Plan Options

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Pharmacy

Our Pharmacy Services Program

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.

CompreHealth EPO (51 +)

We respect that different groups and individuals have different needs. That's why we offer CompreHealth EPO for large groups (51+) in the metropolitan area. EmblemHealth CompreHealth EPO offers:

Plan Overview

Choice

A quality network of established, multi-specialty physician group practices delivering coordinated care at affordable prices.

A tiered rate structure to fit your needs.

Affordability

Our most affordable plan for experience-rated groups—with lower premiums and limited out of pocket costs.

No copay for children for in-network office visits and diagnostic services.

A wide variety of cost-sharing options.

Quality

Physician group practices, including Manhattan's Physician Group, Preferred Health Partners, Queens-Long Island Medical Group and Staten Island Physician Practice, as well as practices run by leading institutions including Montefiore Medical Group and North Shore L.I.J. Faculty Practice.

Coordinated care between primary-care physicians and specialists.

Access to preventive care and wellness programs plus non-traditional benefits, such as alternative medicine, acupuncture, nutritional counseling, and massage therapy.

Access to Care

A full range of health services—primary care, preventive care, specialty care—all at one location. Care is provided by a dedicated team of health care practitioners who work in close collaboration.

No referrals for in-network specialist care.

Same day appointments with most doctors.

Preventive dental services.

Ease

CompreHealth health care practitioners work in close collaboration so members receive needed care faster. It's easy to schedule visits and care with multiple services under one roof.

Reduced paperwork.With CompreHealth EPO there are no claims to file. Our network providers do the work for you.

24/7 customer service.Provider listings, eligibility, benefits and more are 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. At EmblemHealth, we build our plans around your expectations. CompreHealth EPO members don't want to sacrifice quality for affordability. They want to keep things simple and hassle-free. The EmblemHealth CompreHealth coordinated care option does just that.

Plan Details

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Services in-network
Annual Physical Check-up Office Copayment
Preventive Mammography, Pap Smear, Prostate Screening Covered in Full
Well-Baby and Well-Child Care Covered in Full
Inpatient Hospital Services Hospital Copayment
Skilled Nursing Facility Care Covered in Full
Hospice Care - Inpatient and Outpatient Covered in Full
Ambulatory Surgery Facility Ambulatory Surgery Copayment
Home Health Care Covered in Full
Chiropractic Care Specialist Office Visit Copayment
Diagnostic Lab and Radiology Included in Hospital or Office Visit Copayment
Emergency Room Facility ER Facility Copayment
Inpatient Mental Health Care Hospital Copayment May Apply
Outpatient Mental Health Care Specialist Office Visit Copayment
Inpatient Detox Hospital Copayment
Outpatient Chemical Dependency Care Specialist Office Visit Copayment, not to exceed $25
Refractive Eye Exam Frames and Lenses Specialist Office Visit Copayment, $45 Copayment
Prescription Drugs Prescription Drug Copayment if selected
Preventive Dental
(see details)
$5 exam; $10 cleaning; $5 fluoride treatment for kids
The EmblemHealth CompreHealth EPO program is underwritten by HIP Insurance Plan of New York and provide in-network benefits only. Except for emergency hospital care, not 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 HIP policy form numbers EPO 151-23-EMEPOPO L (05/08), et. al.

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