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MetroPlus
Health
Gold Plan

Quality, affordable healthcare for all New York City employees.

Who is it for?

  • ALL New York City employees, their qualified domestic partners and eligible dependents

  • Non-Medicare eligible retirees

  • NYC Health + Hospitals and MetroPlusHealth employees

Plan Features

$0
Monthly Premium
$0
Deductible

Eligibility

Monthly Premium

Deductible

Annual Checkup

Doctors & Specialists

$0 24/7 telehealth with MetroPlusHealth Virtual Visit

Hospital Visits

Prescription Drug Coverage

Prepackaged Medications

Fitness Reimbursement

Weight Loss Program Reimbursement

Transportation Reimbursement

NYC Employees

$0 with basic plan

$0

$0

$250 every 6 months for member
$250 every 6 months for spouse

$100 every 6 mo. for member,
$50 every 6 mo. for spouse

Up to $15 per trip (up to four (4) trips per plan year)

What does the MetroPlusHealth Gold Plan provide?

  • $0 employee premium with basic plan

  • $0 deductibles

  • $0 co-insurance

  • Low-cost optional prescription drug rider is available

  • Participating physicians and hospitals in over 34,000 sites across New York City

  • New! $0 dietician visits***

  • Free 24/7 virtual access to doctors and therapists from your smart phone, tablet or computer

  • Fitness reimbursements** (up to $1000 per year!)

  • Wellness programs

  • Transportation reimbursement – **Up to $15 per trip (up to four (4) trips per plan year)

  • Member website to help you manage your account

  • Expanded access to urgent care

  • MetroPlusHealth will reimburse you up to $300 per year for participating in a weight loss program

  • Medications pre-packaged and delivered to you at no extra cost. Available through PillPack or CVS Pharmacy.

View over a man's shoulder of the phone he is holding and the table he is sitting at with a computer, notebook, and coffee

Representative was very professional and helpful, showed empathy for my well being with no attitude …. Thank you….. 😊 👍👍

Betsy J.
Google Review

How do I enroll?

Contact your benefits manager at work for more information about choosing MetroPlusHealth Gold. Or call us at 1-855-809-4073 or visit us at our Virtual Office. Just click here to find a representative ready to help and answer any of your MetroPlusHealth Gold questions.

Work for NYC Health + Hospitals or MetroPlusHealth?

Work for New York City?

With MetroPlusHealth Gold, you get $0 premiums, deductibles, copays, unlimited telehealth visits, unlimited mental health care, and more. You can also choose from more than 34,000 top providers and sites. You will find many offices right near you, along with local family care sites and 110 urgent care centers like CityMD, Northwell Health-GoHealth Urgent Care, and more. Our network of over 40 hospitals includes NYU Langone, Mount Sinai, NYC Health + Hospitals, and more. MetroPlusHealth Gold health plan is available to ALL New York City employees, their qualified domestic partners and eligible dependents, and non-Medicare eligible retirees.

NYC Employees:

  • Are you really satisfied with your current health plan?
  • Are you paying more and more out-of-pocket costs?
  • Are you getting the services you need such as choice of provider or network?
  • Did you know that you now have a choice?
  • If it’s your one-year anniversary as an NYC employee, you qualify to switch now to the plan that more and more city workers are choosing: MetroPlusHealth Gold.

Take Action Now! Contact your benefits manager at work for more information about choosing MetroPlusHealth Gold. Or call us at 1-855-809-4073 or visit us at our Virtual Office. Just click here to find a representative ready to help and answer any of your MetroPlusHealth Gold questions.

Current member?

Current members with questions can always call the dedicated MetroPlusHealth Gold Concierge Team at 1-877-475-3795, Monday through Friday, 8 AM to 6 PM, and Saturday, 9 AM to 5 PM. From questions on enrollment & eligibility, benefits & extras, or claims, our Concierge Team is ready to help you every step of the way.

Free or Low-Cost Preventive Health Care Services

Preventive Health Care Guidelines

At MetroPlusHealth, we always want you to be at your best. That’s why we encourage you and your family to take advantage of preventive care services available to you at low or no cost. We’ve listed dozens of FREE preventive services here for adults, women and children that just may help you be your healthiest yet.

Free or Low-Cost Preventive Health Care Services

Gold Plan Materials

Summary of Benefits
Certificate of Coverage
Certificate of Coverage (with Drug Coverage)
Certificate of Coverage (with Drug Coverage/Grandfathered)
Gym Reimbursement Form
Transportation Reimbursement Form
Weight Loss Program Reimbursement Form
Member Guide
Women’s Health and Cancer Rights Act
NYS Standard Form to Designate a Representative to Assist with Health Insurance Authorizations, Complaints, Grievances, and Appeals

How Does it Work?

To get covered services, you need to see providers in the MetroPlusHealth network. Receiving care from out-of-network doctors or providers is not covered, and you may have to pay for the medical services if you go out of network.

But, if an urgent medical issue happens outside of our service area, you will be completely covered if you go to an emergency room. That’s anywhere nationwide, whether it’s in our network or not.

Did you know that you can get your medications pre-packaged for free? We offer two ways to do it: through any CVS pharmacy or home-delivered by PillPack. Get the details here (PDF).

MetroPlusHealth wants our members to be healthy. Take advantage of our gym reimbursement program and maximize your results at minimal cost to you. Learn more here.

All MetroPlusHealth Gold members have access to a mail order option for their medications. Access the mail order form here: https://www.caremark.com/portal/asset/mof_unauth.pdf

*Except for emergency room visits which have a $100.00 co-pay (waived if you’re admitted to the hospital) and urgent care visits which have a $25 copay.
**The payout may be considered taxable income, and subject to state and federal taxes in the tax year you get it. We recommend that you consult a professional tax expert with any questions.
***for those who qualify

Due to changes in IRS regulations, if you would like a copy of your 1095-B form, please contact Member Services to request one.

Call: 1-800-303-9626 (TTY: 711)

Write: MetroPlus Health Plan
Attn: Operations
50 Water Street, 7th Floor
​New York, NY 10004

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MetroPlusHealth Virtual Visit

Access to a doctor—whenever and wherever you need it!

MetroPlusHealth Virtual Visit is the fast, easy way for our members to see a provider for common physical, mental, emotional, and behavioral health issues that are not emergencies. MetroPlusHealth Virtual Visit is available anytime, from anywhere in New York State, 24/7 – and in your language.

GREAT NEWS: STARTING JANUARY 1, 2023, METROPLUSHEALTH MEMBERS WILL RECEIVE THEIR DENTAL BENEFITS FROM DENTAQUEST.

Recently, we sent you an announcement along with your new ID Card about our new partnership with DentaQuest, a dental vendor. Starting January 1, 2023, you can begin to use your new ID Card for all your health care needs, including dental services with DentaQuest. Remember to bring your new ID card when you visit your dentist.

Your oral health is important to us. Partnering with DentaQuest, we are able to bring their experience and passion for improving oral health care to you. Their dental network is 65% larger than what we have been offering, with more dentists and specialists available than before. Learn more about your new dental benefit here.

Know your rights and protections against surprise medical bills!

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

Are you receiving care at an NYC Health + Hospitals facility?

Manage Your Health Online With MyChart. Members who receive care at NYC Health + Hospital facilities now have access to MyChart. MyChart is a free secure portal you can use to manage your health information. MyChart allows you to:

  • Message your primary care provider’s office
  • Request refills of your prescription drugs
  • Access your test results
  • Schedule appointments
Preventive Services Resources

Learn about all of the free preventive services for adults, women and children. Preventive care includes immunizations, physical exams, lab tests and prescriptions. If you have any questions, call one of our Member Services Representatives. We’re here to help.

Explore all MetroPlusHealth Plans

last updated: February 6, 2024

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