Find the documents, forms and directories for your plan.
Use the documents listed for complete program information, including benefit summaries, customer service contacts, network information, out of network coverage, if available, prescription coverage information, and grievance and appeals procedures.
To find a doctor in our network select the appropriate
county below, or click here to use our online tool.
To find a doctor in our network, use our online search
Our network providers bill the plan
directly for your covered services and drugs. If you get a bill for
the full cost of medical care or drugs you have received, you should
send this bill to us so that we can pay it. When you send us the bill,
we will look at the bill and decide whether the services should be
covered. If we decide they should be covered, we will pay the
If you have already paid for services or drugs
covered by the plan, you can ask our plan to pay you back (paying
you back is often called “reimbursing” you). It is your right to be paid
back by our plan whenever you’ve paid more than your share of the
cost for medical services or drugs that are covered by our plan.
When you send us a bill you have already paid, we will look at
the bill and decide whether the services or drugs should be
covered. If we decide they should be covered, we will pay you back
for the services or drugs.
Network providers should always
bill the plan directly. But sometimes they make mistakes, and ask
you to pay more than your share of the cost. You only have to
pay your cost-sharing amount when you get services covered by our
plan. We do not allow providers to add additional separate
charges, called “balance billing.” This protection (that you never
pay more than your cost-sharing amount) applies even if we pay
the provider less than the provider charges for a service and
even if there is a dispute and we don’t pay certain provider
charges. For more information about “balance billing,”
please refer to your plans Evidence of Coverage (EOC).
Send us your request for payment, along with your bill and
documentation of any payment you have made. It’s a good idea to
make a copy of your bill and receipts for your records.
your request for payment together with any bills or receipts to
us at one of these addresses:
For Part C (medical)
requests: Affinity Health Plan, Customer Service
Department (Medicare) Metro Center Atrium 1776 Eastchester
Road Bronx, NY 10461
For Part D (prescription drug)
requests: Caremark Inc., Medicare Part D Claims P.O.
Box 52066 Phoenix, AZ 85072-2066
You must submit your claim
to us within one year of the date you received the service,
item, or drug.
Contact Customer Services at
1.877.234.4499, Monday to Sunday, 8am to 8pm; TTY/TTD:
1.800.662.1220 if you have any questions. If you don’t know
what you should have paid, or you receive bills and you don’t
know what to do about those bills, we can help. You can also
call if you want to give us more information about a
request for payment you have already sent to us.
Pharmacy Claims Form: English | Spanish
the Centers for Medicare and Medicaid Services rates plans based on a
5-star system, in areas including customer service, drug pricing and
patient safety. Star Ratings may change from one year to the next. See a
summary of quality and performance for Affinity’s Medicare plans based
on 19 different topics here: English | Spanish | Chinese
For Affinity Medicare Ultimate (HMO/SNP) and Affinity
Medicare Solutions (HMO/SNP) members who get extra help from Medicare to pay
for their prescription drug costs, this table shows what the monthly plan premium will be.
This form is used when someone who is
not the member would like information or assistance on your behalf. Your
representative can be a family member, friend, advocate, attorney, doctor
or anyone else you would like to act on your behalf: English | Spanish
Find information on free interpreter services to answer any
questions you may have about our health or drug plans.