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At EmblemHealth we aim to help you stay healthy, get well and live better.

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For over 75 years, EmblemHealth companies have been bringing quality health benefits to New Yorkers like you.

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Silver

The Select Care Silver plans are comprehensive HMO plans. There are four versions of the Select Care Silver plan, each with different cost sharing arrangements. Based on your income level and other factors such as number of dependents, you may qualify for a cost-sharing “subsidy” or cost reduction, as well as a premium tax credit, which will make your plan more affordable.

You must live in Bronx, Kings, Manhattan, Nassau, Orange, Queens, Richmond, Rockland, Suffolk or Westchester county to be eligible.

  • PCP Required Referral for Specialist Visits Required Deductibles* (Individual/Family) PCP/ Specialist/ER Copay* Out-of-Network Coverage Out-of-Pocket Maximum* (Individual/ Family) Coinsurance
    Yes Yes $2,000/$4,000 $30/$50/$150 No $5,500/$11,000 No

    *Copays and deductibles may be less if you are eligible for a cost-sharing subsidy through NY State of Health.

    Key Features:

    • You may qualify for a cost-sharing subsidy and/or a premium tax credit once you enroll through the New York State Health Benefit Exchange.
    • Medical, hospital and pediatric vision costs are counted towards your deductible.
    • Prescription drug copays count toward your out-of-pocket maximum.
    • Out-of-pocket maximum includes all covered services — medical, hospital, pediatric vision and prescription drugs — as well as the deductible.
    • No copays for in-network preventive care services, including immunizations, routine exams, women’s preventive health services and prostate screening. These services are covered in full.
    • EmblemHealth makes available benefits with no annual and lifetime dollar limits.

    In-Network Care

    The Select Care Plans are HMO plans. You need to get services from providers in the EmblemHealth Select Care Network to receive the covered benefits, and you need a referral from your Primary Care Physician to see participating specialists.

    Getting care from out-of-network doctors or providers is not covered under this plan. You may have to pay for the medical services if you go out of network.

    Emergency care at any hospital nationwide is covered no matter what the provider’s network status. Emergencies should be reported within 48 hours, or as soon as reasonably possible.

    Helping Members Stay Healthy and Live Better

    Good health is worth holding onto. That’s why we offer programs, tools, coupons and more to help you stay fit and enhance your quality of life, as well as programs and resources to help you best manage your health.


    Take a closer look at the health and wellness programs we offer.

    Dependent Age Extension

    Under this rider a young adult dependent will be eligible for coverage through age 29, if the young adult is unmarried, uninsured, lives, works or resides in the service area.

    This benefit is available for purchase with all HIP-underwritten EmblemHealth plans under Rider PLA-140. Rider 155-23-IHXD29 (04/13).

    Benefit Summary

    This Benefit Summary is for information only. It does not reflect all of the services covered or list every limitation or exclusion.

    Download a benefit summary

    Out-of-Network Provider Fee Estimates

    Since our Select Care plans offer in-network coverage only, you may be responsible for paying any providers you go to for services who are not in the Select Care network (i.e., out-of-network providers). To get an estimate of how much you would pay these out-of-network providers, you can use the FAIR Health consumer online calculation tool below.*

    FAIR Health, Inc. is an independent nonprofit organization that uses actual provider charges when calculating fees. FAIR Health ensures that its fee information is accurate and complete. We encourage you to review the privacy policy and terms of conditions as posted on the FAIR Health Web site.

    Access the FAIR Health calculation tool

    *Actual expense may vary.


    Some services are subject to prior authorization. The provider will contact EmblemHealth for prior authorization to perform the service as a covered benefit

    This summary is provided for information only; it does not contain complete details of the plan (which are available only in the Contract and Schedule of Benefits) and it does not constitute an Agreement.

    The EmblemHealth Select Care Silver plans are underwritten by HIP Health Plan of New York 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. Refer to HIP policy form numbers 155-23-IONHIXSSchedule (04/13)

  • Search for a Provider

    EmblemHealth Select Care Network

    Our tailored Select Care network features high-quality, community-based primary care physicians and specialty care doctors who offer you a personalized, caring experience. These health care providers are located throughout the following counties: Bronx, Kings, Manhattan, Nassau, Orange, Queens, Richmond, Rockland, Suffolk and Westchester.

    The Select Care network includes doctors in private practice, leading hospitals, and physician group practices, including AdvantageCare Physicians — one of the largest physician practices in the New York metropolitan area.

    AdvantageCare Physicians - The Care You and Your Family Need, All in One Place

    The EmblemHealth Select Care network includes AdvantageCare Physicians, a network consisting of four New York medical groups: Manhattan's Physician Group, Preferred Health Partners in Brooklyn, Queens-Long Island Medical Group and Staten Island Physician Practice.

    AdvantageCare Physicians brings together more than 400 primary care physicians and specialists in 36 convenient locations. It uses a patient-centered team approach to improve care coordination and, by doing so, produce better health outcomes and greater patient satisfaction.

    Each location offers a full range of health services, from preventive and specialty care, to pediatric and geriatric care - often under one roof. Since many services are available in one medical office, members can get the care they need, when they need it. Many locations have lab services, X-rays, on-site pharmacies, and extra evening and weekend hours.

    Download our brochure about AdvantageCare Physicians, which includes a directory of their 36 locations throughout New York City and Long Island.

    PCP Care: A Partner for Good Health

    Select Care plan members need to pick a primary care physician (PCP). This person will be their regular doctor. The PCP works with members to help them manage their health. The PCP:

    • Provides most primary and preventive care
    • Refers members, as needed, to specialists in the Select Care network
    • Coordinates care from specialists
    • Arranges hospital admissions, when necessary. (Please note that specialists can also arrange for hospital admissions.)

    Members can change their PCP at any time by signing in to myEmblemHealth or calling 1-800-447-8255, daily, from 8 am to 8 pm.

    Services That Don't Need Referrals

    Select Care members need a referral from their PCP before receiving most specialty care. A referral is not required for the following services:

    • Primary and preventive care
    • Primary and preventive obstetric and gynecologic services
    • Chiropractic services
    • Outpatient mental health care
    • Refractive eye exams from an optometrist (covered only up through the first month following a member's 19th birthday)
    • Diabetic eye exams from an ophthalmologist

    Out-of-Network Provider Fee Estimates

    Since our Select Care plans offer in-network coverage only, you may be responsible for paying any providers you go to for services who are not in the Select Care network (i.e., out-of-network providers). To get an estimate of how much you would pay these out-of-network providers, you can use the FAIR Health consumer online calculation tool below.*

    FAIR Health, Inc. is an independent nonprofit organization that uses actual provider charges when calculating fees. FAIR Health ensures that its fee information is accurate and complete. We encourage you to review the privacy policy and terms of conditions as posted on the FAIR Health Web site.

    Access the FAIR Health calculation tool

    *Actual expense may vary.

  • Getting the medications you need is an important part of staying healthy. Our formulary gives you access to thousands of covered medications, and our pharmacy network is large enough to provide the choices you need to fill your prescriptions.

    You must use our network pharmacies to fill all of your prescriptions and any covered over-the-counter medications, diabetic supplies, select durable medical equipment and medical supplies.

    Pharmacy Tools

    Want more information on EmblemHealth's Select Care pharmacy benefits?

    • Look up covered drugs
    • Find a local participating pharmacy
    • Get prices on medications

    Get pharmacy details

    Review our drug formulary (PDF)


    Prescription Drug Mail Order

    One of the benefits of an EmblemHealth prescription drug plan is the opportunity to have your prescription medications delivered to your door, saving you time and trips to the pharmacy.

    To receive new prescriptions

    If you have a prescription for a new maintenance medication, it's easy to get started with Express Scripts (ESI) Mail Order Pharmacy. All you need to do is send the written prescription from your doctor or other licensed health care provider to ESI along with the completed mail order form. To request a mail order form you may contact EmblemHealth Customer Service or ESI Mail Order Pharmacy. You may also ask your doctor to call 1-800-305-5287 for faxing instructions. Only doctors may fax prescriptions.

    To receive refills

    For refills, call ESI at the number provided below. Members may also sign in to myEmblemHealth to request a refill. Your medication will usually be delivered within 14 days of sending your first order to ESI. You may receive refills even faster.

    To request a refill, call ESI Mail Order Pharmacy at 1-877-866-5828; TTY: 1-800-899-2114.

  • Vision

    The EmblemHealth Select Care plans do not offer adult vision care except for pediatric vision, which is part of your covered benefit. Under the pediatric vision benefit, your dependents are covered up to the end of the month in which they turn 19 years of age.

    • Vision and optical coverage includes one exam per 12 month period. Frames/lenses, and or contacts are covered once in any twelve month period.
    • The copay for the eye exam is $30.
    • If you choose any frames or lenses other than the options offered under this plan, you will pay the difference between the retail price of the item selected and the retail price of the item covered.

    Dental

    The Select Care plans do not offer adult dental services. However, for children EmblemHealth offers a pediatric stand-alone dental plan, FirstSmiles. Learn more about this plan.

  • Enrollment

    Starting October 1, 2013, you can sign up for your health plan online through NY State of Health. Find out more at www.nystateofhealth.ny.gov.

    Now that you've decided which of our EmblemHealth Select Care plans is right for you, you'll need to fill out an application on NY State of Health. By enrolling on NY State of Health you'll learn whether you are eligible for federal premium tax credits or cost-sharing subsidies.

    1. Complete your application.
    2. Find EmblemHealth from the list of health insurance carriers.
    3. Focus on the EmblemHealth plan you want to enroll in.
    4. Proceed to the next step.

    Please note that the list of insurance companies is in alphabetical order to make it easier for you to find the carrier you want to enroll with. It is not an indication of how they are rated by the State.

    We recommend that you write down the name of the EmblemHealth plan you want to enroll in before leaving this site.

    www.nystateofhealth.ny.gov

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