CurrentHealthfirstPolicy N/A

OTC Plus Card Special Supplemental Benefits enrollment form

This document governs eligibility verification and provider attestation for members seeking to use the Healthfirst OTC Plus Card to purchase healthy food and pay home utilities; it applies to Medicare members in specified Healthfirst HMO D‑SNP plans who meet at least one qualifying condition.

Policy Summary

PayerHealthfirst

PolicyOTC Plus Card Special Supplemental Benefits enrollment form

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionProvider must complete and fax the attestation form to 1-646-313-4603 and only submit if at least one qualifying condition is selected.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1required provider attestation form

>=1member must have at least one qualifying condition

25+listed qualifying conditions

1fax number for form submission

3form sections

Eligibility for OTC Plus Card Benefits

Eligibility criteria

Covered when ALL of the following are met:

Member belongs to one of the following Healthfirst HMO D‑SNP plans: Plan Mejor Calidad de Vida (HMO D‑SNP), Plan Conexión (HMO D‑SNP), or Atención Integral (HMO D‑SNP).

Member has at least ONE qualifying condition listed in Section 2 (see list of eligible conditions).

Scope of benefit: if eligible, member may use the OTC Plus Card to purchase healthy food and pay home utility services as described in the OTC Plus Card Special Supplemental Benefits materials.

Plan/state limitations: applies to Medicare members in the specified Healthfirst HMO D‑SNP plans (see plan list above) and is subject to plan benefit rules and eligibility verification.

Provider Attestation and Submission Requirements

Policy Summary

PayerHealthfirst

PolicyOTC Plus Card Special Supplemental Benefits enrollment form

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionProvider must complete and fax the attestation form to 1-646-313-4603 and only submit if at least one qualifying condition is selected.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Key Terms and Qualifying Conditions

inv-03: OTC Plus Card

DefinitionOTC Plus Card Special Supplemental Benefits: a benefit that allows eligible Medicare members in specified Healthfirst HMO D‑SNP plans to purchase healthy food and pay for home utility services.

Applicable plansPlan Mejor Calidad de Vida (HMO D-SNP); Plan Conexión (HMO D-SNP); Atención Integral (HMO D-SNP).

Purpose and usage scopeUse the OTC Plus Card to buy healthy food and to pay home utility services when the member meets eligibility criteria.

Enrollment stepMember must ask their provider to complete and submit the attestation form for review; notification will be sent once the card can be used.

How to check statusMembers may also visit es.MyHFNY.org for status and information.

inv-04: Qualifying conditions

DefinitionQualifying conditions: the medical diagnoses or chronic conditions listed in Section 2 of the form; at least one must be selected for eligibility verification.

Requirement for submissionDo not submit the provider attestation form unless at least one qualifying condition is selected.

Examples (selected from Section 2)Autoimmune disorders; Cancer; Cardiovascular disorders; Diabetes; Chronic kidney disease (CKD); Chronic lung disorders; Dementia; Stroke; and others listed in Section 2.

Number of listed conditionsSection 2 lists 25+ qualifying conditions that may establish eligibility when at least one applies.