Benefits and Services

MetroPlus is part of NYC Health + Hospitals, the largest municipal health system in the United States. This means our members have access to a large network of conveniently located hospitals and medical centers and top quality doctors in their neighborhood.
 
With 30 years' experience in quality care management, MetroPlus has earned New Yorkers' trust.

Available Services Under FIDA Program

  • Additional Home Care Services
  • Ambulance
  • Chiropractic Care
  • Dental Services
  • Diabetes Supplies and Services
  • Diagnostic Tests, Lab and Radiology Services, X-Rays
  • Doctor’s Office Visits
  • Durable Medical Equipment (wheelchairs, oxygen, etc.)
  • Emergency Care
  • Foot Care (podiatry services)
  • Hearing Services
  • Home Health Care
  • Hospice
  • Mental Health Care
  • Outpatient Rehabilitation
  • Outpatient Substance Abuse
  • Outpatient Surgery
  • Preventive Care
  • Prosthetic Devices (braces, artificial limbs, etc.)
  • Renal Dialysis
  • Transportation
  • Urgent Care
  • Vision Services

Additional Benefits where you pay nothing:

  • Comprehensive Psychiatric Emergency Program (CPEP)
  • Crisis Intervention Services
  • Residential Additional Services

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Medicare Advantage Plan Annual Notice of Change (ANOC)

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MetroPlus FIDA Plan Benefit Overview*
   
$0 Monthly plan premium  $0 Occupational, Physical, or Speech Therapy
$0 Lab tests, including blood work $0 Ambulance Services
$0 Screenings tests, such as tests to check for cancer $0 Hospital stay
$0 Copay for routine eye exams, eyeglasses or contacts $0 Rehabilitation Services 

*For a comprehensive overview of participant benefits, please read page 10 of the Summary of Benefits.

Out Of Network

You must get your services and items from network providers. Usually, MetroPlus FIDA Plan will not cover services or items from a provider who has not joined MetroPlus FIDA Plan’s network. Here are some cases when this rule does not apply:
 
The plan covers emergency or urgently needed care from an out-of-network provider. To learn more and to see what emergency or urgently needed care means, see page 38.
 
If you need care that our plan covers and our network providers cannot give it to you, you can get the care from an out-of-network provider. In this situation, we will cover the care as if you got it from a network provider and at no cost to you. To learn about getting approval to see an out-of-network provider, see page 34.
 
The plan covers services and items from out-of-network providers and pharmacies when a provider or pharmacy is not available within a reasonable distance from your home.
 
The plan covers kidney dialysis services when you are outside the plan’s service area for a short time. You can get these services at a Medicare-certified dialysis facility.
 
When you first join the plan, you can continue seeing the providers you see now during the “transition period.” In most cases, the transition period will last for 90 days or until your Person-Centered Service Plan is finalized and implemented, whichever is later. However, your out-of-network provider must agree to provide ongoing treatment and accept payment at our rates. After the transition period, we will no longer cover your care if you continue to see out-of-network providers.
 
If you are a resident of a nursing facility, you can continue to live in that nursing facility for the duration of the FIDA Program, even if the nursing facility does not participate in MetroPlus FIDA Plan’s network.
 
If you are receiving services from a behavioral health provider at the time of your enrollment, you may continue to get services from that provider until treatment is complete, but not for more than two years.
 
How to get care from out-of-network providers
 
If you need care that our plan covers and our network providers cannot give it to you, you can get permission from MetroPlus FIDA Plan or your IDT to get the care from an out-of-network provider. In this situation, we will cover the care as if you got it from a network provider and at no cost to you. To find out more about this process, contact Participant Services at 1.844.288.FIDA (3432), TTY users: 711, Monday - Saturday, 8 am - 8 pm. After 8 pm, Sundays & Holidays: 24/7 Medical Answering Service at number listed above.
 
Remember, when you first join the plan, you can continue seeing the providers you see now during the “transition period.” In most cases, the transition period will last for 90 days or until your Person-Centered Service Plan is finalized and implemented, whichever is later. During the transition period, our Care Manager will contact you to help you find and switch to providers that are in our network. After the transition period, we will no longer pay for your care if you continue to see out-of-network providers, unless MetroPlus FIDA Plan or your IDT has authorized you to continue to see the out-of-network provider.
 
Please note: If you need to go to an out-of-network provider, please work with MetroPlus FIDA Plan or your IDT to get approval to see an out-of-network provider and to find one that meets applicable Medicare or Medicaid requirements. If you go to an out-of-network provider without first getting Plan or IDT approval, you may have to pay the full cost of the services you get.