

Every year, Medicare evaluates plans based on a 5-star rating system.

Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Comprehensive Formulary
Healthfirst Life Improvement Plan Formulary Search Tool
Life Improvement Plan Monthly Formulary Changes
Annual Notice of Changes
Evidence of Coverage
Summary of Benefits
2025 Star Ratings

Every year, Medicare evaluates plans based on a 5-star rating system.

Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Medicaid Managed Care – Handbook Addendum

Addendum to the New York State Medicaid Managed Care Member Handbook for the Integrated Benefits for Dually Eligible Enrollees (IB-Dual) Program.

Personal Wellness Plan - Handbook Addendum

Addendum to the New York State Health and Recovery Plan Member Handbook for the Integrated Benefits for Dually Eligible Enrollees (IB-Dual) Program.

Member Handbook
Member Handbook Insert - Social Care Network (SCN)
Comprehensive Formulary
Healthfirst Signature Formulary Search Tool
Signature Monthly Formulary Changes
Annual Notice of Changes
Evidence of Coverage
Summary of Benefits
2025 Star Ratings: New York City & Nassau

Every year, Medicare evaluates plans based on a 5-star rating system.

2025 Star Ratings: Orange, Rockland, Sullivan & Westchester

Every year, Medicare evaluates plans based on a 5-star rating system.

Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Comprehensive Formulary
Healthfirst Signature Formulary Search Tool
Signature Monthly Formulary Changes
Annual Notice of Changes
Evidence of Coverage
Summary of Benefits
2025 Star Ratings

Every year, Medicare evaluates plans based on a 5-star rating system.

Post-Discharge Meals Benefit Frequently Asked Questions
Dental Benefit Limitations and Exclusions Guide
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy

Additional Resources

Pre-Enrollment Checklist
Medicare Part B Step Therapy Information
Regulation 194 - Disclosure
Low Income Subsidy Premium Pricing - 65 Plus, CompleteCare, Connection, Increased Benefit, and Life Improvement Plans
Accessing Clinical Guidelines for Medicare Basic Services
Healthfirst Clinical Guidelines Quick Reference Guide
Advance Directives

Medicare Advantage Members:

*Healthy foods and home utilities are special supplemental benefits for members enrolled in a Healthfirst dual-eligible special needs plan. To be eligible, you must have a chronic condition such as cardiovascular disorder, disabling mental health condition, diabetes, lung disorders, obesity, or another eligible condition not listed. Benefit eligibility is not based on your chronic condition alone.

Premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Healthfirst Medicare Plan has HMO and PPO plans with a Medicare contract. Our SNPs also have contracts with the NY State Medicaid program. Enrollment in Healthfirst Medicare Plan depends on contract renewal.

ATENCIÓN: Dispone de servicios de asistencia lingüística y otras ayudas, gratis. Llame al 1-866-305-0408 (TTY: 1-888-867-4132).

请注意：您可以免费获得语言协助服务和其他辅助服务。请致电 1-866-305-0408 (TTY: 1‑888‑542‑3821)。

Y0147_GEN26_17 5173-25_C

Last update October 1, 2025 @ 6:31 am

Y0147_MKT25_91 5128-24_M

Medicaid Plans

Plan Documents

Member Handbook

For more information on the latest behavioral health services available, please review your Member Handbook.

Medicaid Managed Care – Handbook Addendum

Addendum to the Medicaid Managed Care Member Handbook for the Integrated Benefits for Dually Eligible Enrollees (IB-Dual) Program.

Covered Services
Pharmacy Benefit Change Alert
Pharmacy Benefit Change Alert - Members Who Have Medicare
Medicaid Prescription Drug and OTC Formulary

Medicaid members enrolled in Healthfirst Medicaid Managed Care receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Use the link above to search the list of drugs covered by NYRx.

Institution for Mental Disease (IMD) In Lieu of Service (ILS) Benefit
Member Handbook
Personal Wellness Plan - Handbook Addendum

Addendum to the Personal Wellness Plan Member Handbook for the Integrated Benefits for Dually Eligible Enrollees (IB-Dual) Program.

Covered Services
Pharmacy Benefit Change Alert
Pharmacy Benefit Change Alert - Members Who Have Medicare
Medicaid Prescription Drug and OTC Formulary

Medicaid members enrolled in Healthfirst Personal Wellness Plan receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Use the link above to search the list of drugs covered by NYRx.

Institution for Mental Disease (IMD) In Lieu of Service (ILS) Benefit
Member Handbook
Covered Services
Child Health Plus Formulary

Additional Resources

Preventative Pediatric Guide
What You Need to Know About HIV Testing
Accessing Clinical Guidelines for Medicare Basic Services
Healthfirst Clinical Guidelines Quick Reference Guide

Essential Plans

Plan Documents

Member Handbook
Summary of Benefits - Essential Plan 200-250
Summary of Benefits - Essential Plan 1
Summary of Benefits - Essential Plan 2
Summary of Benefits - Essential Plan 3
Summary of Benefits - Essential Plan 4
Essential Plan Formulary
Essential Plan Formulary Changes

Leaf and Leaf Premier Plans

Plan Documents

Member Handbook
Summary of Benefits - Platinum Leaf Premier Plan
Summary of Benefits - Platinum Leaf Plan
Leaf and Leaf Premier Plan Formulary
Leaf Premier Plan Formulary Changes
Leaf Plan Formulary Changes
Member Handbook
Summary of Benefits - Gold Leaf Premier Plus Plan
Summary of Benefits - Gold Leaf Premier Plan
Summary of Benefits - Gold Leaf Plan
Leaf and Leaf Premier Plan Formulary
Leaf Premier Plan Formulary Changes
Leaf Plan Formulary Changes
Member Handbook
Summary of Benefits - Silver Leaf Premier Plus Plan (>250% FPL)
Summary of Benefits - Silver Leaf Premier Plus Plan (200 - 250% FPL)
Summary of Benefits - Silver Leaf Premier Plus Plan (150 - 200% FPL)
Summary of Benefits - Silver Leaf Premier Plus Plan (100 - 150% FPL)
Summary of Benefits - Silver Leaf Premier Plan (>250% FPL)
Summary of Benefits - Silver Leaf Premier Plan (200 - 250% FPL)
Summary of Benefits - Silver Leaf Premier Plan (150 - 200% FPL)
Summary of Benefits - Silver Leaf Premier Plan (100 - 150% FPL)
Summary of Benefits - Silver Leaf Plan (>250% FPL)
Summary of Benefits - Silver Leaf Plan (200 - 250% FPL)
Summary of Benefits - Silver Leaf Plan (150 - 200% FPL)
Summary of Benefits - Silver Leaf Plan (100 - 150% FPL)
Leaf and Leaf Premier Plan Formulary
Leaf Premier Plan Formulary Changes
Leaf Plan Formulary Changes
Member Handbook
Summary of Benefits - Bronze Leaf Premier Plan
Summary of Benefits - Bronze Leaf Plan
Leaf and Leaf Premier Plan Formulary
Leaf Premier Plan Formulary Changes
Leaf Plan Formulary Changes
Member Handbook
Summary of Benefits - Green Leaf Plan
Leaf and Leaf Premier Plan Formulary
Leaf Plan Formulary Changes

Additional Resources

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