Low-Cost Hospital Plan for Large Group Employers
Health Essentials Plus is a low-cost EPO hospital plan that offers basic hospital insurance and three (3) office visits per calendar year. The plan provides benefits for covered services provided and billed by in-network hospitals, skilled nursing facilities, home care agencies or ambulatory surgical centers. It does not provide basic medical or major medical insurance. With the exception of preventive services and three office visits per year, medical services that are provided and billed by a physician are not covered under this plan. The three office visits are covered for any of the following types of services:
- Physician or specialist office visit for treatment of injury or illness
- Treatment of mental illness or chemical dependence
- Visits for purposes of obtaining surgical and/or cancer treatment options
- Urgent care center visits
- Chiropractic care
- Office visits for physical, speech or occupational therapy
- For businesses headquartered in all New York State counties
- Businesses must have 101 or more employees
- Fulfills the Affordable Care Act requirement that large businesses offer health coverage to their full-time employees or risk paying a penalty.
- Referral free, in-network coverage with our National Network
- Coverage of facility services provided and billed by in-network hospitals, skilled nursing facilities, home care agencies or ambulatory surgical centers.
- 3 office visits (primary or specialty care) per calendar year
- Preventive care covered in full if received from an in-network physician or provider. Preventive care services include routine physicals, immunizations, mammograms, GYN exams, well-baby care, prostate screening, and bone density testing.
- $15 copay for generic drugs
Helping Members Stay Healthy
We know good health is worth holding onto. That's why we want to make it as easy as possible for you. We have programs, tools and more to help you stay fit and enhance your quality of life.
PATH Wellness Programs
Looking for ways to live healthier? Check out our wellness programs.*
- Wellness PATH Program- support for weight management, stress reduction, physical activity and more.
- Healthy Beginnings PATH Pregnancy Management Plan- For the health of mom and baby.
- Tobacco-Free PATH Smoking Cessation Program- Get help quitting.
We help members stay healthy with:
- Fitness Center Reimbursement
- Discounts on weight-loss programs, laser vision, acupuncture and more**
- Quit-smoking programs
- A Nurse Advice Line that members may call 24/7 to speak with a Registered Nurse
- Self-management help tools on our secure member portal of 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 Group Health Incorporated ("GHI") or HIP Health Plan of New York (“HIP”) as part of the plan.
Information 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 (which are available only in the Contract or Certificate of Coverage and Schedule of Benefits) and it does not constitute an Agreement.
The EmblemHealth Health Essentials Plus plan is underwritten by Group Health Incorporated (“GHI”) and provides in-network benefits only. Except for emergency room facility charges, no out-of-network services are covered. Participating Providers have contracted with GHI to provide care to our members; they are not employees, agents, servants or representatives of GHI. Refer to GHI policy form number HCR-CAT-200, et al.