Prenatal and Postpartum Cost Sharing Reduction for Leaf Plan and Leaf Premier Plan Members

Starting January 1, 2025, the New York State of Health (NYSOH) will cover the in-network cost-sharing for select prenatal and postpartum services for eligible members in our Leaf and Leaf Premier Plans.

Who is eligible for the cost share reduction?

Starting January 1, 2025, Leaf Plan and Leaf Premier Plan members will have certain cost-sharing requirements removed for the duration of their pregnancy and for twelve months postpartum as defined by New York State. Additionally, cost sharing for select pregnancy and postpartum services have already been waived for Essential Plan members as of April 1, 2024.

Eligible members will need to contact NYSOH at 1-855-355-5777 to report their pregnancy to receive the cost share reduction.

Which services will be exempt from cost sharing?

Cost sharing, including deductibles, coinsurance, and copayments will be removed for the following services for eligible Leaf Plan and Leaf Premier members:

• Medical services
• Lab and X-Ray services
• Pharmacy and supplies
• Prenatal screening

Which services will still require cost sharing?

Cost sharing will still apply for the following services for eligible Leaf Plan and Leaf Premier members:

• Ambulance services
• Inpatient services (i.e. hospital, rehabilitation, behavioral health inpatient treatment, and hospice)
• Emergency services provided in a hospital setting
• Vision and Dental
• Delivery services provided by a physician, nurse practitioner, and/or midwives
• Delivery services provided in a hospital and/or birthing center setting

What actions do eligible members need to take?

Members will need to report their pregnancy as soon as possible by calling NYSOH at 1-855-5777. NYSOH will notify Healthfirst of the effective dates of the cost share reduction and Healthfirst will apply the cost share reduction to appropriate claims.

If a member is no longer pregnant or miscarries, are they still eligible for postpartum coverage?

Healthfirst will honor any dates communicated by NYSOH for Leaf Plan, Leaf Premier, and Essential Plan members.

More Information and Additional Resources

• Cost Sharing for Prenatal and Postpartum Services for Individuals in a Qualified Health Plans
• Extra Cost-Savings Through New York State of Health in 2025

Questions?

If you have any questions, please contact your Network Account Manager, or call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am–5:30pm.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”).

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