2018 EmblemHealth VIP Gold (HMO) - Richmond and Nassau

  • The EmblemHealth VIP Gold (HMO) provides coverage through our extensive VIP Prime Network. You will pay $0 to see your everyday doctor (your primary care doctor) and $25 to see specialists. This plan offers all the benefits of Original Medicare with low copayments for primary care doctors (specialists, plus Part D prescription drug coverage and more.

    MONTHLY PLAN PREMIUM
    (Amount you pay for your insurance every month)
    Richmond, Nassau

    Your level of Extra Help Premium
    0% (Full Premium) $109.00
    25% $99.30
    50% $89.50
    75% $79.80
    100% $70.00

    Plan Highlights

    Benefits

    What you pay

    Primary Care Doctor Visit $0
    Specialist Doctor Visit $25
    Preventive Care
    (Services that keep you healthy)
    $0
    Urgently Needed Services $35
    Emergency Room $75
    Inpatient Hospital Coverage $195 per day 1-10
    Diagnostic Services/Labs/Imaging $0 or 20% of the cost*
    Foot Care $25
    Dental Services
    (No annual dollar limit)
    Comprehensive and Preventive
    Hearing Aid $2,400 every 3 years
    Routine Eyewear $0 per year
    ($300 plan limit per year)
    24-Hour Nurse Hotline Yes
    SilverSneakers Yes
    Prescription Drug Yes

    *A 20% coinsurance (the percentage you pay for health services) may apply when services are provided in an Outpatient Hospital.


    Disclaimer

    HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract.  Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

    The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2018. All rights reserved.


    To view the 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.

  • Find a Doctor


    Medical Provider Search

    Search
    VIP Prime Network

    Dental Provider Search

    Search
    Dentist

    Download Directories

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

    Disclaimer

    HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract.  Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

    The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2018. All rights reserved.


    To view the 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.

  • Having the medications you need is an important part of staying healthy, which is why we take our pharmacy offerings very seriously. We strive to help you make sure you can afford the medications you take. Our formulary gives you access to thousands of them, and our pharmacy network is large enough to provide the choices you need—close to home.

    THE EMBLEMHEALTH FORMULARY IS ORGANIZED INTO FIVE TIERS OF COVERAGE:


    DEDUCTIBLE
    (The amount you pay before your plan starts to pay)
    INITIAL COVERAGE
    $0-$3,545
    COVERAGE GAP
    Over $3,545
    CATASTROPHIC
    Over $5,000
      You Pay You Pay You Pay You Pay
    Tier 1 Preferred Generic Drugs No Deductible $0 44% of the cost 5% of the cost
    Tier 2 Generic Drugs No Deductible $10 44% of the cost 5% of the cost
    Tier 3 Preferred Brand Drugs $200 $40 35% of the cost 5% of the cost
    Tier 4 Non-Preferred Brand Drugs $200 $95 44%/35% of the cost 5% of the cost
    Tier 5 Specialty Brand/Generic Drugs $200 29% of the cost 44%/35% of the cost 5% of the cost

    Some of our network pharmacies have preferred cost-sharing.

    Four Stages of Drug Coverage

    DEDUCTIBLE

    The deductible is the amount you pay before your plan starts to pay.

    • There is no deductible for Tier 1(preferred generic) and Tier 2 (generic) drugs.
    • There is a $200 deductible for Tier 3 (preferred brand), Tier 4 (non-preferred drug) and Tier 5 (specialty tier) drugs.

    INITIAL COVERAGE STAGE

    After you’ve reached the deductible, you’ll enter the initial coverage phase. In this phase, you and the plan share the costs of some of the covered drugs. Please see above chart for cost-sharing. You pay the cost share until your total drug costs reach $3,545. Total yearly drug costs are the total drug costs paid by both you and our Part D plan. You may get your drugs at network retail and home delivery pharmacies.

    COVERAGE GAP STAGE

    Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means that there’s a brief change in what you will pay for your drugs. The coverage gap starts after the total yearly drug cost (along with what our plan has paid and what you have paid) reaches $3,545. After you enter the coverage gap, you pay 35% of the plan’s cost for covered brand name drugs and 44% of the plan’s cost for covered generic drugs until your costs total $5,000. This dollar amount is the end of the coverage gap.

    CATASTROPHIC STAGE

    After your yearly out-of-pocket drug costs (including drugs bought from your retail pharmacy and through home delivery pharmacy) reach $5,000, you pay the greater of: 5% of the cost or you pay $3.35 for generic (including brand drugs treated as generic). You pay $8.35 for all other drugs.

    See Covered Drugs
    Find the prescription drugs you take in EmblemHealth’s list of covered drugs called a formulary.

    Find a Pharmacy
    There’s an EmblemHealth network pharmacy near you. Here’s how to find one.

    Set up Home Delivery and Refills for Prescription Drugs
    Have your prescriptions and refills delivered directly to your home through Express Scripts, Inc. (ESI), our home-delivery pharmacy.

    Rx Cost Calculator
    Look up the costs of each prescription drugs you take.

    Additional Pharmacy Information

    Learn more about what our over-the-counter debit card covers, how to get money back for a drug, our Medication Management Therapy program, how to get help paying for Part D drugs through the Extra Help program (as known as Low Income Subsidy) and much more.

    To view the Portable Document Format (PDF) files on this page, 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.



    Disclaimer

    HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract.  Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

    The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2018. All rights reserved.


    To view the 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.

  • 2018 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.


    Benefit Summary

    Benefit Summary Download (PDF)
    Benefit Summary - VIP Essential / VIP Gold / VIP Gold Plus

    Evidence of Coverage

    EmblemHealth VIP Gold (HMO) Download (PDF)
    EmblemHealth VIP Gold (HMO)

    Nondiscrimination Policy


    2018 Annual Notice of Change

    EmblemHealth Medicare VIP Gold (HMO) Download (PDF)
    Bronx and Kings
    New York and Queens
    Richmond and Nassau
    Suffolk
    Westchester

    Nondiscrimination Policy


    Comprehensive and Preventive Dental Benefits


    Download Directories

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

    Pharmacy Directory

    Pharmacy Directory Download (PDF)
    HMO/PPO Pharmacy Directory

    Low-Income Subsidy and Plan Ratings

    Do you get extra help from Medicare to pay for your Medicare prescription drug plan costs? If so, your monthly plan premium will be lower than it would be if you did not get extra help from Medicare. The amount of help you get will determine your total monthly premium as a member of our plan.

    Documents Download (PDF)
    LIS Plan Summary
    EmblemHealth Medicare Plan Ratings

    Nondiscrimination Policy


    Disclaimer

    HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract.  Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

    The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2018. All rights reserved.


    To view the 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.

  • Enroll in an EmblemHealth Medicare Advantage Plan

    You've looked at your options, and now you're ready to enroll. We want to make the process as easy as possible for you.

    There are four simple ways to enroll.


    Enroll Online

    Enroll Now

    You may also enroll in an EmblemHealth Medicare Plan through the CMS Medicare Online Enrollment Center.


    Make an In-Home Appointment

    Call us at 1-800-447-9169 (TTY: 711), 8 am to 8 pm, seven days a week to:

    • Schedule an in-home appointment with an EmblemHealth Sales Representative who will answer your questions and help you complete the enrollment application.
    • Request an enrollment kit.

    Call to Enroll

    You may enroll in an EmblemHealth Medicare Advantage Plan for 2018 over the phone beginning October 15th by calling us toll-free at 1-800-447-9169 (TTY:711), seven days a week, 8 am to 8 pm.

    Enroll by Mail

    We make it easy for you to become an EmblemHealth VIP Medicare Advantage plan member.

    • Fill in all the requested Medicare information on your enrollment form.
    • Sign and date your enrollment form.
    • Mail it to us at:
      EmblemHealth
      Attention: Medicare Marketing
      P.O. Box 2859
      New York, NY 10117-7894

    2018 EmblemHealth Medicare Enrollment Form

    2018 EmblemHealth Medicare Advantage Application DownLoad (PDF)
    Application

    Mail the form to:

    EmblemHealth
    Attention: Medicare Marketing
    PO Box 2859
    New York, NY 10117-7894


    Disclaimer

    HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract.  Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

    The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2018. All rights reserved.


    To view the 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.