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 Annual Notice of Change


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

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)

Nondiscrimination Policy

 


Comprehensive and Preventive Dental Benefits


Provider (Health Care Professionals and Facilities) Directory


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

 


Pharmacy Directory


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

 


Formulary (list of covered drugs)


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

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

 

To view Portable Document Format (PDF) files, you need Adobe Acrobat Reader. If you do not already have this software, you can download a free copy from Adobe®. Download the Adobe Reader® now. Follow Adobe's instructions for download and installation.