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.
Find a Pharmacy.
Download Formulary
For plans that contain pharmacy coverage. Check the applicable benefits design or the certificate of insurance for more information.
InBalance PPO (51 +)
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 PPO offers members outstanding provider choice in- or out-of-network, with no referrals to specialists needed.
EmblemHealth InBalance PPO features special cost-sharing requirements so members are offered the same provider choice as EmblemHealth PPO—at lower cost. 1
Affordability
Members receive most covered in-network office-based services for just the cost of a copayment. 1
With EmblemHealth InBalance PPO, members benefit from shared in- and out-of-network deductibles and coinsurance, enabling them to reach their deductibles and coinsurance maximum limits sooner.
Also available, subject to your group's plan, are:
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*:
Quit smoking programs.
Discounts on health-related services such as weight-loss programs, laser vision, and acupuncture. 3
Confidential, professional counseling, education, and referral services through our 24/7 toll-free Employee Assistance Program (EAP) hotline.
Also available, subject to your group's plan, are: 2
Timely reminders about flu shots and diagnostic testing, such as mammograms and prostate exams.
A Nurse Advice Line that members may call 24/7 to speak with a Registered Nurse.
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 PPO and InBalance PPO, there are generally no claims 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 | out-of-network |
|---|---|---|
| Office Visit | Office Copayment | Deductible & Coinsurance |
| Annual Physical Check-up | Covered in Full | Deductible & Coinsurance |
| Preventive Mammography, Pap Smear, Prostate Screening | Covered in Full | Deductible & Coinsurance |
| Well-Baby and Well-Child Care | Covered in Full | Covered in Full |
| Inpatient Hospital Services | Deductible & Coinsurance | Deductible & Coinsurance |
| Skilled Nursing Facility Care | Deductible & Coinsurance | Deductible & Coinsurance |
| Hospice Care - Inpatient and Outpatient | Deductible & Coinsurance | Covered In-Network Only |
| Ambulatory Surgery Facility | Deductible & Coinsurance | Deductible & Coinsurance |
| Home Health Care | 20% Coinsurance | 20% Coinsurance |
| Chiropractic Care | Office Copayment | Deductible & Coinsurance |
| Diagnostic Lab and Radiology | ||
| Facility | Deductible & Coinsurance | Deductible & Coinsurance |
| Office | Diagnostic Copayment | Deductible & Coinsurance |
| Emergency Room Facility | ER Facility Copayment | ER Copayment |
| Inpatient Mental Health Care | Deductible & Coinsurance | Deductible & Coinsurance |
| Outpatient Mental Health Care | Office Copayment | Deductible & Coinsurance |
| Inpatient Chemical Dependency Care | Deductible & Coinsurance | Deductible & Coinsurance |
| Outpatient Chemical Dependency Care | Office Copayment | Deductible & Coinsurance |
| Prescription Drugs | Prescription Drug Copayment | Covered In-Network Only |
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 InBalance PPO.
* Availability of health and wellness programs may vary based on the EmblemHealth product selected.
Please note: If members choose non-network providers, their out-of-pocket costs will increase.
The EmblemHealth InBalance PPO program is underwritten by Group Health Incorporated ("GHI"). Coverage is subject to all terms, conditions, limitations, and exclusions set forth in the contract and certificate of insurance. Refer to GHI policy numbers PLH-SGC-991, et. al.
Press |
Privacy/Security Policies |
Legal |
Glossary |
Site Map |
News & Media |
Careers |
Conversion Information
