NY Manual
SHP Manual

New York Provider Manual
4.5 Member Rights and Responsibilities | 5.1 Reporting Requirements

4.6 Member Services and Education

The Member Services department provides members with an extensive array of customer service, outreach, orientation, and educational programs, including translation services to assist members who do not understand English.

New Member Outreach and Orientation

All new Healthfirst members are contacted and invited to attend monthly orientations, which are also open to existing members. These sessions are conducted at selected participating hospitals, at community-based organizations, and in Healthfirst’s offices. They reinforce and supplement the information provided in Healthfirst marketing presentations. Orientations focus on explaining the enrollment process, benefits, and rights and responsibilities to new members. Member orientations include presentations on covered benefits and services, the role of the PCP, free access services, and access to “carved out” services.

All members receive a new member enrollment kit and Provider Directory that lists primary care, OB/GYN, specialists, and ancillary service providers. The new member enrollment kit contains a member handbook and subscriber contract or EOC, depending on which product the member enrolls in. Members also receive copies of our member newsletter and health education materials.

As part of the mandatory Medicaid managed care program, Maximus, the enrollment broker, issues health risk assessment questionnaires to newly enrolled individuals and families as part of the enrollment process. Healthfirst also sends health risk assessment forms to new members and once annually to all existing Medicare Special Needs Plan (SNP) members (e.g., members in Healthfirst’s Maximum, CompleteCare, and Life Improvement Plans). Healthfirst uses these self-reported health assessment tools to better understand the member's health and lifestyle, their wellness, or specific service needs. Healthfirst encourages these members to visit their PCP as soon as possible to obtain services. In addition, Healthfirst Case Managers call members with complex medical needs to ensure that they receive appropriate attention and care.  

Special Outreach and Care Management

Healthfirst sponsors special outreach programs to encourage appropriate preventive care and to provide care management services for selected conditions. Outreach programs include Quality Improvement initiatives that remind members to seek preventive care services such as well-child care, immunizations, and screening tests such as mammograms and regular Pap smears.

Healthfirst’s Care Management includes Asthma, Healthy Mom/Healthy Baby (for normal and high-risk pregnancies), Congestive Heart Failure, HIV, Behavioral Healthcare, Diabetes, Domestic Violence, Health Buddy (CHF and Diabetes), and the Coordinated Care Program.

Commercial Plans

Members new to Healthfirst Leaf, Healthfirst Leaf Premier, or HMO A-D plans will receive the following new member material:

·     A letter with their assigned Primary Care Physician (or PCP) and their Healthfirst Member ID number
·     A New Member Welcome Kit including the Healthfirst Member Handbook
·     A member ID Card

These members will all receive a welcome call which will explain plan benefits, inform members of their PCP selection; offer members the opportunity to change their PCP; explain their financial responsibilities, such as deductibles, maximum-out-of-pocket, copay, and coinsurance; and cover the definition of emergency services. Additionally, these members will be asked to complete a health questionnaire to assess their baseline health status. The health questionnaire will be available on the member portal at www.myhfny.org. Healthfirst will also follow up with members who do not fill out the health questionnaire to ask them to complete the questionnaire by phone.