MetroPlus GoldCare II

MetroPlus GoldCare II

MetroPlus GoldCare II benefits include: 

No-premium health care: The MetroPlus GoldCare II plan has no employee premium for employees and their dependents.

No deductibles: There are no deductibles for any covered services, so you start saving right away.

No paperwork: There are no bills or claims forms for in-network services.

Low co-pays for specialists, lab and X-rays.

Extensive provider and hospital network: MetroPlus has providers in over 27,000 sites in Manhattan, Brooklyn, Queens, the Bronx and Staten Island. PCPs are located in private doctor's offices, neighborhood family care sites and hospitals. MetroPlus has agreements with over twenty hospitals in NYC, including NYC Health + Hospitals' facilities and Diagnostics and Treatment Centers. 

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MetroPlus GoldCare II

 
Deductible $0
Out of Pocket Maximum $6,850 single/$13,700 family
PCP office visits $30 co-pay per visit
Specialist office visits $50 co-pay per visit
Hospital admission $500 co-pay per hospital admission
Emergency room co-pay (waived if admitted) $150 co-pay per visit
Prescription drugs $25 generic / $50 brand / $75 non-formulary

MetroPlus Care Management Program

  • Help members with chronic conditions stay healthy  
  • Diabetes and Asthma programs to encourage members to partner with their PCPs to reduce complications from illnesses and lead healthier lives
  • Care Management for high-risk pregnant women
  • Partnership in Care helps people living with HIV/AIDS manage their condition and stay healthy
Care Management is also available for members with Behavioral Health or Complex Medical Transplant. The Care Management Action Line is 1.877.475.3795, TTY users: 711

Eligibility

All verified permanent and non-administrative employees who work in an Administration for Children’s Services/Agency for Child Development (ACS/ACD) funded Day Care and/or Family Day Care Centers that are a party to a Labor-Management contract with the Community and Social Agency Employees Union, District Council 1707, Local 205, AFSCME and who work a minimum of 30 hours a week, are eligible for the Welfare Fund enrollment. Part time employees working at least 20 hours but less than 30 hours per week are eligible to enroll in GoldCare I ONLY, with the same health insurance payroll deductions as employees working 30 hours or more per week.
 

MetroPlus GoldCare II Resources

 
Certificate of Coverage Download
Certificate of Coverage with Young Adult Rider Download
   
Provider Directory Take Me There
Formulary Take Me There
   
Guide Download