We would like to show you a description here but the site won’t allow us.Jan 1, 2023 · Y0066_SB_H0271_045_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ Femenino UnitedHealthcare - H0271 For 2023, UnitedHealthcare - H0271 received the following Star Ratings from Medicare: Overall Star Rating: 4 stars Health Services Rating: 3.5 stars Drug Services Rating: 3 stars Every year, Medicare evaluates plans based on a 5-star rating system. Why Star Ratings are Important Medicare rates plans on their health and ...Number of Members enrolled in this plan in (H0271 - 057): 3,821 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...See full list on uhcprovider.com o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security NumberGuía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Área de servicio: New York - condados de Albany, Allegany, Broome, Cattaraugus, Cayuga,Resumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud queY0066_SB_H0271_027_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO D-SNP) H0271-060-001 plans for New York and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Datos del miembro (escriba a máquina o en letra de molde con tinta negra o azul) Apellidos Nombre Inicial del segundo nombre Fecha de nacimiento Sexo ¨ Masculino ¨ Femenino Number of Members enrolled in this plan in (H0271 - 057): 3,821 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... Y0066_SB_H0271_060_001_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ... H0271-060-001 NYMCNYDSNP5P NYMCNYDSNP5F UnitedHealthcare Dual Complete® Choice (PPO DSNP) Bronx, Kings, Nassau, New York, Queens, Richmond H0271-060-002 NYMCNYDSNP6P o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security Number5. Introduction. SHIBA (Senior Health Insurance Benefits Assistance) is a statewide network of certified . counselors volunteering in their community to help all Oregonians make educated 2023 Medicare Advantage Plan Details. Medicare Plan Name: UnitedHealthcare Dual Complete Choice (PPO D-SNP) Location: Essex, New York Click to see other locations. Plan ID: H0271 - 060 - 1 Click to see other plans. Member Services: 1-800-514-4912 TTY users 711.Medical Plans. Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc.License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc ...Jan 1, 2023 · h0271-029-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Y0066_SB_H0271_045_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura Sus Beneficios y Servicios de Salud y su Cobertura de Medicame Guía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Área de servicio: New York - condados de Albany, Allegany, Broome, Cattaraugus, Cayuga, TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete (PPO D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify for both ...Jan 1, 2023 · h0271-043-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. The following UnitedHealthCare plans are accepted at Oak Street Health locations. Plan Name. Effective Year. Benefit Package. Summary. AARP Medicare Advantage. 2023. H1944-024. AARP Medicare Advantage.H0271-060: Download: UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO) 2023: R5342-001: Download: UnitedHealthcare Medicare Advantage Choice Plan 4 ...Guía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Área de servicio: New York - condados de Bronx, Kings, Nassau, New York, Queens y Richmondh0271 023 014 ct in me 020 028 mi 029 030 mt 016 sc 037 sd 038 ut 013 wv 042 wy 039 024 h0321 arizona physicians ipa, inc. az h0423 metroplus health plan, inc. h0432 009 h0439 cigna healthcare of georgia, inc. h0473 humana insurance company of kentucky h0482 centene venture company michigan h0524 kaiser foundation hp, inc. ca h0544 blue cross ...h0271-043-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan.Jan 1, 2023 · Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Service area: New York - Bronx, Kings, Nassau, New York, Queens, Richmond counties 5. Introduction. SHIBA (Senior Health Insurance Benefits Assistance) is a statewide network of certified . counselors volunteering in their community to help all Oregonians make educatedSee full list on uhcprovider.com This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 060 – 1 available in Select Counties in Upstate NY. IMPORTANT : This page has been updated with plan and premium data for 2023. Number of Members enrolled in this plan in (H0271 - 057): 3,821 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...Plan ID: H0271-060-002. * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. $0.00 Monthly Premium. New York Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A ... Y0066_EOC_H0271_046_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security Number2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H0271-060-002; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-013-000; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-001; 2023 UnitedHealthcare Dual Complete Plan Benefit Flyer H3387-014-002Thermal Conductivity Btu/ sq ft/ ft hr/ °F at 68°F. 17. Coefficient of Thermal Expansion 68-572 10 to -6 power per °F (68 – 572°F) 9. Specific Heat Capacity Btu/ lb /°F at 68°F. 0.09. Modulus of Elasticity in Tension ksi. 22000. Modulus of Rigidity ksi.o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security NumberWe would like to show you a description here but the site won’t allow us.This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 060 – 1 available in Select Counties in Upstate NY. IMPORTANT : This page has been updated with plan and premium data for 2023. Resumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud que H0271-022-000 OR Local PPO UnitedHealthcare Medicare Advantage ... H0543-060-000 CA HMO AARP Medicare Advantage SecureHorizons Premier Not SNP NeitherY0066_EOC_H0271_046_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage H0271-060-001 CMS Rating 4 out of 5 stars. Monthly premium: $ 0.00 * * Your costs may be as low as $0, depending on your level of Medicaid eligibility. ...UnitedHealthcare Dual Complete Choice (PPO D-SNP) 4 out of 5 stars* for plan year 2023. UnitedHealthcare Dual Complete Choice (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by UnitedHealthcare.Jan 1, 2023 · h0271-029-000 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. Y0066_EOC_H0271_060_001_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de CoberturaUnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO D-SNP) H0271-060-001 plans for New York and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll.Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Service area: New York - Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung,Y0066_EOC_H0271_060_001_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Coberturah0271 023 014 ct in me 020 028 mi 029 030 mt 016 sc 037 sd 038 ut 013 wv 042 wy 039 024 h0321 arizona physicians ipa, inc. az h0423 metroplus health plan, inc. h0432 009 h0439 cigna healthcare of georgia, inc. h0473 humana insurance company of kentucky h0482 centene venture company michigan h0524 kaiser foundation hp, inc. ca h0544 blue cross ...Number of Members enrolled in this plan in (H0271 - 060): 6,780 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...Y0066_EOC_H0271_060_002_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverage Monday – Friday 8 a.m. – 6 p.m. EST 1-888-617-8979 TTY 711. To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit www.nystateofhealth.ny.gov or call 1-855-355-5777.o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security Number2023 UnitedHealthcare (H0271) Star Rating Details; UnitedHealthcare Dual Complete Choice (PPO D-SNP) (H0271-060-1) Benefits & Contact Info The UnitedHealthcare Dual Complete Choice (PPO D-SNP) (H0271-060-1) in Putnam, NY: CMS MA Region 3 which includes: NY: Star Rating Category & Measures: 2023: 2022: Overall Star Rating: 4: 4Y0066_EOC_H0271_060_002_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura Call us: Call UnitedHealthcare at 1-877-596-3258 / TTY 711, 8 a.m. to 8 p.m. 7 days a week. 1 $0 cost-share for in-network dental care, specified services only. If your plan offers out-of-network dental coverage and you see an out-of-network dentist you might be billed more, even for services listed as $0 copay.Monday – Friday 8 a.m. – 6 p.m. EST 1-888-617-8979 TTY 711. To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit www.nystateofhealth.ny.gov or call 1-855-355-5777.Number of Members enrolled in this plan in (H0271 - 057): 3,821 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...UnitedHealthcare offers UnitedHealthcare Dual Complete® (HMO D-SNP) H0271-060-002 plans for New York and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about steps to enroll. Jan 1, 2023 · h0271-060-001 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan. See full list on uhcprovider.com Number of Members enrolled in this plan in (H0271 - 036): 2,359 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...2023 New York UnitedHealthcare Dual Complete® Plan Frequently Asked Questions: H0271-060-001 Subject: UnitedHealthcare Community Plan of New York manages the Medicare Advantage benefits and reimburses you according to your existing contracted rates. Created Date: 20230220173758Z H0271 027 * 4. Christian. UnitedHealthcare; UnitedHealthcare Chronic Complete Assure (PPO C-SNP) Local PPO Chronic or Disabling Condition $ 9.80 $ 505.00 No; DS H0271; o UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security NumberY0066_EOC_H0271_060_001_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura Number of Members enrolled in this plan in (H0271 - 027): 4,053 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ... TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete (PPO D-SNP) benefit details. — Medicare Plan Features —. Monthly Premium: $0.00 for people who qualify for both Medicare and Medicaid. (see Plan Premium Details below) Annual Deductible: $0 for people who qualify for both ...What you'll pay. Dental $3,000 per year for covered dental services. $0 copay for covered network preventive services including oral exams, routine cleanings, X-rays and fluoride. $0 copay for covered network comprehensive services such as fillings, crowns, root canals, extractions, dentures and implants.Jan 1, 2023 · Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Service area: New York - Bronx, Kings, Nassau, New York, Queens, Richmond counties Y0066_EOC_H0271_060_001_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura H0271-060-001 CMS Rating 4 out of 5 stars. Monthly premium: $ 0.00 * * Your costs may be as low as $0, depending on your level of Medicaid eligibility. ...UnitedHealthcare offers UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-001 Lookup Tools plans for New York and eligible counties. This plan gives you a choice of doctors and hospitals. Learn about lookup tools.This page features plan details for 2023 UnitedHealthcare Dual Complete Choice (PPO D-SNP) H0271 – 060 – 1 available in Select Counties in Upstate NY. IMPORTANT : This page has been updated with plan and premium data for 2023. Enrollment Guide 2023 Take advantage of all your Medicare Advantage plan has to offer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Service area: New York - Bronx, Kings, Nassau, New York, Queens, Richmond countiesNumber of Members enrolled in this plan in (H0271 - 027): 4,053 members : Plan’s Summary Star Rating: 4 out of 5 Stars. • Customer Service Rating: 5 out of 5 Stars. • Member Experience Rating: 3 out of 5 Stars. • Drug Cost Accuracy Rating: 4 out of 5 Stars. — Plan Premium Details — The Monthly Premium is Split as Follows: : Total ...Learn more about the UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 plan for New York. Check eligibility, explore benefits, and enroll today. Jan 1, 2023 · h0271-060-002 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan.
H0271-022-000 OR Local PPO UnitedHealthcare Medicare Advantage ... H0543-060-000 CA HMO AARP Medicare Advantage SecureHorizons Premier Not SNP Neither. Royal doulton figurinesandprevsearchandptoaue
H0271 - 060 - 2 Click to see other plans. Member Services: 1-800-514-4912 TTY users 711. — Enrollment Options —. Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Dual Complete Choice (PPO D-SNP) benefit details. H0271 027 * 4. Christian. UnitedHealthcare; UnitedHealthcare Chronic Complete Assure (PPO C-SNP) Local PPO Chronic or Disabling Condition $ 9.80 $ 505.00 No; DS H0271; Y0066_EOC_H0271_060_001_2023_SP_C. OMB Approval 0938-1051 (Expires: February 29, 2024) Del 1 de enero al 31 de diciembre de 2023 Evidencia de Cobertura H0271-060-001 NYMCNYDSNP5P NYMCNYDSNP5F UnitedHealthcare Dual Complete® Choice (PPO DSNP) Bronx, Kings, Nassau, New York, Queens, Richmond H0271-060-002 NYMCNYDSNP6P Copayment for Fluoride Treatment $0.00. Maximum 2 visits every year. Copayment for Dental X-Rays $0.00. Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3000.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined. Resumen de Beneficios 2023 UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Consulte esta guía y aproveche las coberturas de medicamentos y los servicios de salud queH0271 027 * 4. Christian. UnitedHealthcare; UnitedHealthcare Chronic Complete Assure (PPO C-SNP) Local PPO Chronic or Disabling Condition $ 9.80 $ 505.00 No; DS H0271; H0271-022-000 OR Local PPO UnitedHealthcare Medicare Advantage ... H0543-060-000 CA HMO AARP Medicare Advantage SecureHorizons Premier Not SNP NeitherGuía de Inscripción 2023 Aproveche todo lo que su plan Medicare Advantage tiene para ofrecer UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 Área de servicio: New York - condados de Bronx, Kings, Nassau, New York, Queens y RichmondTTY users 1-877-486-2048. or contact your local SHIP for assistance. Email a copy of the UnitedHealthcare Medicare Advantage Assure (PPO) benefit details. — Medicare Plan Features —. Monthly Premium: $29.10 (see Plan Premium Details below) Annual Deductible: $480. Annual Initial Coverage Limit (ICL):Y0066_EOC_H0271_046_000_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of Coverageo UnitedHealthcare Dual Complete® Choice (PPO D-SNP) H0271-060-002 - UO7 Information about you (Please type or print in black or blue ink) Last Name First Name Middle Initial Birth Date Sex ¨ Male ¨ Female Home Phone Number ( ) - Mobile Phone Number ( ) - Social Security Number Sep 1, 2023 · What you'll pay. Dental $3,000 per year for covered dental services. $0 copay for covered network preventive services including oral exams, routine cleanings, X-rays and fluoride. $0 copay for covered network comprehensive services such as fillings, crowns, root canals, extractions, dentures and implants. h0271-060-002 Look inside to take advantage of the health services and drug coverages the plan provides. Call Customer Service or go online for more information about the plan.Y0066_SB_H0271_016_000_2023_M. Summary of Benefits January 1st, 2023 - December 31st, 2023 This is a summary of what we cover and what you pay. Review the Evidence of ...COVERAGE Cigna Preferred Savings Medicare (HMO) H0354-029 1 Summary of Benefits H0354_23_791307_M Reducing your Medicare Part B premium; no referrals requiredH0271-060-001 CMS Rating 4 out of 5 stars. Monthly premium: $ 0.00 * * Your costs may be as low as $0, depending on your level of Medicaid eligibility. ...Monday – Friday 8 a.m. – 6 p.m. EST 1-888-617-8979 TTY 711. To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit www.nystateofhealth.ny.gov or call 1-855-355-5777. Y0066_EOC_H0271_060_001_2023_C. OMB Approval 0938-1051 (Expires: February 29, 2024) January 1 – December 31, 2023 Evidence of CoverageCopayment for Fluoride Treatment $0.00. Maximum 2 visits every year. Copayment for Dental X-Rays $0.00. Maximum 1 visit (Please see Evidence of Coverage for details) Maximum Plan Benefit of $3000.00 every year for in and out of network services combined for Preventive and Non-Medicare Covered Comprehensive combined..