EmblemHealth EPO Value

  • Our EPO Value Plan offers a large network of doctors and hospitals, and a broad range of in-network-only benefits. It’s an affordable and convenient plan for members and groups.

    Members who enroll in EmblemHealth’s EPO Value Plan must choose a Primary Care Physician (PCP).

    They do not need a referral from their primary care physician to see in-network specialists.

    Members receive services that include medical, hospital, and prescription drug coverage.

    Key Features:

    • This plan is available for businesses headquartered in New York City, Nassau, Suffolk, and Westchester counties.
    • Businesses must have 101 or more employees.
    • This plan provides in-network coverage.
    • There are no claims to file - our network doctors do it for you.

    Helping Members Stay Healthy

    In addition to their doctor’s care, below are some programs members can join to help them and their enrolled family members stay healthy. Wellness PATH Programs* .

    • Wellness Program: Support for weight management, stress reduction, physical activity and more.
    • Healthy Beginnings Pregnancy Management Program: For the health of mom and baby.
    • Tobacco-Free Smoking Cessation Program: Get help quitting.

    Discount Health Programs

    • Discounts on weight-loss programs, laser vision, acupuncture and more.**
    • Quit-smoking programs.
    • A Nurse Advice Line that members can call 24/7 to speak with a registered nurse.
    • Self-management help tools on our secure member portal at emblemhealth.com.

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

    * Availability of health and wellness programs may vary based on the EmblemHealth product selected.

    ** EmblemHealth cannot ensure that a particular vendor will remain in the program. The services available under these programs are not covered services underwritten by HIP Insurance Company of New York (“HIPIC”) as part of the plan.

    Informational Purposes Only

    Some services are subject to prior authorization. This summary is provided for information only; it does not contain complete details of the plan and it does not constitute an Agreement.

    The EmblemHealth EPO Value program is underwritten by HIP Insurance Company of New York (HIPIC) and provides 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 and certificate of insurance. Refer to HIPIC policy form numbers 151-23-LGEPOSCHEDULE (10/16), et. al.

  • Large Network of Medical Providers

    With our Prime Network, members can choose from over 90,000 private and group practice health care professionals, facilities and 144 hospitals in 28 New York State counties — all five boroughs of New York City (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), plus Nassau, Suffolk, Orange, Rockland, and Westchester counties and upstate areas that stretch north of Albany.

    • The Prime Network also includes:
      • ConnectiCare HMO Network which has 18,000 primary care providers and specialists, and all 31 hospitals located in the eight counties in Connecticut.
      • QualCare HMO Network includes 114,000 primary care providers and specialists, and 65 hospitals in the 21 counties across New Jersey.

    Members also have coverage at many of the area’s most acclaimed hospitals, such as:

    • Lenox Hill Hospital
    • Montefiore Medical Center
    • Northwell Health
    • NYU Hospital Center
    • Staten Island University Hospital

    Convenient Care

    In addition to doctors in private practice, our network also includes physician group practices. At group practices, many health care professionals work together in one location.

    When members go to a group practice, they can expect a coordinated, team-based approach to care, which can lead to better health outcomes.

    Other benefits may include:

    • A full range of health services: preventive, primary care and specialty care.
    • Lab tests.
    • Longer evening and weekend hours.
    • Same day appointments for routine medical care.
    • Urgent care centers.

    In-Network Care

    To take advantage of plan benefits members need to see doctors in our network. Care from out-of-network doctors is not covered under this plan. Members must pay for these services.

    In the case of an emergency, care is covered whether or not the hospital emergency room is in network – members will be covered at any hospital nationwide. Emergency admissions should be reported within 48 hours, or as soon as reasonably possible."

  • This plan does not provide any dental coverage.

  • Vision Care

    This plan covers refractive eye exams every 12 months.

  • For more than 80 years, EmblemHealth has been a health care partner with New York businesses and the people they employ.

    We know companies like yours want to offer health care your employees can afford and that meets their ever-changing needs. Health care that provides access to quality doctors where they live and work. Health care with hassle-free administration that saves you time and resources.

    Let us help you find the right plan for your group. Contact us today.

    For more information, call John Kobi, Director of Group Sales, at 646-447-5038.