New York - Essential Plan - Frequently Asked Questions

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Essential Plan

Frequently Asked Questions

Who do I call if I have a question?

If you have questions or problems, call Member Services at 1-800-493-4647. We can help with:

  • Any concerns you may have about your health care benefits or services
  • Answers to questions about how to get services
  • Health education information
  • Errors on the UnitedHealthcare ID card

Please have the UnitedHealthcare ID card available when you call so we can help you sooner.


How do I choose a Primary Care Provider?

You may choose any plan provider to be your Primary Care Provider. Plan Providers are listed in the provider directory (insert link to online directory here) or you may call Member Services for assistance in finding a plan provider at 1-800-493-4647, TTY 711.

How does my Primary Care Provider help?

As an enrollee of UnitedHealthcare, you must choose a Primary Care Provider. To help you decide what is best for you, here are some definitions:

  • Family practice doctors see patients of all ages from infants to adults for general health care.
  • Internal medicine doctors (internist) treat diseases in adults. They do not do surgery or treat young children, but may treat children over the age of 16.
  • Pediatricians are doctors who care for children from birth to age 16, sometimes 18.


Your Primary Care Provider can help you with all of your health care needs and should always be a part of your medical care team. To help you with your  medical needs, your Primary Care Provider and staff are available to you by telephone for advice or an appointment. He or she should:

  • Refer you to a specialist when necessary
  • Give you advice or appointments
  • Admit you to a hospital if medically necessary
  • Be called whenever possible if an emergency happens (unless it is life threatening. If you are suffering from a life threatening injury or illness and you cannot call your Primary Care Provider, call 911 or go to your nearest emergency room).
How can I switch to another Primary Care Provider?

Your Primary Care Provider is important to his health care. If you are unhappy with your doctor, please talk with him or her so that they know why you are unhappy. Your doctor can only correct a problem that he/she knows about.

If you feel it will be better to change to another Primary Care Provider, call Member Services at 1-800-493-4647, TTY 711. If you need help in finding a new doctor, Member Services will help you. After you change your Primary Care Provider, be sure to have your medical records transferred to your new doctor.


What if my doctor or other provider leaves the plan?

Sometimes a Primary Care Provider, specialist, clinic, hospital or other plan provider you are using might leave the Plan.  If this happens, you will have to switch to another provider who is part of our Plan.  If your Primary Care Provider leaves our Plan, we will let you know and help you choose another Primary Care Provider so that you can keep getting covered services.

What happens if I am traveling out of the Essential Health Plan area and need care?

When you are outside the service area, you are only covered for emergency and urgent care. If you have questions about your medical costs when you travel, please call Member Services at 1-800-493-4647, TTY 711.

How is a “medical emergency” defined?

A “medical emergency” is when you reasonably believe that your health is in serious danger – when every second counts. A medical emergency includes severe pain, a bad injury, a serious illness, or a medical condition that is quickly getting much worse. 

What should I do if I have a medical emergency?

If you have a medical emergency:

  • Get medical help as quickly as possible. Call 911 for help or go to the nearest emergency room, hospital, or urgent care center. You don’t need to get approval or a referral first from your Primary Care Provider or other plan provider. 
  • Make sure that your Primary Care Provider knows about your emergency, because your Primary Care Provider needs to be involved in following up on your emergency care. You or someone else should call to tell your Primary Care Provider about your emergency care as soon as possible, usually within 48 hours
How to get urgently needed care?

If, while temporarily outside the Plan’s service area, you require urgently needed care, like a sprained ankle, a bad splinter you can’t remove or an episode of persistent vomiting or diarrhea, then you may get this care from any provider. The plan is obligated to cover all urgently needed care at the cost-sharing levels that apply to care received within the Plan network. Please call Member Services at 1-800-493-4647, TTY 711.

How do I use the plan ID Card?

You will receive an ID card after you enroll that shows that you are a member of the UnitedHealthcare Community Plan for Adults program. Carry the ID card with you at all times and show the ID card each time you receive medical care. Showing your card makes sure that medical bills for covered services are not sent to you.

How do I get prescriptions?

Take your prescription and your UnitedHealthcare Community Plan Member ID Card to any pharmacy that participates with UnitedHealthcare Community Plan.  The pharmacy will accept your United ID Card as payment for the prescription; but you may have to pay a co-pay.  Under Family Health Plus, there is a $3 copay per generic prescription and a $6 copay for brand name items. Check your Family Health Plus Member Handbook for a complete list of copayments under the plan. Certain medications may require prior authorization, check the Preferred Drug List on this website to see which items require prior authorization.


Can I use my neighborhood pharmacy?

You can use any pharmacy that is listed in the Provider Directory on this website.

What if I use non-plan providers to receive services that are “covered”?

Except in limited cases such as emergency care, urgently needed care when our network is not available, or out of service area dialysis, you must obtain covered services from network providers for the services to be covered.  If you get non-emergency care from non-network providers without prior authorization, you must pay the entire cost yourself.

What should I expect as a new member of the plan?

As a new member you should expect to receive your UnitedHealthcare Community Plan ID card within 14 days of joining the plan. You should also receive your new member welcome kit which includes your Member Handbook, the Provider Directory and other important information,

Additionally, we will contact you by phone to welcome you to the plan and conduct a new member orientation and a health risk assessment (HRA). The new Member Orientation is a great way to learn about the benefits available to you under the plan. UnitedHealthcare Community Plan reviews all HRAs and identifies members with chronic and long term medical conditions that we can help you manage. In some cases, you may be assigned a Case Manager who will work with you and your physician to manage your healthcare needs.

Will I have to pay any money?

As a member of the UnitedHealthcare Community Plan you do not have to pay for any covered services your receive except for services which require a copayment like prescription drugs, office visits and other services. Check your Family Health Plus Member Handbook for a list of services that require copayments.


If you receive a bill from a provider, do not send them payment. Instead return the bill to your provider along with your UnitedHealthcare Community Plan ID number and ask your provider to bill us directly, If the bill is for a copayment that you didn’t pay at the time you received care, your provider is permitted to bill you and you are responsible for paying the required copayment.

Do I need to schedule appointments?

It is always a good idea to schedule appointments with your providers. You should arrive early for your appointment so you have enough time to complete any forms your provider may need from you.


If you are unable to keep an appointment, please call your provider to let him/her know you cannot make it. This will allow your doctor to schedule other patients.


What if I need an interpreter?

We can help you if you do not speak or understand English. We have representatives that speak different languages.  If you we don’t have a representative who speaks your language, we will arrange for a translator or interpreter to help us with your call. Please call Member Services at 1-800-493-4647, TTY 711 and notify our representatives what languages you speak. If you need an interpreter when you visit your doctor, ask the doctors office to arrange for a translator.


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TTY: 711

Monday - Friday 8 a.m. - 8 p.m. EST.

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