About Your Summary of Benefits and Coverage SBC

Your Summary of Benefits and Coverage (SBC) summarizes what your plan covers and what (if any) cost-sharing responsibilities you have. Your SBC is designed to help you understand your health plan coverage and plan options so you can make informed benefit decisions for you and your dependents.

For your Summary of Benefits and Coverage, click on the name of your plan. If you prefer a printed copy, please call the appropriate Customer Service department listed below. The printed SBC is available to you free of charge.

Want to know more about this document? Here are some answers to questions you may have about the SBC.

HIP HMO Preferred and HIP Prime POS Download (PDF)
HIP HMO Preferred Base Download (PDF)
HIP HMO Download (PDF)
HIP HMO Preferred with DME and PDN Download (PDF)
HIP HMO Download (PDF)
HIP HMO Preferred with Rx Download (PDF)
HIP Prime POS Base Download (PDF)
HIP Prime POS with Rx Download (PDF)

Call 1-800-447-8255, seven days a week (excluding major holidays), 8 am to 8 pm. If you have a hearing or speech impairment and use a TDD, call 711.

Vytra Download (PDF)
Vytra Download (PDF)
Vytra with Rx Download (PDF)

Call 1-866-409-0999, seven days a week (excluding major holidays), 8 am to 8 pm. If you have a hearing and impairment and use a TDD, call 711.

GHI Comprehensive Benefits Plan (CBP):

City of New York CBP — basic Download (PDF)
Includes the basic benefit package Download (PDF)
City of New York CBP — with optional benefits Download (PDF)
Includes the enhanced non-participating provider schedule only (enhanced option) Download (PDF)
Includes prescription drug coverage and the enhanced non-participating provider schedule (full option) Download (PDF)

Call 1-800-624-2414, seven days a week (excluding major holidays), 8 am to 8 pm. If you have a hearing or speech impairment and use a TDD, call 711.

DC37 Med Team Download (PDF)
DC37 Med Team Download (PDF)
DC37 Med Team (Active/Retiree) Download (PDF)

Call 1-800-624-2414, seven days a week (excluding major holidays), 8 am to 8 pm. If you have a hearing or speech impairment and use a TDD, call 711.

GHI HMO Download (PDF)
GHI HMO Download (PDF)
GHI HMO with Rx Download (PDF)

Call 1-877-244-4466, seven days a week (excluding major holidays), 8 am to 8 pm. If you have a hearing or speech impairment and use a TDD, call 711.

VIP Premier (HMO) Medicare and Senior Supplement:

Summaries of Benefits Coverage's are not available for these plans on our website.

For printed details of your plan benefits please call:

VIP Premier (HMO) Medicare Plan1-877-344-7364, seven days a week (excluding major holidays), 8 am to 8 pm. If you have a hearing or speech impairment and use a TDD, call 711.

GHI Supplement Plans: 1-800-624-2414, seven days a week (excluding major holidays), 8 am to 8 pm. If you have a hearing or speech impairment and use a TDD, call 711.

For the policy form number(s) for each of the above-referenced plans, please refer to the end of the respective sections of each plan.