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Essential Plan

Young man in Williamsburg
The Essential Plan is a health insurance plan in New York for people who have limited income, but don’t qualify for Medicaid. You may be eligible for the Essential Plan through Empire if you:

  • Are between the ages of 19 and 64
  • Live in Brooklyn, the Bronx, Queens, Manhattan, Staten Island, Nassau or Putnam County
  • Are not eligible for Medicaid or Child Health Plus
  • Are not eligible for minimum essential coverage

You do not have to be a citizen or legal resident to qualify for the Essential Plan. Participation in this program will not affect any future immigration status.

What you get with Empire

Doctor check up patient

Visits to the doctor

Nurse

Hospital stays

Prescription pills

Prescription medicines

There are four versions of the Essential Plan. Some benefits vary based on the plan you’re in.

  • Primary care provider (PCP) visits
  • Immunizations and wellness visits
  • Specialist visits
  • Urgent care
  • Emergency care
  • Lab and X-ray services
  • Pregnancy services
  • Family planning
  • Hospital care
  • Physical therapy
  • Behavioral health care

Your plan may have copays for covered services. See your member handbook for a full list of benefits in your plan.

Find a Doctor

If your plan includes dental services, you can get:

  • Teeth cleaning twice a year
  • Oral exams
  • X-rays
  • Extractions
  • Fillings
  • Emergency care
  • Dentures (removable or partial)
  • Orthodontics

See your member handbook for a full list of benefits in your plan. Your plan may have copays for covered services.

Dental benefits are provided through Liberty Dental. To find or change your dentist, call Liberty Dental at 1-833-276-0847, or visit their website.

Go to Liberty Dental

If your plan includes vision services, you can get:

  • One eye exam each year
  • Prescription glasses or contact lenses each year

See your member handbook for a full list of benefits in your plan. Your plan may have copays for covered services.

Find a vision provider

Your benefits include a wide range of prescription and over-the-counter (OTC) drugs. We work with Express Scripts (ESI) to provide these benefits. Your plan may have prescription copays. Check your handbook for information about copays.

Visit the pharmacy page to find a pharmacy near you and check if your medicine is covered.

Go to Pharmacy page

It pays to stay healthy. With our ExerciseRewards™ program, you can get reimbursed up to $200 for your gym membership dues every six months. Simply work out at one of our many participating gyms or fitness centers at least 50 times in a six-month period. Then submit your fitness log and proof of your gym membership payment (see forms below) and you’ll receive your check!

Activate your ExerciseRewards™ now!

Learn more about ExerciseRewards™

Reimbursement request forms

Treatment Cost Calculator

Calculate your treatment costs

We understand you need the full picture in order to make health care decisions. Taking care of yourself is easier when you understand how much it costs. Our Treatment Cost Calculator can give you an estimate of your out-of-pocket costs for many common services. Use this tool to:

  • Get an estimate for common treatments and services
  • Compare the costs of one or more providers
  • Print or save estimates
  • Review past treatment cost calculations

How to use the Treatment Cost Calculator

  1. Log in and go to the Treatment Cost Calculator
  2. Select the member
  3. Select the treatment
  4. Select your provider (skip if no provider)
  5. Review, print and/or save your estimate

Already a member? We’re glad you chose Empire.

Women walking in fall
We want you to understand your benefits and receive the best possible care. Here are some resources to help:

Member handbooks

Complete benefit information can be found in your member handbook.

Essential Plan 1

Essential Plan 1 with Dental and Vision

Essential Plan 2

Essential Plan 2 with Dental and Vision

Essential Plan 3

Essential Plan 4

Community Service Centers

We’ll help arrange for you and your family to get the benefits you need to get and stay healthy. Come talk to us at any one of our Community Service Centers.

Find the nearest center

Member Services

If you have any questions, call Member Services at 1-800-300-8181 (TTY 711). Our team is available Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 9 a.m. to 5 p.m. You can also log in to your account to send us a message at any time.

Send us a message

24/7 NurseLine

Whether it’s 3 a.m. or a Sunday afternoon, health issues come up. That’s why you can always call our 24/7 NurseLine and speak directly to a nurse. Call 1-800-300-8181 (TTY 711) anytime, day or night.

 
 
NurseLine illustration

24/7 NurseLine

Whether it’s 3 a.m. or a Sunday afternoon, health issues come up. That’s why you can always call our 24/7 NurseLine and speak directly to a nurse. Call 1-800-300-8181 (TTY 711) anytime, day or night.

Pay your premium

Make a payment