Members 2019 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 2019.

 


2019 EmblemHealth Annual Notice of Change


EmblemHealth VIP Value (HMO) Download (PDF)
EmblemHealth VIP Value (HMO)
EmblemHealth VIP Essential (HMO)
Bronx, Kings, Queens and New York
Richmond and Nassau
Suffolk
Westchester, Orange and Rockland
EmblemHealth VIP Gold (HMO)
Bronx, Kings, Queens and New York
Richmond and Nassau
Suffolk
Westchester, Orange and Rockland
EmblemHealth VIP Gold Plus (HMO)
EmblemHealth VIP Gold Plus (HMO)
EmblemHealth Dual SNP (HMO)
Bronx, Kings, Queens and New York
Suffolk
Richmond, Nassau, Westchester, Orange and Rockland
EmblemHealth Affinity Medicare Essentials (HMO)
EmblemHealth Affinity Medicare Passport Essentials (HMO)
EmblemHealth Affinity Medicare Passport Essentials NYC (HMO)
EmblemHealth Affinity Medicare (HMO SNP)
EmblemHealth Affinity Medicare Ultimate (HMO SNP)
EmblemHealth Affinity Medicare Solutions (HMO SNP)

Nondiscrimination Policy

 


Evidence of Coverage


Evidence of Coverage Download (PDF)
EmblemHealth VIP Value Plan (HMO)
EmblemHealth VIP Part B Saver (HMO)
EmblemHealth VIP Essential (HMO)
EmblemHealth VIP Rx Saver (HMO)
EmblemHealth VIP Go (HMO-POS)
EmblemHealth VIP Gold (HMO)
EmblemHealth VIP Gold Plus (HMO)
EmblemHealth VIP Dual (HMO SNP)
EmblemHealth Affinity Medicare Passport Essentials NYC (HMO) /
EmblemHealth Affinity Medicare Passport Essentials
EmblemHealth Affinity Medicare Ultimate (HMO SNP)
EmblemHealth Affinity Medicare Solutions (HMO SNP)

Nondiscrimination Policy

 


Comprehensive and Preventive Dental Benefits


Provider (Health Care Professionals and Facilities) Directory


HMO Provider Directories Download (PDF)
Bronx 01/01/2019
Kings 01/01/2019
Nassau 01/01/2019
New York 01/01/2019
Orange and Rockland 01/01/2019
Queens 01/01/2019
Richmond 01/01/2019
Suffolk 01/01/2019
Westchester 01/01/2019
Hudson Valley (Dutchess, Putnam, Sullivan and Ulster) 01/01/2019

 


Pharmacy Directory


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

 


Dental Directory


Dental Directory Download (PDF)
EmblemHealth Medicare HMO Dental Directory

 


Formulary (list of covered drugs)


 
EmblemHealth VIP Formulary (list of covered drugs) Download (PDF)
2019 EmblemHealth HMO Medicare Drug Formulary
2019 EmblemHealth VIP Dual (HMO SNP) Drug Formulary
Prior Authorization
(means that you will need to get approval from your plan before you fill your certain prescriptions)
Step Therapy
(you may need to try a different or more common drug first)
 
EmblemHealth Affinity Formulary (list of covered drugs) Download (PDF)
2019 EmblemHealth Affinity HMO and HMO SNP Drug Formulary
Prior Authorization
(means that you will need to get approval from your plan before you fill your certain prescriptions)
Step Therapy
(you may need to try a different or more common drug first)

Nondiscrimination Policy

 


Evidence of Coverage


Evidence of Coverage (Group) Download (PDF)
EmblemHealth VIP Rx Carveout (HMO) - Group (NYSHIP)
EmblemHealth VIP Rx Carveout (HMO) - MA ONLY (CNY)
EmblemHealth VIP Premier (HMO) – Group
EmblemHealth VIP Premier (HMO) - Group (Preferred Pharmacy)
EmblemHealth City of New York GHI Standard/Enhanced Medicare Prescription Drug Plan (PDP)
EmblemHealth VIP Premier (HMO) - Group (NYSHIP)
EmblemHealth VIP Dual (HMO SNP) – Group
EmblemHealth Group Access Rx National (PPO)
EmblemHealth Group Access Rx (PPO)
EmblemHealth National Drug Plan (PDP)

 


Nondiscrimination Policy


Notice of Nondiscrimination Policy

 

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