Keeps the Care In Network — Includes Cost-Sharing Requirements to Bring Employer Costs Down
InBalance EPO offers members in-network, national coverage. No referrals to specialists needed. The plan features special cost-sharing requirements resulting in lower costs. Gives comprehensive coverage, including medical and pharmacy benefits.
- For businesses headquartered in Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans or Wyoming counties.
- Businesses must have 101 or more employees.
- In-network coverage with our National Network.
- Wide range of covered services.
- No referrals.
- Open formulary for all FDA-approved medications.
- Deductibles and coinsurance apply for certain services.
- Your deductible and coinsurance apply only to inpatient and outpatient hospital or facility-based services.
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 Program - For the health of mom and baby.
- Tobacco-Free PATH Smoking Cessation Program - Get help quitting.
We help members stay healthy with:
- 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 InBalance EPO program is underwritten by Group Health Incorporated ("GHI") and provide 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 GHI policy form number HCR –EPO 100, et. al.