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Non-Discrimination Notice

Notice Informing Individuals About Nondiscrimination and Accessibility Requirements

PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Partners Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Partners Health Plan

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Provides free language services to people whose primary language is not English, such as:
    • Qualified interpreters
    • Information written in other languages

If you need these services, contact the Participant Call Center at 1-855-747-5483 from 8AM to 8PM, seven days a week (TTY users call 711.)

If you believe that Partners Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Linda Colón, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Jacob Javits Federal Building
26 Federal Plaza - Suite 3312
New York, NY 10278

Customer Response Center:
(800) 368-1019

Fax: (202) 619-3818
TDD: (800) 537-7697
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

You can file a grievance in person or by mail, fax, or email.

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Linda Colon, Regional Manager is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue SW., Room 509F, HHH Building,
Washington, DC 20201
1-800-868-1019, 800-537-7697 (TDD).

Partners Health Plan is a managed care plan that contracts with Medicare and the New York State Department of Health (Medicaid) to provide benefits to Participants through the Fully Integrated Duals Advantage for individuals with Intellectual and Developmental Disabilities (FIDA-IDD) Demonstration. The State of New York has created a Participant Ombudsman Program called the Independent Consumer Advocacy Network (ICAN) to provide participants free, confidential assistance on any services offered by PHP Care Complete FIDA-IDD Plan. ICAN may be reached toll-free at 1-844-614-8800 (TTY users call 711, then follow the prompts to dial 844-614-8800) or online at icannys.org. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

H9869_2022_Nondiscrimination Notice_Approved

Written on .

2023 Non-Discrimination Notice

Notice Informing Individuals About Nondiscrimination and Accessibility Requirements

PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Partners Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Partners Health Plan:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Provides free language services to people whose primary language is not English, such as:
    • Qualified interpreters
    • Information written in other languages

If you need these services, contact the Participant Call Center at 1-855-747-5483 from 8AM to 8PM, seven days a week (TTY users call 711.)

If you believe that Partners Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Linda Colón, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Jacob Javits Federal Building
26 Federal Plaza - Suite 3312
New York, NY 10278

Customer Response Center:
(800) 368-1019

Fax: (202) 619-3818
TDD: (800) 537-7697
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Linda Colon, Regional Manager is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at:

Option:

or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue SW., Room 509F, HHH Building,
Washington, DC 20201
1-800-868-1019, 800-537-7697 (TDD).

Partners Health Plan is a managed care plan that contracts with Medicare and the New York State Department of Health (Medicaid) to provide benefits to Participants through the Fully Integrated Duals Advantage for individuals with Intellectual and Developmental Disabilities (FIDA-IDD) Demonstration. The State of New York has created a Participant Ombudsman Program called the Independent Consumer Advocacy Network (ICAN) to provide participants free, confidential assistance on any services offered by PHP Care Complete FIDA-IDD Plan. ICAN may be reached toll-free at 1-844-614-8800 (TTY users call 711, then follow the prompts to dial 844-614-8800) or online at icannys.org. Complaint forms are available at: 

Option:

Partners Health Plan is a managed care plan that contracts with Medicare and the New York State Department of Health (Medicaid) to provide benefits to Participants through the Fully Integrated Duals Advantage for individuals with Intellectual and Developmental Disabilities (FIDA-IDD) Demonstration.

The State of New York has created a Participant Ombudsman Program called the Independent Consumer Advocacy Network (ICAN) to provide participants free, confidential assistance on any services offered by PHP Care Complete FIDA-IDD Plan. ICAN may be reached toll-free at 1-844-614-8800 (TTY users call 711, then follow the prompts to dial 844-614-8800) or online at icannys.org.

H9869_2023 Nondiscrimination Notice_Approved 

Written on .

2025 Member Materials

Member Resources & Support

2025 Member
Materials

  • Evidence of Coverage/Participant and Family Handbook

    This handbook tells you about your coverage under PHP Care Complete FIDA-IDD Plan (MedicareMedicaid Plan) from the date you are enrolled with PHP Care Complete FIDA-IDD Plan through December 31, 2025.

  • Annual Notice of Changes for 2025

    Annual Notice of Changes to learn about your coverage choices. Key terms and their definitions appear in alphabetical order in the last chapter of the Participant Handbook.

  • Summary of Benefits

    This document is a brief summary of the benefits and services covered by PHP Care Complete FIDA-IDD Plan.

  • Out-of-Network Coverage Rules

    If a medically necessary service or benefit is unavailable within PHP Care Complete FIDA-IDD Plan’s provider network, your care coordination team will authorize the out-of-network services subject to utilization review.

  • CMS Appointment of Representative Form (CMS Form - 1696)

    If you wish to name a family member, a friend, or a person whom you trust to act on your behalf to ask to file an appeal or a grievances with Partners Health Plan, both you and the individual you choose must fill out and sign this Appointment of Representative Form (AOR). 

  • 2025 NY CDPAP Changes

    New York’s Consumer Directed Personal Assistance Program (CDPAP) is changing. Effective March 28, 2025, there will be one Fiscal Intermediary (FI) to oversee the program, Public Partnerships LLC or “PPL.” Members in the CDPAP program must register with PPL by the deadline.

Formulary Information and Documents

  • Prescription Drug Coverage Information

    PHP Care Complete FIDA-IDD Plan has a List of Covered Drugs, also known as a Formulary.

    When you get a prescription for any of these covered drugs, PHP Care Complete FIDA-IDD Plan will cover the prescription when you go to a network pharmacy. (Some drugs have limits – see Limits on coverage for some drugs below).

    PHP Care Complete FIDA-IDD Plan has more than 5,000 retail pharmacies across their nine-county service area. These include Costco, CVS, Duane Reade, King Kullen, Kinney Drugs, Kmart, Pathmark, Price Chopper, Rite Aid, Sam’s, ShopRite, Stop & Shop, Target, TOPS, Waldbaum’s, Walgreens, Wal-Mart, Wegmans plus many “mom & pop” pharmacies.  You can always check our pharmacy directory for a network pharmacy near your home.

    PHP has partnered with MedImpact Direct Mail Order to offer participants with a mail-order pharmacy program.  If you are on any maintenance medications, you can conveniently have up to a three-month supply delivered to your home.  Maintenance medications are used to treat chronic illnesses. Please view the below links for more information on this program, including how to register.

    Our Formulary has three tiers and includes drugs covered under Medicare Part D and some prescription and over-the-counter (OTC) drugs covered under your Medicaid benefits.  Each tier has a $0 copay.   You can contact us at Participant Services 1-855-747-5483 or TTY/TDD: 711 for the most recent drug list.

    • Tier 1 covers Generic Drugs that are covered by Medicare Part D.
    • Tier 2 covers Brand Drugs that are covered by Medicare Part D.
    • Tier 3 covers Medicaid-covered drugs and Medicaid-covered Over-the-Counter Drugs (both generic and brand).

  • Limits on coverage for some drugs

    For certain prescription and covered over-the-counter (OTC) drugs, special rules limit how and when we cover them. In general, our rules encourage you to get a drug that works for your medical condition and is safe and effective.

    1. Step Therapy: Trying a different drug first

    In general, we want you to try lower-cost drugs (that often are as effective) before we cover drugs that cost more. For example, if Drug A and Drug B treat the same medical condition, and Drug A costs less than Drug B, PHP Care Complete FIDA-IDD Plan’s rules may require you to try Drug A first. If Drug A does not work for you, the plan will then cover Drug B. This is called step therapy.

    2. Quantity limits

    For some drugs, we limit the amount of the drug you can have. For example, the plan might limit:

    • how many refills you can get, or
    • how much of a drug you can get each time you fill your prescription.

    3. Prior Authorization

    For some drugs, we may ask your prescribing doctor to get prior approval from PHP Care Complete FIDA-IDD Plan before we can have the pharmacy dispense the drug to you.  This is called prior authorization.

    Here are some examples of the limits of coverage for some drugs:

    • Digoxin Tabs (Tier 1) requires Prior Authorization
    • Avandia (Tier 2) requires Step Therapy
    • Abilify Tab (Tier 2) requires Quantity Limit of 30 tabs for 30 days;
    • Tamiflu Cap (Tier 2) requires a Quantity Limit of 28 cap over a 180-day period.
    • Acne Medication, Allergy Creams, Vitamins are all Tier 3 covered prescriptions.

  • What if I’m taking a drug that is not on PHP’s formulary?

    If you are a new PHP Care Complete FIDA-IDD Plan participant living in the community and are currently taking a drug that is not on PHP’s formulary but otherwise meets the definition of a Part D drug or a non-Part D drug covered by Medicaid (including formulary drugs that require prior authorization or step therapy), PHP will continue to pay for the drug on a temporary basis (i.e., 90 days). During this period, our Pharmacy Coordinator will consult with you and your Interdisciplinary Team about possible alternatives to the drug. We will also notify you and your authorized representative of your right to file for an exception request to continue taking the drug after the transition period has expired.

    If you are a new PHP Care Complete FIDA-IDD Plan participant residing in a long-term care facility such as a nursing home or ICF, you can receive at least a 30 day and up to a 31-day supply of non-formulary drugs that otherwise meet the definition of a Part D drug (including formulary drugs that require prior authorization or step therapy) within the first 90 days of coverage unless a lesser amount is requested.

  • 2025 Formulary - List of Covered Drugs
    This document is called the List of Covered Drugs (also known as the Drug List). It tells you which prescription drugs and over-the-counter drugs and items are covered by PHP Care Complete FIDA-IDD Plan.

  • Step Therapy Criteria
    It requires patients to try one or more medications specified by the insurance company, typically a generic or lower cost medicine, to treat a health condition. Patients must then fail on the medication(s) before allowing a “step up” to another medicine that may be more expensive for the insurer.

  • Prior Authorization Criteria (Part D)
    What is the prior authorization process? Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

  • Future Formulary - August 2025

    Effective immediately, certain drugs will no longer be covered under our formulary due to recent changes, including updates to Medicare Part D coverage, FDA withdrawals, or the need for prior authorization. For detailed information on how these changes may affect your prescriptions, please refer to the updated Future Formulary document. If you have any questions or need assistance with prior authorization, our support team is here to help.

ATTENTION

CDPAP Fair Hearing Notice

  • CDPAP Notice of Class Action Settlement (English)

  • CDPAP Notice of Class Action Settlement (Spanish)

  • CDPAP Notice of Class Action Settlement (Language Assistance)

Provider, Pharmacy, and Dental Directories

Search Directories

To request a copy of a provider directory, please send an email with the name of the requested county and your full mailing address to This email address is being protected from spambots. You need JavaScript enabled to view it.. Can’t find a provider? Call us at 1-855-747-5483 or TTY/TDD: 711 for the most up to date provider listing.

2025 Pharmacy Materials

  • Abbott Diabetic Supplies

  • Coverage Determination Request Form

  • Coverage Redetermination Request Form

  • BIRDI / MedImpact Direct Mail Order Registration Form

  • BIRDI / MedImpact Direct Mail Order Registration Form (SPANISH)

  • MedImpact Consumer Portal Overview

  • MedImpact Direct Mail Order Flyer

  • MedImpact Direct Mail Order Flyer (SPANISH)

  • MedImpact Direct Specialty Program

  • Reconsideration Request Form

  • Medication Therapy Management Program

  • Medication Therapy Management Program – Medication List

Participant Rights and Responsibilities
Policy Effective Date: 04/01/2016
  • You have a right to get information in a way that meets your needs
  • We must treat you with respect, fairness, and dignity at all times
  • We must ensure that you get timely access to covered services, items, and drugs
  • We must protect your personal health information
  • We must give you information about PHP Care Complete FIDA-IDD Plan, its network providers, and your covered services
  • Network providers cannot bill you directly
  • You have the right to leave PHP Care Complete FIDA-IDD Plan at any time
  • You have a right to make decisions about your health care
  • You have the right to ask for help
  • You have the right to file a grievance and to ask us to reconsider decisions we have made
  • You have the right to suggest changes
  • You also have responsibilities as a Participant of PHP Care Complete FIDAIDD Plan

Multi-language Interpreter Services

  • English

    We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at 1-855-747-5483. Someone who speaks English/Language can help you. This is a free service.

  • Spanish

    Tenemos servicios de intérprete sin costo alguno para responder cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un intérprete, por favor llame al 1-855-747-5483. Alguien que hable español le podrá ayudar. Este es un servicio gratuito.

  • Chinese Mandarin

    我们提供免费的翻译服务，帮助您解答关于健康或药物保险的任何疑 问。如果您需要此翻译服务，请致电1-855-747-5483。我们的中文工作人员很乐意帮助您。 这是一项免费服务。

  • Chinese Cantonese

    您對我們的健康或藥物保險可能存有疑問，為此我們提供免費的翻譯 服務。如需翻譯服務，請致電1-855-747-5483。我們講中文的人員將樂意為您提供幫助。這 是一項免費服務。

  • Tagalog

    Mayroon kaming libreng serbisyo sa pagsasaling-wika upang masagot ang anumang mga katanungan ninyo hinggil sa aming planong pangkalusugan o panggamot. Upang makakuha ng tagasaling-wika, tawagan lamang kami sa 1-855-747-5483. Maaari kayong tulungan ng isang nakakapagsalita ng Tagalog. Ito ay libreng serbisyo.

  • French

    Nous proposons des services gratuits d'interprétation pour répondre à toutes vos questions relatives à notre régime de santé ou d'assurancemédicaments. Pour accéder au service d'interprétation, il vous suffit de nous appeler au 1-855-747-5483. Un interlocuteur parlant Français pourra vous aider. Ce service est gratuit.

  • Vietnamese

    Chúng tôi có dịch vụ thông dịch miễn phí để trả lời các câu hỏi về chương sức khỏe và chương trình thuốc men. Nếu quí vị cần thông dịch viên xin gọi 1-855-747-5483 sẽ có nhân viên nói tiếng Việt giúp đỡ quí vị. Đây là dịch vụ miễn phí .

  • German

    Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu unserem Gesundheits- und Arzneimittelplan. Unsere Dolmetscher erreichen Sie unter 1-855-747-5483. Man wird Ihnen dort auf Deutsch weiterhelfen. Dieser Service ist kostenlos.

  • Korean

    당사는 의료 보험 또는 약품 보험에 관한 질문에 답해 드리고자 무료 통역 서비스를 제공하고 있습니다. 통역 서비스를 이용하려면 전화1-855-747-5483]번으로 문의해 주십시오. 한국어를 하는 담당자가 도와 드릴 것입니다. 이 서비스는 무료로 운영됩니다.

  • Russian

    Если у вас возникнут вопросы относительно страхового или медикаментного плана, вы можете воспользоваться нашими бесплатными услугами переводчиков. Чтобы воспользоваться услугами переводчика, позвоните нам по телефону 1-855-747-5483. Вам окажет помощь сотрудник, который говорит по-pусски. Данная услуга бесплатная.

  • Arabic

    اننإ مدقن تامدخ مجرتملا يروفلا ةيناجملا ةباجلإل نع يأ ةلئسأ قلعتت ةحصلاب وأ لودج دلأاةيو انيدل . لوصحلل ىلع مجرتم ،يروف سيل كيلع ىوس لاصتلاا انب ىلع 855-747-5483-1 .موقيس صخش ام ثدحتي ةيبرعلا كتدعاسمب .هذه ةمدخ ةيناجم.

  • Hindi

    हमारे स्वास््य या दवा की योजना के बारे में आपके ककसी भी प्रश्न के जवाब देने के लिए हमारे पास मफ्त दभाषिया सेवाएँ उपिब्ध हैं. एक दभाषिया प्राप्त करने के लिए, बस हमें 1-855-747-5483 पर फोन करें. कोई व्यक्तत जो हहन्दी बोिता है आपकी मदद कर सकता है. यह एक मफ्त सेवा है.

  • Italian

    È disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sul nostro piano sanitario e farmaceutico. Per un interprete, contattare il numero 1-855-747-5483. Un nostro incaricato che parla Italianovi fornirà l'assistenza necessaria. È un servizio gratuito.

  • Portugués

    Dispomos de serviços de interpretação gratuitos para responder a qualquer questão que tenha acerca do nosso plano de saúde ou de medicação. Para obter um intérprete, contacte-nos através do número 1-855-747-5483. Irá encontrar alguém que fale o idioma Português para o ajudar. Este serviço é gratuito.

  • French Creole

    Nou genyen sèvis entèprèt gratis pou reponn tout kesyon ou ta genyen konsènan plan medikal oswa dwòg nou an. Pou jwenn yon entèprèt, jis rele nou nan 1-855-747-5483. Yon moun ki pale Kreyòl kapab ede w. Sa a se yon sèvis ki gratis.

  • Polish

    Umożliwiamy bezpłatne skorzystanie z usług tłumacza ustnego, który pomoże w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania leków. Aby skorzystać z pomocy tłumacza znającego język polski, należy zadzwonić pod numer 1-855-747-5483. Ta usługa jest bezpłatna.

  • Japanese

    当社の健康 健康保険と薬品 処方薬プランに関するご質問にお答えするため に、無料の通訳サービスがありますございます。通訳をご用命になるには、1-855-747-5483にお電話ください。日本語を話す人 者 が支援いたします。これは無料のサー ビスです。

How can we assist you?

Contact Partners Health Plan for current member assistance, to learn more about becoming a PHP member, or for general questions and inquiries.

Contact Us

Written on .

Share a Success Story

Share a
Success Story!

Have you recently experienced a positive outcome you would like to share? If a Care Manager, PHP team member, or service provider has impacted or improved a member’s quality of life, please tell us below who you would like to highlight and how they made an impact on a PHP member.

Stories may be featured in PHP email newsletters, the website and on social media.

Please note: Your name and email address are required for security purposes only and will not be used in your submission or to contact you.
Drag and drop files here or Browse

Partners Health Plan Media Release and Authorization

By signing this form, I understand that I am providing consent and authorization for Partners Health Plan to take and use photo imagery, audio, video image, and/or testimonial (with or without the use of the person’s first name) in perpetuity. This will allow Partners Health Plan to take and use photo imagery, audio, video image, and/or testimonial for internal or external communications for the purposes of education, advertising, marketing, publicity, and/or fundraising. Use could include distributing materials on the website, in email newsletter, social media, TV, radio, news releases for the media, and/or print publications such as newspapers, magazines, and Partners Health Plan publications (brochures that are provided to the general public). I also give permission, if interviewed, by Partners Health Plan or its affiliates to use the story, and any of the direct quotes in any medium, including descriptive details that individual chooses to share about their life with Partners Health Plan.

By signing this form, I understand and agree to the following:

1. Giving consent will publicize that services are provided to the individual by Partners Health Plan.

2. Partners Health Plan will retain all rights to the photographs, moving images, sound recordings, and other media, and that there will be no compensation by Partners Health Plan.

3. I waive any right to inspect or approve media that contains my name, image, sound recordings, story, and/or information.

4. I will not assert any claim of any nature against Partners Health Plan, its employees and agents, and/or affiliate programs relating to the exercise of the permissions granted by this Release and Authorization.

5. I understand and acknowledge that the Internet allows for wide sharing and forwarding of information and that PHP cannot control all reproduction and/or re-disclosure of information.

6. The photo imagery, audio, video image, and/or testimonial obtained during the period of this authorization may be utilized indefinitely. This authorization will remain in effect until the person supported by Partners Health Plan (identified above) is discharged at which time no new photos, audio, video or testimonials obtained from that date forward may be used.

7. I may revoke this Release and Authorization at any time, in writing, but a revocation, or discharge, will not impact any use or disclosure made prior to the date the revocation is received or discharge has taken effect.

8. I understand that I have read this document (or it has been translated to me), I fully understand it, and my consent is made knowingly and voluntarily. I am signing this Release and Authorization voluntarily and understand that provision of services to me by Partners Health Plan and/or its affiliate programs is not conditioned on whether or not I sign it.

How can we assist you?

Contact Partners Health Plan for current member assistance, to learn more about becoming a PHP member, or for general questions and inquiries.

Contact Us