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What is a PCP?
I want to change my PCP. What do I do?
How can I see a specialist?
I lost my ID card and/or I did not receive my ID card. What do I do?
I am expecting a baby. Will my baby be enrolled in MetroPlus Health Plan?
I have a complaint. What do I do?
What do I do if I want to leave MetroPlus Health Plan?
Where can I go to enroll in MetroPlus Health Plan?
How do I recertify if I am enrolled in MetroPlus Child Health Plus B?
How do I recertify if I am enrolled MetroPlus Medicaid Managed Care?
Am I eligible to join MetroPlus Health Plan?
What should I do if I get a bill from a provider?
Does MetroPlus Health Plan cover pharmacy and dental services?
If my children are in Child Health Plus, does that mean I am eligible for Family Health Plus?
What is a PCP?
"PCP" stands for Primary Care Provider. A PCP is the MetroPlus doctor or nurse practitioner you choose
to see for your health care needs. Your PCP is responsible for making sure you get the best care and
will arrange for you to see a specialist, get x-rays or lab tests or go into the hospital, if necessary.
You chose your PCP when you join the plan. You may want to choose a PCP who already knows you, speaks
your language, understands your health problems and is on the your subway or bus route.
In some cases a specialist can also be your PCP. Please call Member Services at 1-800-303-9626 for more
information.
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I want to change my PCP. What do I do?
You can change your PCP by calling Member Services any time during your enrollment. You can request a PCP
change for any reason twice in one year. You may select a PCP more than twice in one year for good
reason. An example of this is if the PCP's location is not close to you, the PCP does not speak your
language or the PCP's clinic hours are not convenient. If you need to change your PCP more than twice a
year you can do so by calling Member Services and we will assist you
You can request a PCP change on this website. You may also contact MetroPlus Member Services at
1-800-303-9626 to change your PCP.
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How can I see a specialist?
If you need care that your PCP cannot give, he or she will arrange for you to see one of our specialty
providers. This is called a "Referral".
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I lost my ID card and/or I did not receive my ID card. What do I do?
After you enroll in the plan, you will receive a welcome packet and a MetroPlus ID card. The welcome packet
and ID card will be mailed within 14 days after the date you become a member. If it has been more than
14 days since you enrolled and you did not receive your ID card, you can request an ID card on this
website. You may also call MetroPlus Member Services at 1-800-303-9626 and a new card will be mailed to you.
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I am expecting a baby. Will my baby be enrolled in MetroPlus Health Plan?
If you are a member of MetroPlus Medicaid Managed Care your baby will be enrolled in MetroPlus from birth.
Please remember to let your Local Department of Social Services know when you are pregnant and
have your OB/GYN doctor tell MetroPlus.
If you are a MetroPlus Family Health Plus or Child Health Plus member, your baby may be
eligible for Medicaid or Child Health Plus. Please call MetroPlus Member Services at 1-800-303-9626 for any
additional information.
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I have a complaint. What do I do?
We hope our health plan serves you well. If you have a problem, please call Member Services at
1-800-303-9626. You can also write to MetroPlus Member Services at:
MetroPlus Health Plan
Member Services Department
160 Water Street 3rd Fl
New York, NY 10038
A Member Services Representative will help resolve your complaint and as necessary forward your complaint
to the right departments for investigation and resolution.
Please contact Member Services to obtain any additional information.
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What do I do if I want to leave MetroPlus Health Plan?
If you are a MetroPlus Medicaid Managed Care, you may be enrolled in mandatory Medicaid Managed Care,
which means that you can only transfer to another Plan not disenroll from managed care. You may only
disenroll from managed care if you are exempt or
excluded from managed care. You can find out more about who is exempt or excluded by
calling New York Medicaid CHOICE at 1-800-505-5678.
A MetroPlus member can ask for a transfer to another health plan or disenrollment anytime during the
first 90 days after you enroll. After the 90 days, you must stay with the plan for nine months. To
leave the plan after the 90-days you must show good reason (or just cause) to leave the plan. Some
examples of just cause are:
- We cannot provide a suitable PCP for you within 30 minutes or 30 miles from your home
- You are or become exempt or excluded from managed care, or
- You move out of our service area
If you are member of Child Health Plus, Family Health Plus, Partnership in Care, or MetroPlus Gold
plan, please call MetroPlus Member Services at 1-800-303-9626 for assistance.
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Where can I go to enroll in MetroPlus Health Plan?
Please contact the MetroPlus Customer Service Department at 800-475-METRO (800-475-6387) to get enrollment information
and to set up an appointment to meet with a Marketing Representative to complete an enrollment application.
You can also enroll in MetroPlus Health Plan at a number of hospital and health care facilities throughout
the four boroughs (Manhattan, Queens, the Bronx and Brooklyn). Click here for the list of MetroPlus
enrollment sites. You will need some important documents to
complete an application to join MetroPlus. Click here for the
list of documents.
You can also enroll in MetroPlus Medicaid Managed Care or Family Health Plus through New York Medicaid
CHOICE, at 1-800-505-5678. New York Medicaid CHOICE can also tell you about Medicaid Managed Care and
Family Health Plus in New York City, including what other health plans are available where you live.
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How do I recertify if I am enrolled in MetroPlus Child Health Plus B?
Child Health Plus members must complete a renewal application once a year. You will be mailed a renewal
application to complete and return by the "RESPOND BY" date printed on the application. Included with
the packet is a full list of instructions to make it easier to fill out. If you need help with completing
the application, a MetroPlus Customer Service Representative is available to provide further assistance
and can even visit your home to walk you through the process. To find out more information on how to
recertify click here. You can contact our office at
1-800-475-METRO.
If you have not received a renewal application, please call our office at 800-475-METRO (800-475-6387) and we will be
happy to help.
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How do I recertify if I am enrolled MetroPlus Medicaid Managed Care?
MetroPlus Medicaid Managed Care members must recertify once a year with New York City Human Resources
Administration (HRA). HRA sends out a notice about 60 days before your recertification date with instructions
on how to recertify. To find out more information on how to recertify click here.
If you have not received a recertification packet please call the MetroPlus at
1-800-475-METRO and we will help you.
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Am I eligible to join MetroPlus Health Plan?
Click on Eligibility Information to see if you are eligible to join MetroPlus Medicaid Managed Care,
Child Health Plus, Family Health Plus or the Partnership in Care program.
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What should I do if I get a bill from a provider?
MetroPlus pays for your care and you should not get a bill from a provider. If you get a bill, please call
Member Services at 1 - 800 - 303 - 9626 and we will help.
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Does MetroPlus Health Plan cover pharmacy and dental services?
MetroPlus Medicaid Managed Care Plan and Family Health Plus Plan members can get prescriptions, over-the-counter medicines and certain medical supplies by using their Medicaid Card at any pharmacy that accepts Medicaid.
MetroPlus Child Health Plus members can get pharmacy services by using their MetroPlus Health Plan Card and going to pharmacies who participate with MetroPlus Health Plan. Please call Member Services at 1-800-303-9626 to find a pharmacy near you.
MetroPlus Medicaid Managed Care Plan members can get dental services from any dental provider who accepts Medicaid.
MetroPlus Child Health Plus Plan and Family Health Plus Plan members can get dental services by using their MetroPlus Health Plan Card and going to dental providers who participate with MetroPlus Health Plan. Please call Member Services at 1-800-303-9626 to find a dental provider near you.
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If my children are in Child Health Plus, does that mean I am
eligible for Family Health Plus?
Not necessarily. The maximum income levels for Family Health Plus are different from Child Health Plus.
If your child or children are in Child Health Plus that does not mean you are eligible for Family Health
Plus. Please call a MetroPlus Member Services Representative at 1-800-303-9626 for assistance.
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