Member Handbook Table_of_Contents
ActionHealthNYC MEMBER HANDBOOK...... 3
WHAT IS ActionHealthNYC? ...... 4
Is there an ActionHealthNYC membership card? ...... 4
What is a Primary Care Home?...... 5
Can I change my Primary Care Home? ...... 5 GETTING CARE ...... 6
How should I prepare for my doctor’s visit? ...... 6
What health care services can I get through ActionHealthNYC? ...... 9
Primary and Preventive Care ...... 9
Specialty Care ...... 9
Emergency Care ...... 10
Mental Health Care ...... 10
Dental Care ...... 11
Family Planning ...... 11
Medical and Laboratory Tests ...... 11
Vision ...... 11
Pharmacy ...... 12
How much does my health care cost?...... 13
Is the cost of transportation to a clinical appointment covered? ...... 13
Is the cost of taking an ambulance to the emergency room covered? ...... 13 MEMBER SERVICES ...... 15
How can I get help in my preferred language? ...... 15
How does ActionHealthNYC protect my personal information? ...... 15
How can I make a complaint? ...... 15
1 How long can I receive services under ActionHealthNYC? ...... 15
Can I choose to leave ActionHealthNYC? ...... 15
Can ActionHealthNYC remove me from the program? ...... 15 ActionHealthNYC NETWORK ...... 16
Primary Care Homes ...... 16
Hospitals and Emergency Rooms ...... 17
2 ActionHealthNYC MEMBER HANDBOOK This handbook has answers to questions such as: What is ActionHealthNYC? How and where should I get health care as an ActionHealthNYC member? Which services are covered? How much do I have to pay for health care services? Where should I go for emergency health care needs? How does ActionHealthNYC protect my personal information?
Llame al Centro de Atención Primaria (Primary Care Home) si desea obtener el folleto en español.
如需简体中文版手册，请致电您的初级医疗保健之家 (Primary Care Home)。
如果您想要索取繁體中文版手冊，請致電您的基礎照護之家 (Primary Care Home)。
안내서를 한국어로 받아보고 싶으시면, 1 차 진료 본부(Primary Care Home)로 연락해주십시오.
दी मᴂ प्राꥍि करना चा िे ℂ, िो अपने प्राइमरी केयर ोम (प्राथममकﴂ अगर आप अपनी वििरण पुस्तिका ह देखभाल प्रदािा) को कॉल करᴂ.
3 WHAT IS ActionHealthNYC? ActionHealthNYC is a low-cost health care program for New York City residents who: Are at least 19 years old Have low income (less than $23,760 for a single person or less than $48,600 for a ActionHealthNYC is NOT a family of four) health insurance plan. Do not have insurance Are not eligible for Medicaid or other ActionHealthNYC is a program that health insurance through the New York helps you access quality, low-cost State of Health Marketplace health care services in New York City.
ActionHealthNYC is not health insurance. Health insurance is a way to pay for health care. Different types of health insurance plans determine which services are covered for illnesses, injuries and health conditions and how much you pay for those services. On the other hand, ActionHealthNYC connects you to a network of health care providers that provide services at a low cost. Is there an ActionHealthNYC membership card? Your ActionHealthNYC membership card is the New York City IDNYC card. Show your IDNYC card at your doctor’s appointments and hospital visits. You may also take your IDNYC card to the pharmacist to get discounts on some medications through BigAppleRx.
This is a sample IDNYC card. This card also serves as your ActionHealthNYC membership card.
Make sure the information on your IDNYC card is correct. If you have questions about your IDNYC card, or if your card is lost, stolen, damaged or destroyed, call 311 or visit nyc.gov/idnyc.
4 What is a Primary Care Home? ActionHealthNYC Primary Care Homes A Primary Care Home is the main place you go for your doctor’s appointments. At your Manhattan Primary Care Home, doctors, nurses and William F. Ryan-NENA Community Health Center rd other staff will listen to your medical 279 East 3 Street, New York, NY 10009 history and help with health care needs. 212-477-8527
Community Healthcare Network Abate Health The ActionHealthNYC program has many Center Primary Care Home options (see right 150 Essex Street, New York, NY 10002 panel). You chose a location when you 212-477-1120 enrolled in ActionHealthNYC. To find or change your Primary Care Home, call 311 Charles B. Wang Community Health Center - and ask for ActionHealthNYC. Chinatown 268 Canal Street, New York, NY 10013 Your Primary Care Home will help you: 212-379-6998 Have a regular doctor Find services with other doctors if NYC Health + Hospitals/Gouverneur Health 227 Madison Street, New York, NY 10002 needed, such as for heart problems 212-238-7897 or diabetes Answer questions and address any health concerns Queens Urban Health Plan Plaza Del Sol Health Center 37-16 108th Street, Corona, NY 11368 718-651-4000
Community Healthcare Network Family Health Center 90-04 161st Street, 5th Floor, Jamaica, NY 11432 718-523-2123
Charles B. Wang Community Health Center – 37th Avenue 136-26 37th Avenue, Flushing, NY 11354 718-886-1200
Can I change my Primary Care Charles B. Wang Community Health Center – 45th Home? Avenue 137-43 45th Avenue, Flushing, NY 11355 Yes. Call 311 and ask for ActionHealthNYC 929-362-3006 to change your Primary Care Home. NYC Health + Hospitals/Elmhurst 79-01 Broadway, Queens, NY 11373 718-334-2424
5 When should I contact my Primary Care Home?
If you have not seen a doctor since you enrolled in ActionHealthNYC, contact your Primary Care Home to book your first visit.
Contact your Primary Care Home when: You need a doctor’s appointment Your contact information changes You have questions about paying for health care services You need help getting your medications, including refills You had to go to an emergency room (If you need immediate help, go to the emergency room but let your Primary Care Home know about it afterwards.) You need a procedure or surgery done, or you have to stay overnight at a hospital You need to see a specialist doctor
Remember to say you are an ActionHealthNYC member.
Ask your Primary Care Home how you can contact a doctor or other health care professional after business hours. For example, you may need to speak to a doctor after hours if: You are not feeling well and are not sure if you need to see a doctor You have a time-sensitive question about a medication
GETTING CARE
How should I prepare for my doctor’s visit? Prepare for your appointment to get the most out of your time with the doctor. To make sure you get the best care, your doctor will want to understand your health status and learn as much about your medical history as possible.
Use the next two pages to prepare for your next doctor’s visit.
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Preparing for Your Doctor’s Visit
Before Your Visit
□ Find your IDNYC card. □ Fill out the Health Notes below. □ Bring a list of vaccinations you received recently. □ Bring any medical documents or X-rays from your last visit to another health care facility (for example, if you saw a different doctor, or went to an urgent care center or emergency room). □ Be on time for your doctor’s visits. Call if you need to reschedule or if you miss your appointment.
During Your Visit
□ Show your IDNYC card when you check in for your appointment. □ Use your Health Notes to describe how you are feeling and past health problems. □ Ask any questions you have about your health, and ask your doctor for clarification if you don’t understand his or her answers. □ If you have any tests, ask how you will receive test results and when your next appointment will be. □ Ask for a copy of your care plan, which describes your upcoming appointments and other important information. □ Ask if low-cost medications and refill options are available.
After Your Visit
□ Keep your care plan, medical information and test results in one place. □ Follow the instructions your doctor gave you during the visit. □ Pick up and take your medications. Be sure to read directions on how to store your medications, as some may need to be refrigerated. If you are not sure about how to take or store your medications, or about whether you need a refill, ask the pharmacist or call your Primary Care Home. □ Call your Primary Care Home if you have questions or concerns about your health or about your care plan.
For more information about how to prepare for a doctor’s visit, read the “Talking to Your Doctor” Health Bulletin. Visit nyc.gov/health/pubs and search “Talking to Your Doctor,” or call 311 to order a free copy in your preferred language.
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Health Notes
My Health Status Write down your symptoms and concerns. Describe all of your current and past health problems.
My Health History Write down your current health conditions.
My Family Health History Write down information about any diseases or health conditions that may run in your family.
My Medications Write down any prescription medicines, over-the-counter medicines, herbs, supplements or vitamins you are taking.
Notes
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What health care services can I get through ActionHealthNYC?
Primary and Preventive Care Primary and preventive care means regular check-ups, treatment of medical Services Included Through conditions, and health screenings to help ActionHealthNYC you stay healthy. Talk to your Primary Care Regular check-ups, vaccines and Home if you have questions about the screenings for diabetes, blood pressure, primary and preventive care services you cancer and other health conditions can get. Dental care Vision care Specialty Care Mental health and substance use services You may need care from a specialty care Family planning, including birth control doctor or a hospital. Specialty care means Help accessing and using health care care for a specific medical problem, such as diabetes or heart problems. resources
Some ActionHealthNYC Primary Care Homes have specialty care doctors who work at that location and can treat you. If you need care that cannot be treated on-site, your Primary Care Home can help set up an appointment for you at another location in the ActionHealthNYC Network.
What is the ActionHealthNYC network?
The ActionHealthNYC Network is made up of health care clinics and hospitals
that have agreed to provide services to ActionHealthNYC members at fees set by ActionHealthNYC. If you see a specialty care doctor outside of the ActionHealthNYC Network, you may need to pay a higher fee. Talk to your Primary Care Home about your options. See pages 16 and 17 for a list of health care clinics and hospitals in the ActionHealthNYC Network.
Having a regular primary care doctor who knows your health history is important, even if you have been seeing a specialty care doctor for certain health care needs up until now. If you would like to continue getting care from a particular specialty care doctor, talk to your Primary Care Home.
9 Emergency Care
In an emergency, call 911 or go to the hospital.
If you are not feeling well and do not know if you need to see a doctor, contact your Primary Care Home immediately. Staff can tell you if a doctor can see you or if you should go to the emergency room.
Emergency room visits and stays at certain NYC Health Any hospital in New York City + Hospitals locations are covered for ActionHealthNYC will care for you, regardless members based on the “Fees for Health Services” table of your immigration status on page 14. Members are encouraged to visit one of the emergency rooms listed on page 17 because they and ability to pay. You will offer ActionHealthNYC’s low-cost fee scale. not be turned away.
All New York City hospitals offer financial assistance and affordable payment plans. If you cannot pay your hospital bill, ask the hospital billing department about your options.
Mental Health Care Many people experience stress, depression, anxiety, relationship problems or emotional issues. Don’t struggle alone. Let your doctor know, and ask your Primary Care Home for help accessing confidential mental health services, such as counseling.
Trouble coping? NYC Well counselors can help with problems like stress, depression, anxiety and drug or alcohol misuse.
Call 1-888-NYCWELL (1-888-692-9355) for services in your language. Services are confidential, free and available 24/7.
10 Dental Care As an ActionHealthNYC member, you can receive preventive dental care (such as teeth cleaning and check-ups) and basic procedures (such as cavity fillings). See the “Fee for Health Services” table on page 14. Complex dental procedures or surgeries may cost more.
Primary Care Homes with On-Site Dental Care
Only the following ActionHealthNYC Primary Care Homes located in Manhattan have dental care on site: Charles B. Wang Community Health Center – Chinatown Community Healthcare Network Abate Health Center NYC Health + Hospitals/Gouverneur William F. Ryan-NENA Community Health Center
If your Primary Care Home does not offer dental services on-site, they can refer you to a dentist in the ActionHealthNYC Network.
Family Planning ActionHealthNYC members can receive basic family planning services, such as counseling, birth control and pregnancy testing. Call your Primary Care Home to make an appointment.
Medical and Laboratory Tests Certain basic medical or laboratory tests are covered under ActionHealthNYC. Depending on your health conditions, medical or laboratory tests may be performed either at your Primary Care Home or at another health clinic in the ActionHealthNYC Network. For more information, ask your Primary Care Home.
Vision ActionHealthNYC members can access basic and preventive vision services, including eye exams, at certain Primary Care Homes. If you need specialty eye care for severe or complex eye conditions (for example, cataracts or glaucoma), you may be referred to a hospital in the ActionHealthNYC Network. Ask your Primary Care Home what vision services they provide.
11 Pharmacy Your Primary Care Home will work with you to make sure you get the medications you need. Some Primary Care Homes may have pharmacies on-site. If so, you may be able to get medications right after your doctor’s appointment, for a fee. Otherwise, Primary Care Homes work with pharmacies that are near the clinic.
Ask your Primary Care Home for pharmacy referrals where low-cost medications are available for people without insurance. You may also ask your pharmacy if they have any discounts.
In addition, the City of New York has an official prescription discount program called BigAppleRx. Show your IDNYC card at many pharmacies for discounts on brand-name and generic medications and some over-the-counter medications, such as smoking cessation aids and supplies for managing diabetes. Find out more at BigAppleRx.com or by calling 311.
This is the back of a sample IDNYC card, which has the BigAppleRx information.
Services Not Included Through ActionHealthNYC
Though ActionHealthNYC covers a wide range of health services, it does not cover every service. If you need one of the following services, talk to your Primary Care Home.
Acupuncture Chiropractic Non-restorative cosmetic procedures Long-term care
12 How much does my health care cost? ActionHealthNYC services are low-cost for members. When you receive services at your Primary Care Home, a specialist office or a hospital, you will be asked to pay a fee based on your income and family size, and on the services you get. Refer to “Fees for Health Services” on the next page for more information.
The fees will be the same in all health centers or hospitals in the ActionHealthNYC Network. Health care services outside of the ActionHealthNYC Network may cost more.
If you have questions about a bill from a health center or hospital outside of the network, contact that center or hospital’s billing office directly.
Is the cost of transportation to a clinical appointment covered? The cost of transportation to your Primary Care Home is not covered under ActionHealthNYC. However, you can choose a Primary Care Home that is close to where you live or work. Talk to the staff at your Primary Care Home, or call 311 to ask about your options.
Is the cost of taking an ambulance to the emergency room covered? The cost of taking an ambulance to the emergency room is not covered under ActionHealthNYC.
13 Fees for Health Services Use this table to estimate the fees for different health services under ActionHealthNYC.
Step 1: Find your family size (the number of adults and children in your household, including yourself). Step 2: Look for your yearly income on the right columns. Step 3: Look to the bottom of the column to find out what group you are in and how much you will pay for different health care services. Yearly Income Family Size Equal to or less than Between 1 $17,820 $17,821 - $23,760 2 $24,030 $24,031 - $32,040 3 $30,240 $30,241 - $40,320 4 $36,450 $26,451 - $48,600 5 $42,660 $42,661 - $56,880 6 $48,870 $48,871 - $65,160 7 $55,095 $55,096 - $73,460 8 $61,335 $61,336 - $81,780 If you found your income If you found your income above, you are in Group A above, you are in Group B
Service Group A Fees Group B Fees
Clinic visit (primary or specialty care) $15 $20 Emergency room visit $15 $20 Family planning visit $0 - $15 $20 Outpatient surgery or MRI $150 $250 Hospital stay $150 $300
Here are three examples of how you estimate costs using this table: Example 1: You are an adult Example 2: You and your Example 3: You earn in a four-person household spouse have a combined $16,900 a year. Your doctor with a $35,000 annual salary of $25,500 a year. You tells you that you need an income. You need to go to need to have surgery, but MRI. the emergency room. you will not need to stay How much would you pay? overnight at the hospital. How much would you pay? You are in Group A. You You are in Group A. You How much would you pay? would pay $150 for your would pay $15 to go to an You are in Group B. You MRI plus $15 for the clinic emergency room in the would pay $250 for your visit. ActionHealthNYC Network. outpatient surgery.
14 MEMBER SERVICES
How can I get help in my preferred language? All New Yorkers have the right to free language services in ActionHealthNYC and City-run health care centers. If you do not get language services at your Primary Care Home or a New York City Health Department clinic, call 311 to file a complaint. How does ActionHealthNYC protect my personal information? ActionHealthNYC respects your confidentiality. Since ActionHealthNYC uses IDNYC, visit nyc.gov/idnyc and search privacy and confidentiality to see the protections for all IDNYC applicants and cardholders. If you have any questions or concerns, call 311. How can I make a complaint? ActionHealthNYC wants to make sure you are happy with the care you receive. If you have concerns, let your Primary Care Home know.
If the problem is not resolved, you may file a complaint by calling 311. You will not be dropped from ActionHealthNYC for filing a complaint, and you will still get health services.
How long can I receive services under ActionHealthNYC? The ActionHealthNYC program is currently funded to operate through June 30, 2017. We will let you know of any important changes to the program. Can I choose to leave ActionHealthNYC? Yes, you can choose to leave the ActionHealthNYC program at any time for any reason. If you no longer want to be in ActionHealthNYC, call 311. This will not affect your ability to continue receiving care from your Primary Care Home at the normal fee scale. Can ActionHealthNYC remove me from the program? ActionHealthNYC can remove members from the program if they: Misuse services provided by ActionHealthNYC. This includes medication diversion, like getting medications you do not need and reselling or giving them to someone else. Show disruptive, threatening and/or violent behavior. Threats, threatening behavior or acts of violence against staff or other patients is prohibited.
15 ActionHealthNYC NETWORK
Primary Care Homes When you enrolled, you chose a Primary Care Home to receive health care. You must go to the Primary Care Home you selected. To change your Primary Care Home, call 311.
Manhattan William F. Ryan-NENA Community Health Center 279 East 3rd Street, New York, NY 10009 212-477-8527
Community Healthcare Network Abate Health Center 150 Essex Street, New York, NY 10002 212-477-1120
Charles B. Wang Community Health Center - Chinatown 268 Canal Street, New York, NY 10013 212-379-6998
NYC Health + Hospitals/Gouverneur 227 Madison Street, New York, NY 10002 212-238-7897
Queens Urban Health Plan Plaza Del Sol Health Center 37-16 108th Street, Corona, NY 11368 718-651-4000
Community Healthcare Network Family Health Center 90-04 161st Street, 5th Floor, Jamaica, NY 11432 718-523-2123
Charles B. Wang Community Health Center – 37th Avenue 136-26 37th Avenue, Flushing, NY 11354 718-886-1200
Charles B. Wang Community Health Center – 45th Avenue 137-43 45th Avenue, Flushing, NY 11355 929-362-3006
NYC Health + Hospitals/Elmhurst 79-01 Broadway, Queens, NY 11373 718-334-2424
16 Hospitals and Emergency Rooms
Bronx Manhattan NYC Health + Hospitals/Jacobi NYC Health + Hospitals/Bellevue 1400 Pelham Parkway South 462 First Avenue Bronx, New York 10461 New York, New York 10016 718-918-5000 212-562-5555
NYC Health + Hospitals/Lincoln NYC Health + Hospitals/Harlem 234 East 149th Street 506 Lenox Avenue Bronx, New York 10451 New York, New York 10037 718-579-5000 212-939-1000
NYC Health + Hospitals/North Central NYC Health + Hospitals/Metropolitan Bronx 1901 First Avenue 3424 Kossuth Avenue New York, New York 10029 Bronx, New York 10467 212-423-6262 718-519-5000 Queens Brooklyn NYC Health + Hospitals/Elmhurst NYC Health + Hospitals/Coney Island 79-01 Broadway 2601 Ocean Parkway Elmhurst, New York 11373 Brooklyn, New York 11235 718-334-2424 718-616-3000 NYC Health + Hospitals/Queens NYC Health + Hospitals/Kings County 82-68 164th Street 451 Clarkson Avenue Jamaica, New York 11432 Brooklyn, New York 11203 718-883-3000 718-245-3131
NYC Health + Hospitals/Woodhull 760 Broadway Brooklyn, New York 11206 718-963-8000
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