Provider and Pharmacy Directories

Provider Directory

This directory provides a list of Elderplan’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage.

You will have to choose one of our network providers who are listed in this directory to be your Primary Care Physician (PCP). Generally, you must get your health care services from your PCP The term “PCP” will be used throughout this directory.

The “network providers” listed in this directory have agreed to provide you with health care, long term care benefits, vision and dental services. You may go to any of our network providers listed in this directory. If you have been going to one network provider, you are not required to continue to go to that same provider.

If an out‐of‐network provider sends a bill directly to you, you should not pay the bill, but should submit it to the plan at the address provided below, for processing and determination of enrollee liability, if any.

Medical Claims:

Elderplan
Attn: Member Services
6323 Seventh Avenue
Brooklyn, New York 11220

The Elderplan provider directory contains:

  • 717 Ancillaries
  • 72 Hospitals
  • 590 Long-Term Services
  • 4,908 Primary Care Physicians
  • 23,214 Specialists
  • 2,920 Dentists
  • 121 Skilled Nursing Facilities
  • 4,967 Pharmacies

Get medical help as quickly as possible. Dial 911 for help or go directly to the nearest emergency room. In any emergency, you never need to contact any plan providers, even your own PCP, for either permission (“authorization”) or referral.

However, as soon as possible, you or someone else should contact your PCP or Elderplan about your emergency. Your PCP or Elderplan will need to be involved in following up on your emergency care. Your PCP’s telephone number appears on your Elderplan membership card. To contact Elderplan, please call Member Services at 1-800-353-3765, between 8:00 A.M. and 8:00 P.M., 7 days a week. TTY users should dial 711.

You can get covered emergency medical care whenever you need it, anywhere in the world.

Emergency care can always be obtained in or out of the service area from the nearest available provider. When in the service area you must use plan providers for urgent care.

You must use plan providers except in emergency or urgent care situations or for out‐of‐area renal dialysis. If you obtain routine care from out‐of‐network providers, neither Medicare nor Elderplan will be responsible for the costs.

The counties in our service area are listed below.

Bronx, Kings, Monroe, Nassau, New York, Queens, Richmond, Suffolk and Westchester.

If you have questions about Elderplan or require assistance in selecting a PCP, please call our Member Services Department at 1-800-353-3765, between 8:00 A.M. and 8:00 P.M., 7 days a week. TTY users should dial 711.

Pharmacy Directory

This booklet provides a list of Elderplan’s network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Elderplan’s formulary.

We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to plan members. In most cases, your prescriptions are covered under Elderplan only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription, and instead can switch to any other of our network pharmacies. We will fill prescriptions at non‐network pharmacies under certain circumstances as described in your Evidence of Coverage.

You can get prescription drugs shipped to your home through our network mail order delivery service, which is called CVS/Caremark mail order pharmacy. For more information, please contact us or see the mail order section of this pharmacy directory.

You can get prescription drugs shipped to your home through our network mail order delivery program which is called CVS/Caremark mail order pharmacy.

For refills of your mail order prescriptions, please contact us 10 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time.

For refills of your mail order prescriptions, you have the option to sign up for an automatic refill program called Readyfill. Under this program, we will start to process your next refill automatically when our records show that you should be close to running out of your drug. We will contact you prior to shipping each refill to make sure you are in need of more medication. You can cancel scheduled refills if you have enough of your medication or if your medication has changed. If you choose not to use the auto refill program, please contact us 29 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time. To opt out of the automatic refill program, please contact CVS/Caremark at 1‐866‐490‐2102, 24 hours a day, 7 days a week. TTY users should dial 711.

Typically, you should expect to receive your prescription drugs 5 to 7 days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact CVS/Caremark at 1‐866‐490‐2102, 24 hours a day, 7 days a week. TTY users should dial 711.

Home Infusion Pharmacies specialize in provision of infusion therapies to patients in their homes or other alternate sites. To get more information on Home Infusion Pharmacies please call our Member Services Department at 1-800-353-3765, between 8:00 A.M. and 8:00 P.M., 7 days a week. TTY users should dial 711.

Residents of a long‐term care facility may access their prescription drugs covered under Elderplan through the facility’s long‐term care pharmacy or another network long‐term care pharmacy.

Long-Term Care Pharmacies dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. To get more information on Long-Term Care Pharmacies, please call our Member Services Department at 1-800-353-3765, between 8:00 A.M. and 8:00 P.M., 7 days a week. TTY users should dial 711.

Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies

Only Native Americans and Alaska Natives have access to Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies through Elderplan’s pharmacy network. Those other than Native Americans and Alaskan Natives may be able to access these pharmacies under limited circumstances (e.g., emergencies).

An Indian Health Service / Tribal / Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. To get more information on Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies, please call our Member Services Department at 1-800-353-3765, between 8:00 A.M. and 8:00 P.M., 7 days a week. TTY users should dial 711.

Looking for information?

Questions? Call Elderplan today.

1-800-353-3765

[TTY 711]

for the hearing impaired

Hours of Operation:
8 a.m. - 8 p.m., 7 days a week

Elderplan is available
in the 5 boroughs of NYC,
Nassau, Suffolk, Westchester
and Monroe counties.