What the Plan Covers and Costs


Summary of Benefits and Coverage:

HIP Prime HMO Base | HIP Prime HMO with Durable Medical Equipment and PDN | HIP Prime HMO with Rx

If you have questions about the plan’s benefits or would like a copy of the plan’s benefits summary, prospective members can call our Information Line at 1-800-447-6929, Monday – Friday, 8 am to 8 pm; and current members can call Customer Service at 1-800-447-8255.


Benefits At-a-Glance: HIP Prime HMO

Medical Care

Your In-Network Cost

PCP office visit

$0

Specialist office visit

$0

Diagnostic lab/X-ray

$0

Routine physical exam

$0

Well child care

$0

Outpatient mental health

$0

Urgent care

$0

Ambulatory surgery

$50 copay

Ambulance

$0

Inpatient care

$100 copay

Anesthesia

Included in hospital copay

Emergency room

$50 copay (waived if admitted)

 Additional Riders

City employees can add the following in-network benefits to their HIP Prime HMO 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 and $15 for brand drugs from network retail drug stores). Note that Formulary copays are reduced by 50% when utilizing the Mail Order Pharmacy Service for home delivery.