Provider health care facts
What will my HIP UFT FHPlus benefits cover?
Covered benefits
- Physician services (regular checkups and preventive health services)
- Specialty care
- Inpatient/outpatient hospital care
- Women’s health services (including gynecological exams and family planning)
- Breast exams (including mammography)
- Maternity care (prenatal care, childbirth classes doctor/midwife services, hospital delivery and postpartum care)
- Dental care
- HIV counseling and testing services
- Early Periodic Screening Diagnosis and Treatment (EPSDT) services for UFT Family Health Plus members 19 and 20 years old, including transportation to obtain these services
- Prescription drugs, select over-the-counter medications, diabetic supplies and smoking cessation products
- Laboratory tests and x-rays
- Emergency room visits
- Non-emergency transportation
- Eye exams and eyeglasses and other medically needed vision aids
- Allergy testing and treatment
- Hearing exams and hearing aids
Benefits not covered
- Long-term care/residential care
- Personal care
- Private duty nursing
- Medical supplies (except diabetic supplies)
What will these benefits cost me?
You will not need to pay any monthly premiums. However, you may have to pay co-payments when receiving certain medical care and services.
| Services | Co-pay |
|---|---|
| Generic prescription drugs | $3.00 for each prescription and refill |
| Brand name prescription drugs | $6.00 for each prescription and refill |
| Clinic visits | $5.00 per visit |
| Physician office visits | $5.00 per visit |
| Dental visits | $5.00 per visit, up to $25.00 per year |
| Lab services | $0.50 per test |
| Radiology services (like diagnostic X-rays, ultrasound, nuclear medicine and oncology services) | $1.00 per service |
| Inpatient hospital stay | $25.00 per stay |
| Non-urgent emergency room visit | $3.00 per visit |
| Over-the-counter (OTC) drugs (e.g., smoking cessation products, insulin) | $0.50 per item |
| Medical supplies (e.g., hearing aid batteries, enteral formula, diabetes test strips, lancets and syringes) | $1.00 per item |
Services to which co-payments DO NOT apply
- Emergency room visits for needed emergency care
- Family planning services, drugs and supplies
- Mental health clinic visits
- Chemical dependency clinic visits
- Drugs to treat mental illness
- Drugs to treat tuberculosis
- Prescription drugs for residents of Adult Care Facilities
Members that do not have to make co-payments
- Members under age 21
- Pregnant women (through 60 days postpartum)
Note: Members that also have Regular Medicaid coverage that are over 21 years of age and are not pregnant (through 60 days postpartum) only have to make pharmacy co-payments.
You will not be denied health care services based on your inability to pay the co-payment at the time of service.
Note: Medicaid Eligible members will only be responsible for the current Medicaid co-payments.
