InBalance EPO Large Group

  • 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.

    Key Features

    • 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.

  • Search our Provider Directories

    Large Network of Medical Providers

    The EmblemHealth National Network includes an extensive roster of quality doctors and other health care practitioners in the Buffalo region - and across all 50 states. You also have coverage at many of the area's leading hospitals and hospital systems, including:

    • Kaleida Health
    • Catholic Health Systems
    • Erie County Medical Center
    • Roswell Park Cancer Institute
    • Niagara Falls Memorial Medical Center
    • Mt. St. Mary's Hospital

    Members also have access to the best physicians in the Buffalo region's top group practices, as well as convenient urgent care and ambulatory surgery centers.

    In-Network Care

    To take advantage of all the benefits this plan offers, you need to see providers in the plan. You can get covered services from any provider within this network.

    Receiving care from out-of-network doctors or providers is not covered under this plan. You may have to pay for the medical services if you go out of network.

    In cases of emergency, your care is covered regardless of the provider's network status; you will be completely covered at any hospital nationwide. Emergency admissions should be reported within 48 hours, or as soon as reasonably possible.

  • Dental Coverage

    Groups can choose to add an EmblemHealth dental program* to their medical plan. We offer three different dental programs that feature different benefit designs, network size and member and group cost-sharing responsibilities. * EmblemHealth dental programs are underwritten by Group Health Incorporated (GHI).


    Preferred Plus Preferred Dental Access

    Benefits

    Traditional benefits with cost sharing and a larger network

    Roll-over feature for unused annual benefits maximum

    No approvals or referrals required

    Paid-in-full, in-network coverage for all covered services

    Roll-over feature for unused annual benefits maximum

    No approvals or referrals required

    Paid-in-full, in-network coverage for preventive and diagnostic care

    100% coverage for crown, bridge and denture repair

    Network

    8,100 dentists and specialists in NY and NJ

    Nationwide coverage available

    6,300 dentists and specialists in NY and NJ

    5,500 dentists and specialists in NY and NJ

    Cost sharing

    Out-of-network benefits for covered services

    Out-of-network benefits for covered services.

    In-network discounts for more costly services

    Out-of-network benefits for covered services

    *Individuals in a group plan: These dental benefits can be selected at the time your employer purchases your health plan.

  • Vision Care

    You can choose to add vision benefits to your employee’s benefit coverage. Vision benefits for this plan are administered by EyeMed Vision Care, LLC, with CPS Optical Inc., a leading national administrator of routine vision care programs. Eligibility for vision care benefits is determined by the same rules that apply to other health care benefits.

    Refractive eye exams, written prescriptions for corrective lenses and hardware (i.e., frames, lenses and contacts) are covered for eligible members. Various benefit designs are available.

  • EmblemHealth has served New Yorkers for over 75 years, through ever-changing economic and health care landscapes, and we plan to stay. We are born in New York, are headquartered in New York, and most of our 4,500 employees live and work in New York.

    We are proud of our tradition of offering New Yorkers coverage that addresses their health coverage needs, gives them access to a network of quality doctors where they live and work, and responds to their concerns and questions with prompt and friendly service. We also recognize the needs you have as an employer — so, you benefit from streamlined, hassle-free administration that demonstrates our respect for your time and your budget.

    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 1-646-447-5038.