2018 EmblemHealth VIP Value (HMO)

  • EmblemHealth VIP Value (HMO) gives you services through our Medicare Essential Network, which includes leading doctors and hospitals. You will pay $0 each month for the plan — a “$0 premium.” This plan provides all the benefits of Original Medicare plus Part D prescription drug coverage and more.

    MONTHLY PLAN PREMIUM
    (Amount you pay for your insurance every month)
    New York, Queens, Nassau, Richmond, Suffolk, Orange, Rockland and Westchester

    Your level of Extra Help Premium
    0% (Full Premium) $0.00
    25% $0.00
    50% $0.00
    75% $0.00
    100% $0.00
     

    Plan Highlights

    Benefits

    What you pay

    Primary Care Doctor Visit $30
    Specialist Doctor Visit $50
    Preventive Care
    (Services that keep you healthy)
    $0
    Urgently Needed Services $65
    Emergency Room $75
    Inpatient Hospital Coverage $275 per day 1-7
    Diagnostic Services/Labs/Imaging 20% of the cost
    Foot Care $50
    Dental Services
    (No annual dollar limit)
    Preventive
    Hearing Aid Not Covered
    Routine Eyewear $0 per year
    ($350 plan limit per year)
    24-Hour Nurse Hotline Yes
    SilverSneakers Not Covered
    Prescription Drug Yes

    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.


    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
    Medicare Essential Network

    Dental Provider Search

    Search
    Dentist

    Download Directories

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


    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 Download (PDF)
    Essential Provider Directory Updates

    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.


    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 medicines 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 prescription drugs you take. Our list of covered drugs (formulary) gives you access to thousands of them, and our pharmacy network (a group of pharmacies that we contract with) is large enough to provide the choices you need—close to home.

    The EmblemHealth Formulary (list of covered drugs) is organized into five tiers (levels) of drug coverage:


    DEDUCTIBLE
    (The amount you pay before your plan starts to pay)
    INITIAL Coverage
    $0-$3,595
    Coverage GAP
    Over $3,595
    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 $16 44%of the cost 5% of the cost
    Tier 3 Preferred Brand Drugs $250 $42 35% of the cost 5% of the cost
    Tier 4 Non-Preferred Brand Drugs $250 $95 44%/35% of the cost 5% of the cost
    Tier 5 Specialty Brand/Generic Drugs $250 28% 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 $250 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 $3,595. 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 $3,595.

    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 Value HMO

    Evidence of Coverage

    EmblemHealth VIP Value Plan (HMO) Downlaod (PDF)
    EmblemHealth VIP Value Plan (HMO)

    Nondiscrimination Policy


    2018 Annual Notice of Change

    EmblemHealth Medicare VIP Value (HMO) Download (PDF)
    EmblemHealth VIP Value (HMO)

    Nondiscrimination Policy


    Download Directories

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


    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 Download (PDF)
    Essential Provider Directory Updates

    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.


    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.