Members 2018 Important Plan Documents

Your important plan documents below include coverage and costs for medical product and services and prescription drugs that will start on January 2018.



2018 Annual Notice of Change


EmblemHealth Medicare VIP Essential (HMO)
Bronx and Kings Download (PDF)
New York and Queens Download (PDF)
Richmond and Nassau Download (PDF)
Suffolk Download (PDF)
Westchester Download (PDF)
EmblemHealth Medicare VIP Gold (HMO)
Bronx and Kings Download (PDF)
New York and Queens Download (PDF)
Richmond and Nassau Download (PDF)
Suffolk Download (PDF)
Westchester Download (PDF)
EmblemHealth Medicare VIP Gold Plus (HMO)
Bronx and Kings Download (PDF)
New York, Queens, Richmond and Nassau Download (PDF)
Suffolk Download (PDF)
Westchester Download (PDF)
EmblemHealth Medicare VIP Value (HMO)
EmblemHealth VIP Value (HMO) Download (PDF)
EmblemHealth VIP Dual (HMO SNP)
EmblemHealth VIP Dual (HMO SNP) Download (PDF)
EmblemHealth Medicare Supplemental COST Plan
Basic Cost Plan Download (PDF)
HMO Cost Plan Download (PDF)

Nondiscrimination Policy



Evidence of Coverage


Evidence of Coverage
EmblemHealth VIP Essential (HMO) Download (PDF)
EmblemHealth VIP Gold (HMO) Download (PDF)
EmblemHealth VIP Gold Plus (HMO) Download (PDF)
EmblemHealth VIP Value Plan (HMO) Download (PDF)
EmblemHealth VIP Dual (HMO SNP) Download (PDF)
Basic HMO Medicare Supplement (Cost) Download (PDF)
HMO Medicare Supplement (Cost) Download (PDF)

Nondiscrimination Policy



Provider (Health Care Professionals and Facilities) Directory


Monthly Provider Directory Updates

Monthly provider directory updates include recent additions, deletions and changes to the provider network. A group of health care professionals or facilities, such as hospitals, that contract with EmblemHealth for all the counties.

Monthly Provider Directory Updates
Essential Provider Directory Updates Download (PDF)
HMO Provider Directory Updates Download (PDF)

Full Provider Directories

Essential Provider Directories
Bronx Download (PDF)
Kings Download (PDF)
Nassau Download (PDF)
New York Download (PDF)
Orange and Rockland Download (PDF)
Queens Download (PDF)
Richmond Download (PDF)
Suffolk Download (PDF)
Westchester Download (PDF)
HMO Provider Directories
Bronx Download (PDF)
Kings Download (PDF)
Nassau Download (PDF)
New York Download (PDF)
Orange and Rockland Download (PDF)
Queens Download (PDF)
Richmond Download (PDF)
Suffolk Download (PDF)
Westchester Download (PDF)


Pharmacy Directory


Pharmacy Directory
HMO/PPO Pharmacy Directory Download (PDF)
National Drug Plan (PDP) Pharmacy Directory Download (PDF)


Formulary (list of covered drugs)


Formulary (list of covered drugs)
2018 EmblemHealth HMO Drug Formulary Download (PDF)
Prior Authorization
(means that you will need to get approval from your plan before you fill your certain prescriptions)
Download (PDF)
Step Therapy
(you may need to try a different or more common drug first)
Download (PDF)

Nondiscrimination Policy



Multi-Language Insert


Multi-Language Insert
HMO Download (PDF)
1199 Download (PDF)


Nondiscrimination Policy


Notice of Nondiscrimination Policy

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