HIPaccess^® II

HIP<em>access</em><sup>®</sup> II

HIPaccess II Plan: No referrals and more choices.
The HIPaccess II plan is a referral-free POS plan with in- and out-of-network coverage. Members select a Primary Care Physician (PCP) to handle basic health care needs, but they can visit specialists on their own or with the help of their PCP. It is their choice.

Features of the HIPaccess II plan include:

Referral-free plan.

Little or no paperwork when using a network provider.

Coverage for care received outside the participating provider network

The HIPaccess II plan is offered through the Prime network and the expanded Premium network. Choose the network option that works best for your organization.

You can also customize a plan to fit your group’s needs by choosing from a wide range of cost-sharing options and benefit riders.

HIPaccess II Details

Services	in-network	out-of-network
Office Visits	Copayment	Deductible & Coinsurance
Office visits and diagnostic copay for dependent children	Copayment	Deductible & Coinsurance
Annual Physical Check-up	No Copayment for Preventive Care Services Provided During Annual Physical Exam	No Deductible & Coinsurance for Preventive Care Services Provided During Annual Physical Exam
Preventive Mammography, Pap Smear, Prostate Screening	No Copayment	No Deductible & Coinsurance
Well-Baby and Well-Child Care	No Copayment	No Deductible & Coinsurance
Inpatient Hospital Services	Copayment	Deductible & Coinsurance
Skilled Nursing Facility Care	No Copayment May be subject to maximum number of days per calendar year	Not covered
Hospice Care - Inpatient and Outpatient	No Copayment Subject to maximum number of days	Not covered
Ambulatory Surgery Facility	Copayment	Deductible & Coinsurance
Home Health Care	Copayment Subject to maximum number of visits per calendar year	Deductible & Coinsurance
Chiropractic Care	Copayment	Deductible & Coinsurance
Diagnostic Lab	Provider’s office: Included in office copayment Outpatient facility: No copayment	Deductible & Coinsurance
Diagnostic Radiology	Provider’s office: Included in office copayment Outpatient facility: No copayment	Deductible & Coinsurance
Emergency Room Facility	Copayment	Copayment
Inpatient Mental Health Care	Copayment Unlimited	Deductible & Coinsurance
Outpatient Mental Health Care	Copayment Unlimited	Deductible & Coinsurance
Inpatient Substance Use Disorder	Copayment Unlimited	Deductible & Coinsurance
Outpatient Substance Use Disorder	Copayment Unlimited	Deductible & Coinsurance
Vision Exam, Frames And Lenses For Children	Refractive eye exam: Copayment Eyeglasses: Copayment Subject to coverage period (number of months)	Refractive eye exam subject to Deductible & Coinsurance Eye glasses covered In-Network Only
Prescription Drugs	Copayment	Covered In-Network Only

¹ Some services are subject to prior approval.

² Please note: If members choose non-network providers, their out-of-pocket costs will increase.

³ EmblemHealth participating providers are contracted to provide care to our members; they are not employees,
agents, servants or representatives of EmblemHealth.

⁴ This summary is provided for information only; it does not contain complete details of the Plan which are available
only in the Contract or Certificate of Coverage and Schedule of Benefits, and it does not constitute an Agreement.

	Plan Options
	SMALL BUSINESS
	MEDIUM & LARGE BUSINESS
	INDIVIDUALS
	CITY, STATE AND FEDERAL MEMBERS
	MEDICARE
	MEDICARE SUPPLEMENT INSURANCE
	STATE SPONSORED PROGRAMS - Medicaid - Family Health Plus - Child Health Plus
	FIND A DOCTOR

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HIPaccess® II

HIPaccess II Details

HIPaccess^® II