Essential Plan
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All the Essential Benefits for Less
The Essential Plan offers the same essential benefits as other plans, but costs much less. It’s for individuals who make too much for Medicaid but not enough to afford a Qualified Health Plan.
If you’re eligible and don’t have affordable insurance through an employer, you can purchase an Univera Healthcare Essential Plan through the NY State of Health (NYSOH) website. And you’ll be making a smart choice. Our Essential Plan was rated #1 in New York for quality and satisfaction!
What's Included?
- $0 monthly premium
- Coverage accepted by a large network of doctors and hospitals in your area
- FREE preventive care, including check-ups, flu shots, vaccines, screenings and more
- VitalizeSM - Our health and wellbeing benefit, in partnership with Personify Health
- Easy access to care 24/7 with our telemedicine program powered by MDLIVE®
Learn more about what’s included in the Essential Plan
Need Help?
We can help you get coverage.
Essential Plan:
Call: 1-888-679-7166 (TTY 711)
All Other NYS Sponsored Plans:
Call: 1-800-650-4359 (TTY 711)
Who’s Eligible?
There are five Essential Plan levels, all with the same benefits and features. Eligibility for each level is based on income, household size, and other criteria. The following table shows the income range eligibility for each household size and plan level.
For more information, call 1-888-679-7105 (TTY 711) or visit the NYSOH website
| Household Size | Essential Plan 200-250 |
Essential Plan 1 | Essential Plan 2 | Essential Plan 3* | Essential Plan 4* |
|---|---|---|---|---|---|
| 1 | $30,121 - $37,650 | $22,591 - $30,120 | $20,784 - $22,590 | $15,060 - $20,783 | $0 - $15,059 |
| 2 | $40,881 - $51,100 | $30,661 - $40,880 | $28,208 - $30,660 | $20,440 - $28,207 | $0 - $20,439 |
| 3 | $51,641 - $64,550 | $38,731 - $51,640 | $35,633 - $38,730 | $25,820 - $35,632 | $0 - $25,819 |
| 4 | $62,401 - $78,000 | $46,801 - $62,400 | $43,057 - $46,800 | $31,200 - $43,056 | $0 - $31,199 |
| 5 | $73,161 - $91,450 | $54,871 - $73,160 | $50,481 - $54,870 | $36,580 - $50,480 | $0 - $36,579 |
| 6 | $83,921 - $104,900 | $62,941 - $83,920 | $57,906 - $62,940 | $41,960 - $57,905 | $0 - $41,959 |
| 7 | $94,681 - $118,350 | $71,011 - $94,680 | $65,330 - $71,010 | $47,340 - $65,329 | $0 - $47,339 |
| 8 | $105,441 - $131,800 | $79,081 - $105,440 | $72,755 - $79,080 | $52,720 - $72,754 | $0 - $52,719 |
Important Plan Documents
The following documents contain important information about each Essential Plan level. The Summary of Benefits and Coverage (SBC) document outlines how you and the plan share costs for covered services. The Member Contract is a legal document that has complete information about the benefits and services included in that plan.
| Essential Plan 200-250 | Essential Plan 1 | Essential Plan 2 | Essential Plan 3* | Essential Plan 4* | |
| Summary of Benefits and Coverage (SBC) | |||||
| Member Contract |
EP 200-250 Member ContractOpen a PDF EP 200-250 Member Contract for American Indian/Native AlaskanOpen a PDF |
EP 1 Member ContractOpen a PDF EP 1 Member Contract for American Indian/Native AlaskanOpen a PDF |
EP 2 Member ContractOpen a PDF EP 2 Member Contract for American Indian/Native AlaskanOpen a PDF |
* Must be a lawfully present immigrant. The term “lawfully present” includes immigrants who have "qualified non-citizen” immigration status without a waiting period; humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, Convention Against Torture, victims of trafficking); valid non-immigration visas; and legal status conferred by other laws (temporary resident status, LIFE Act, Family Unity individuals). To see a full list of eligible immigration statuses, please visit the HealthCare.gov website or call NY State of Health at 1-855-355-5777.
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