HIP HMO Preferred

Welcome to your new plan. Here are your changes for July 1, 2016: Click here to view the letter.

If you choose a Preferred Primary Care Physician (PCP) provider from our Prime Network, most services will have a $0 copay. If you choose a non-preferred participating PCP or provider from the Prime Network, you will have a $10 copay for most services.

Key Plan Features

HIP HMO Preferred gives you real value, real choice and great health coverage with low out-of-pocket costs:

  • No payroll deduction for the base plan
  • $0 copays and no additional charges for most services when you choose a Preferred PCP
  • $10 copay when you choose a non-preferred PCP
  • Coverage for in-network services
  • Value-added wellness and disease management programs
Medical Care In-Network Cost when enrolled with a Preferred PCP Provider In-Network Cost when enrolled with a non-preferred participating PCP in the Prime Network
PCP office visit $0 copay $10 copay
Specialist office visit $0 copay $10 copay
Diagnostic lab/X-ray $0 copay $10 copay
Routine physical exam $0 copay $0 copay
Well child care $0 copay $0 copay
Physical therapy $0 copay $10 copay
Urgent care $0 copay $10 copay
Ambulatory surgery $50 copay $50 copay
Ambulance $0 copay $0 copay
Inpatient hospital care $100 copay $100 copay
Anesthesia Included in hospital copay Included in hospital copay
Emergency room $50 copay (waived if admitted) $50 copay (waived if admitted)
  • Care received from out-of-network providers is generally not covered under this plan. You may have to pay for medical services if you go out-of-network.
  • In cases of emergency, care is covered regardless of the provider's network status, and you will have coverage at any hospital nationwide.

Optional Rider

City employees can add the following option rider benefit to their HIP HMO Preferred plan through a payroll deduction if the benefits are not already provided by their welfare fund:

  • Durable medical equipment and private duty nursing
  • Prescription drugs - $5 for generic drugs and $15 for brand drugs from network retail drug stores

Formulary copays are reduced by 50 percent when you use the Mail Order Pharmacy Service for home delivery


This is an online service you can use to find and book in-network doctors’ appointments, often for the same day. For more information regarding this new benefit visit zocdoc.com/nyc.

Find A Doctor
or Hospital

Locate a doctor, hospital or other health care service near you.

Search Preferred Providers

Summary of Benefits Coverage (SBC)

See your SBC or check out your benefits at a glance.

Learn More

EmblemHealth Behavioral Management Program

Members can call
to seek advice about mental health and substance abuse treatment. This phone line is administered by ValueOptions.

Call Customer Service