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Welcome to the Gold Standard

HIP HMO Preferred Plan Overview

Summary, Features and Basics

Pick a preferred doctor for a $0 copay. Call the Gold Line
or go to Find a Doctor.

At EmblemHealth, we’re helping you create a healthier future.

Get to know these important basics about how to use and get the most out of your plan.

Use services within the Prime Network.

Your plan covers services within our Prime Network. What that means is that you have to use health care providers and facilities within this network. A network is a group of health care professionals and facilities that arranges with EmblemHealth to provide covered services and products to members, like you.

The Prime Network is robust. There are more than 100,000 doctors across New York, New Jersey, and Connecticut to take care of you. Your plan includes providers in the QualCare and ConnectiCare networks, too. Services you get outside the Prime Network won’t be covered, unless it’s an emergency.

Choose a primary care physician.

One of the first things to do is to pick a primary care physician. The relationship with your primary care doctor is one of the most important you’ll have.

This is the doctor who gives you your everyday care. They help take care of your overall health. They provide preventive care and help treat conditions before they become serious. When you see doctors and health care professionals within the Prime Network, you will be covered and pay less.

See a preferred doctor for a lower copay.

Certain doctors in the Prime Network are preferred doctors. You can see a preferred doctor in the network for a lower copay than other doctors. Doctors at AdvantageCare Physicians, Montefiore, HealthCare Partners, St. Barnabas and Middletown Medical are preferred.

If you pick a preferred primary care doctor from our Prime Network, you’ll have a $0 copay for most services, including if you are referred to a specialist in the network. A copay is the set dollar amount you pay for health services each time you use them.

Go to Find a Doctor and search results by the Preferred Provider indicator to find out whether a Prime Network doctor is a preferred doctor. Preferred doctors are marked, so they are easy to find.

We also have non-preferred doctors in the Prime Network. A non-preferred doctor is one who is in our network, but is not a preferred doctor.

If you pick a non-preferred primary care doctor, you’ll have a $10 copay for most services, including seeing a specialist. Your choice of primary care doctor determines your copay for many services.

Consider AdvantageCare Physicians

At AdvantageCare Physicians, you’ll experience a level of quality care and service you won’t find anywhere else. As an AdvantageCare Physicians patient, you’ll be surrounded by a Care Team focused on helping you achieve and maintain your best health. The high-quality, team-based, coordinated care focuses on patient needs. The team partners with patients in their pursuit of better health through primary and specialty care, urgent care, and on-site services such as laboratory and radiology.

Choose AdvantageCare Physicians and you will benefit from the following advantages:

  • Convenient hours, same day appointments, and treatment of your overall well-being.
  • Quality physicians affiliated with most of the area’s leading hospitals.
  • Medical offices that have achieved Level 3 status for Patient-Centered Medical Homes from the National Committee for Quality Assurance (NCQA) – the highest recognition possible.

There are more than 36 medical offices right in your neighborhood, with locations throughout Brooklyn, Manhattan, Queens, Staten Island and Long Island. All AdvantageCare Physicians doctors and specialists are preferred providers in the Prime Network, so you do not have to worry about out-of-network costs.

Gold Line Service
Call our Gold Line, 833-CNY-GOLD (833-269-4653) (TTY: 711), where our specially trained Gold Line agents will make it easier for you to get your questions answered, and get the care you need more quickly.

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