MetroPlusHealth Gold Plan
You take care of New York.
Gold takes care of you.
Designed for NYC employees.
*No copay for urgent care, effective 1/1/2027. $100 copay for ER waived if admitted.
†Note: This is a drug discount program, not a prescription drug benefit. Drugs on the list are provided to covered individuals at a discounted price of $0 as part of a health and wellness benefit. Coverage for drugs that are not included in the discount program, require purchase of the optional rider and may be subject to copays. List of drugs can be found at metroplus.org/gold-rx-list
^NYC Health + Hospitals specialists may require medical referrals
On this page
Who is eligible for Gold Plan?
1
All employees of the City of New York
and their qualified domestic partners and eligible dependents
2
NYC Health + Hospitals employees
and their qualified domestic partners and eligible dependents
3
Non-Medicare eligible retirees
New and Enhanced 2027 Benefits
- No referrals required for in-network specialist visits*
- $0 urgent care copays beginning January 1, 2027
- New doula services for expectant parents, including:
- Up to eight prenatal or postpartum visits
- One labor and delivery support visit per pregnancy
- Prescription Concierge: Help accessing manufacturer copay assistance.
- More than 100 commonly prescribed medications available at no cost.**
- Diabetes Support: Expanded access to CGMs and insulin pumps through participating suppliers.
*NYC Health + Hospitals specialists may require medical referrals
**Note: This is a drug discount program, not a prescription drug benefit. Drugs on the list are provided to covered individuals at a discounted price of $0 as part of a health and wellness benefit. Coverage for drugs that are not included in the discount program, require purchase of the optional rider and may be subject to copays. List of drugs can be found at https://metroplus.org/gold-rx-list/
The New Gold Signature Experience
Available to all new and existing Gold members, this enhanced service provides white-glove support to help members navigate their health care journey with ease.
From benefit questions to care coordination and everything in between, we’re making it easier than ever for Gold members to get the support they need, when they need it, how they need it.
Because exceptional service should be part of every member’s experience.
Plan Benefits
- $0 copays for primary care provider visits
- $0 copays for specialist visits
- $0 per month premium for individuals and families
- $0 deductible
- $0 copay for over 125 commonly used prescription drugs
- $0 telehealth visits – 24/7 access to doctors and therapists
- Access in-network providers without a referral from your primary care physician.*
- 26 dietician visits per year at no cost
- 10 acupuncture visits per year at no cost
- Up to $60 transportation reimbursement per year
- Fitness reimbursements
Effective January 1, 2027
- $0 copay for urgent care
- Eligible members and their dependents earn up to $250 in rewards by doing heathy activities
- Doula visits
* NYC Health + Hospitals specialists may require medical referrals
Join thousands of city employees who’ve chosen MetroPlusHealth Gold
Open enrollment starts on November 1st.
Access top-rated health care providers
- Tens of thousands of top-rated providers citywide.
- 40+ premier hospitals including Mount Sinai, NYU Langone, and NY Health + Hospitals
- 110+ urgent care locations including convenient CityMD sites
Major Retail Pharmacies
Broad access across trusted national and regional chains.
CVS
Home delivery available
Duane Reade
Convenient neighborhood access
Walgreens
National retail network
Stop & Shop
Pharmacy access while you shop
More ways to fill prescriptions
Flexible options built around member preference and convenience.
Independent pharmacies
Several hundred community locations
Amazon Pharmacy
Home delivery, including PillPack
Capsule Pharmacy
Free same-day prescription delivery
Additional network options
And many more participating pharmacies
Cost Comparison for Members Who Select the Optional Drug Rider
Frequently asked questions about the Gold Plan
What does the Gold Plan provide?
$0 Cost Benefit
- $0 deductibles
- $0 co-insurance
- $0 employee premium with basic plan
- $0 24/7 virtual access to doctors and therapists
- $0 for select prescription drugs†
- $0 dietician visits
- $0 copay for urgent care, effective 1/1/2027
- Access in-network providers without a referral from your primary care physician.^
Health Care Access
- Tens of thousands of participating physician and hospital locations across NYC
- Expanded urgent care access
- Medications pre-packaged and delivered at no extra cost via PillPack or CVS Pharmacy
Wellness Perks
- Fitness reimbursements up to $1,400 per year
- Up to $300 per year reimbursement for wellness apps
- Transportation reimbursement – up to $60 per plan year
Additional Features
- Low-cost optional prescription drug rider available
- Doula visits
- Member portal to easily manage your account
†Note: This is a drug discount program, not a prescription drug benefit. Drugs on the list are provided to covered individuals at a discounted price of $0 as part of a health and wellness benefit. Coverage for drugs that are not included in the discount program, require purchase of the optional rider and may be subject to copays. List of drugs can be found at metroplus.org/gold-rx-list
^NYC Health + Hospitals specialists may require medical referrals
How can I enroll in the Gold Plan?
- Reach out to your company’s benefits manager for more information about choosing MetroPlusHealth Gold.
- You can also call us at 877.475.3795 or visit us at our Virtual Office to find a representative ready to answer your MetroPlusHealth Gold questions.
What other benefits do I get with the Gold plan?
- You, your spouse and dependents can get up to $1,400 reimbursement for working out
- 10 acupuncture sessions per plan year
- You may qualify for $0 copays for dietician visits
- $0 24/7 telehealth through MetroPlusHealth virtual visit
- And more!
Does MetroPlusHealth Gold plan offer fitness reimbursement?
Yes, Gold Plan offers a fitness reimbursement:
- Up to $250 per member, every 6 months
- Up to $250 per spouse, every 6 months
- Up to $100 per dependent (up to 2 dependents), every 6 months
Want to learn more about Gold?
Join a free Webinar!
Webinars are offered on the first Wednesday of each month or the last Friday of each month through December 2026.
last updated: October 1, 2026