EmblemHealth HMO Preferred Plus


  • Our HMO Preferred Plus plan is a unique approach to a traditional HMO plan. It offers three levels of benefit choices with a range of deductibles (the amount a member must pay before the plan starts to pay) that lower premium costs. Groups can choose a health plan that fits members’ financial comfort level.

    Plus, with no cost for preventive services, and maternity and newborn care, members will save money. In addition, members will have access to benefits like telemedicine and acupuncture.

    Plan description

    This is the right plan for employers who want to control costs while providing an extensive set of benefits to their employees. The plan features little or no paperwork and you can choose expanded network coverage with our Premium network. This plan gives comprehensive coverage, including hospital, medical, and pharmacy benefits.

    Key Features

    • For businesses headquartered in New York State.
    • Businesses must have 101 or more employees.
    • In-network coverage.
    • Wide range of covered services, including prescription drug coverage.
    • Referrals are required.
    • Little or no paperwork.

    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. PATH 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.

    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 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 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 and it does not constitute an Agreement.

    The HMO Preferred Plus plan is underwritten by HIP Health Plan of New York (HIP). This summary provides only benefit highlights. Coverage is subject to all terms, conditions, limits and exclusions set forth in the contract and certificate of insurance. Refer to HIP Policy Form 155-23-LGTIERCERT (04/16), et. al.

  • With our Prime Network, members can choose from over 90,000 private and group practice health 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 get many of their medical needs taken care of during a single appointment.

    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 the Prime Network.

    Care from out-of-network doctors is not covered under this plan. Members may have to pay for these services.

    In cases of 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.