Plan Options
Considering EmblemHealth?
Please contact your broker or EmblemHealth sales at
1-877-411-3625
Pharmacy
Drug Lookup
See covered drugs in our formulary.
Download Formulary
For plans that contain pharmacy coverage. Check the applicable benefits design or the certificate of insurance for more information.
EPO (2 - 50)
Plan Overview
Choice
We respect that different people have different needs. That's why we offer a choice of affordable, quality plans with extensive benefits that provide real value:
EmblemHealth EPO offers:
Outstanding provider choice from any Network provider, with no gatekeepers or referrals to specialists needed. 1
Hospital, medical and prescription drug coverage
In-network only coverage in our National Network of over a million provider locations
Several cost-saving options
Coverage across all of New York state
Affordability
Available options, subject to your group's plan, are: 2
No copay for children for office visits and diagnostic tests performed in-network.
No copay for generic drugs when members use network pharmacies.
Quality
Quality doctors. Our National network includes more than half the "Top Docs" from New York Magazine's list, and virtually every acute care hospital in the region-great hospitals like Memorial Sloan-Kettering, Montefiore Medical Center, Lenox Hill Hospital, North Shore- Long Island Jewish Health System, and Albany Medical Center. Health and Wellness Programs. We help members stay healthy with*:
Timely reminders about flu shots and diagnostic testing, such as mammograms and prostate exams.
Quit-smoking programs.
A Nurse Advice Line that members may call 24/7 to speak with a Registered Nurse.
Discounts on health-related services such as weight-loss programs, laser vision, and acupuncture. 2
Confidential, professional counseling, education, and referral services through our 24/7 toll-free Employee Assistance Program (EAP) hotline.
Access to Care
Our National network provides access regionally to more than 106,000 doctors at more than 172,000 locations in New York, New Jersey, and Connecticut and to more than one million practitioners nationwide.
Ease
Less paperwork. With EmblemHealth EPO, there are generally no claim forms to file for services received in-network.
24/7 customer service. Provider listings, eligibility, claims status, benefits, and more are all available at www.emblemhealth.com or by calling our automated phone system.
Respect
At EmblemHealth, we understand the things that matter to members about their health care coverage-including respect for their time, intelligence, and money.
Plan Details
[ Back to Top]
| Services | in-network |
|---|---|
| Office Visits | Copayment |
| Office visits and diagnostic copay for dependent children/students | $0 |
| Annual Physical Check-up | Covered in Full |
| Preventive Mammography, Pap Smear, Prostate Screening | Covered in Full |
| Well-Baby and Well-Child Care | Covered in Full |
| Inpatient Hospital Services | Hospital Copayment May Apply |
| Skilled Nursing Facility Care | Covered in Full |
| Hospice Care - Inpatient and Outpatient | Covered in Full |
| Ambulatory Surgery Facility | Facility Copayment may apply |
| Home Health Care | Covered in Full |
| Chiropractic Care | Office Copayment |
| Diagnostic Lab and Radiology | |
| Facility | Diagnostic Copayment |
| Office | Diagnostic Copayment |
| Emergency Room Facility | ER Facility Copayment |
| Inpatient Mental Health Care | Hospital Copayment May Apply |
| Outpatient Mental Health Care | Office Copayment |
| Inpatient Chemical Dependency Care | Hospital Copayment May Apply |
| Outpatient Chemical Dependency Care | Covered in Full |
| Vision Exam, Frames And Lenses For Children | $10 Copayment, $20 Copayment |
| Prescription Drugs | Prescription Drug Copayment |
1 Some services are subject to precertification.
2 EmblemHealth cannot ensure that a particular vendor will remain in the program. The services available under these programs are not covered services underwritten by Group Health Incorporated ("GHI") as part of the EmblemHealth EPO.
* Availability of health and wellness programs may vary based on the EmblemHealth product selected.
The EmblemHealth EPO program is underwritten by Group Health incorporated ("GHI") and provide in-network benefits only. Except for emergency hospital care, no out-of-network services are covered. Coverage is subject to all terms, conditions, limitations, and exclusions set forth in the contract and certificate of insurance. Refer to GHI policy form numbers PLH-EPO -100A, et. al.
Press |
Privacy Policies |
Legal |
Glossary |
Site Map |
News & Media |
Careers |
Conversion Information
