GuildNet Gold Plus FIDA Plan

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GuildNet Gold Plus FIDA Plan Resources

GuildNet Gold Plus FIDA Plan Resources

Plan Information
Provider and pharmacy lists
Other important documents
Contact

Contact Info

GuildNet Gold Plus FIDA Plan
250 West 57th Street, 10th Floor
New York, NY 10107
800-815-0000 (TTY 711)
646-619-6093 (Fax)
Monday through Sunday, 8am to 8pm
gninfo@lighthouseguild.org

NY Medicaid Choice
855-600-3432 (TTY 888-329-1541)
Monday through Friday 8:30am to 8pm
Saturday 10am to 6pm

What is GuildNet Gold Plus FIDA Plan?

GuildNet Gold Plus FIDA Plan is a managed care plan that combines all of the benefits of Medicare and Medicaid. With this plan, your medical and home care services revolve around you and your needs, helping you live safely and comfortably in your home.

This plan benefits you and your family in many ways:

  • You and your care team, including your doctor, manage all your healthcare and home care.
  • You can keep your current doctor.
  • You will receive all of your covered Medicare and Medicaid benefits directly from GuildNet.
  • There are no monthly premiums, and there are no co-pays or other costs from in network providers and out of network providers for Medicare Services.

What we offer:

All of these services are included at no cost when you use in-network providers and out of network providers for Medicare:

  • Physician care (primary and specialty care)
  • Transportation for doctor’s visits
  • Immunizations, lab tests, scans (such as X-Rays) and screening tests
  • Generic, brand name and over-the-counter drugs
  • Occupational, physical and speech therapy
  • Emergency room and urgent care
  • Rehabilitation services
  • Medical equipment for home use
  • Skilled nursing care
  • Ambulance services
  • Eye and hearing exams
  • Glasses or contact lenses
  • Dental check-ups
  • Hearing aids
  • Diabetes supplies and services
  • Mental and behavioral health services
  • Substance abuse services
  • Inpatient mental health care
  • Home services, such as cleaning and housekeeping
  • Home healthcare services
  • Adult daycare
  • Assisted living
  • Meal delivery
  • Nursing facility care
  • Respite care for caregivers

If you go to an out-of-network provider, the provider must be eligible to participate in Medicare. We cannot pay a provider who is not eligible to participate in Medicare. If you go to a provider who is not eligible to participate in Medicare, you must pay the full cost of the services you get. Providers must tell you if they are not eligible to participate in Medicare.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Participant Handbook.

Limitations and restrictions may apply. For more information, call GuildNet Gold Plus FIDA Plan Participant Services or read the GuildNet Gold Plus FIDA Plan Participant Handbook.

Benefits, List of Covered Drugs, and pharmacy and provider networks may change from time to time throughout the year and on January 1 of each year.

Are you eligible?

To enroll in GuildNet Gold Plus FIDA Plan MMP-POS, you must:

  • Be 21 or older
  • Qualify for benefits under Medicare Part A and be enrolled under Parts B and D
  • Receive full Medicaid benefits
  • Live in Bronx, Kings, New York, Queens or Richmond Counties

You must also:

  • Be nursing facility clinically eligible and receive facility-based long term services and supports (LTSS) OR
  • Qualify for the Nursing Home Transition and Diversion Waiver (NHTD) OR
  • Require community-based LTSS for more than 120 days.

Important Notes about GuildNet Gold Plus FIDA Plan:

Enrollment in GuildNet Gold Plus FIDA Plan depends on contract renewal.

GuildNet Gold Plus FIDA Plan is a managed care plan that contracts with both Medicare and New York State Department of Health (Medicaid) to provide benefits of both programs to Participants through the Fully Integrated Duals Advantage (FIDA) Demonstration.

For information on GuildNet Gold Plus FIDA Plan, contact GuildNet Gold Plus FIDA Plan or the New York Enrollment Broker. To enroll or for other options for your health care, call the New York Enrollment Broker at 855-600-FIDA, TTY 888-329-1541 from Monday to Friday from 8:30 am to 8:00 pm and Saturday from 10:00 am to 6:00 pm, or visit NY Medicaid Choice.

The State of New York has created a participant ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide Participants free, confidential assistance on any services offered by GuildNet Gold Plus FIDA Plan. ICAN may be reached toll-free at 844-614-8800 or online at icannys.org.

If you need this information in other formats, such as large print, braille, or audio. Call 1-800-815-0000 and TTY/TDD 711, Monday through Sunday, 8am to 8pm. The call is free.

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Last updated 5/24/18