Daycare worker and child making a cactus craft

GoldCare I Plan

Thousands of doctors across all of NYC, with access to 19 hospitals. Low monthly premiums – and no monthly cost to you! Plus the same low cost for office visits and medications.

Who is it for?

  • 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

  • ALL eligible Local 205, DC 1707 members, and AFSCME who work a minimum of 30 hours a week

  • Part time employees working at least 20 hours but less than 30 hours per week

Plan Features

$0
Monthly Premium
$0
Deductible

Eligibility

Monthly Premium

Deductible

Out of Pocket Maximum

PCP Office Visits

Specialist Office Visits

Hospital Admission

Emergency room co-pay (waived if admitted)

Prescription Drug Coverage

NYC Daycare Employees

$0–$28.02 (see chart below)

$0

$6,850 single / $13,700 family

$10 copay per visit

$20 copay per visit

$150 copay per hospital admission

$100 copay per visit

$5 generic / $20 brand / $50 non-formulary / Mail Order – Discounted

What does the GoldCare I Plan provide?

  • Low premiums starting at $0 per month

  • No deductibles for any covered services

  • No paperwork (bills, claims forms) for in-network services

  • Low co-pays for specialist, lab and X-Rays

A woman pauses to look at her phone before going through the subway turnstiles to leave the subway

I was so worried about my insurance ending but my counselor was fantastic and got it set up so quickly! It was a brief phone call and I was able to get the coverage I needed. She was pleasant to talk to and answered all of my questions.

Saira A.
Yelp Review
EMPLOYEEEMPLOYEE / CHILD(REN)EMPLOYEE / SPOUSEFAMILY
Employee OnlyEmployee and his/her child(ren)Employee and his/her legal spouseEmployee, his/her legal spouse and their child(ren)
$0.00$10.57$19.12$28.02

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.

For MetroPlusHealth GoldCare I:

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.

Extensive provider and hospital network

MetroPlusHealth has providers in over 21,000 sites in Manhattan, Brooklyn, Queens, the Bronx and Staten Island. PCPs are located in private doctor’s offices, neighborhood family care sites and hospitals. GoldCare I members have access to 19 hospitals in NYC, including NYC Health + Hospitals’ facilities and Diagnostics and Treatment Centers.

The GoldCare I Provider Network includes primary, OB/GYN, behavioral health and specialty care at thousands of sites across New York City – and at these great hospitals:

METROPLUSHEALTH GOLDCARE I MEMBERS
ManhattanBellevue Hospital Center
Harlem Hospital Center
Metropolitan Hospital Center
QueensElmhurst Hospital Center
Queens Hospital Center
BrooklynConey Island Hospital
Kings County Hospital Center
Woodhull Medical Center
The BronxJacobi Medical Center
Lincoln Medical Center
North Central Bronx Hospital
Staten IslandRichmond University Medical Center
Staten Island University Hospital

Additional Facilities for Care

NYC Health + Hospitals Diagnostic & Treatment Centers
Cumberland D&TC
East New York D&TC
Gouverneur Health
Morrisania D&TC
Renaissance Health Care Network
Segundo Ruiz Belvis D&TC
…and at more than 40 Urgent Care Centers

To learn more about the drugs covered by our GoldCare Plans, please visit the MetroPlusHealth Pharmacy page

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 coming soon).

All MetroPlusHealth GoldCare members have access to a mail order option for their medications. Access the mail order form here.

GoldCare I Plan Materials

For comprehensive listing of benefits, review your Certificate of Coverage.

For a quick review of GoldCare I, including monthly rates, review your Summary of Benefits.

Summary of Benefits
Certificate of Coverage
Member Guide
Women's Health and Cancer Rights Act
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MetroPlusHealth Virtual Visit

Access to your 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.

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.

Health Risk Assessment 

HRA can be returned to:
ATTENTION: QM Health Risk Assessment Unit
MetroPlus Health Plan
50 Water Street, 7th Floor
​New York, NY 10004
or by completing our Contact form by clicking here.

IMPORTANT INFORMATION: MONKEYPOX CASES ARE RISING IN NYC.

Monkeypox cases are rising in NYC. Learn more about Monkeypox, including prevention and treatment, here.

last updated: April 1, 2022

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