2019 EmblemHealth VIP Gold (HMO) - Richmond and Nassau

  • EmblemHealth VIP Gold (HMO) –You will pay $0 to see your primary care doctor and $25 to see specialists. You will also get benefits Medicare does not cover, like comprehensive dental, hearing aids, vision and a SilverSneakers® membership.

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

    Your level of Extra Help Premium
    0% (Full Premium) $88.50
    25% $78.70
    50% $68.80
    75% $59.00
    100% $49.20

    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 $90
    Inpatient Hospital Coverage $290 per day 1-7
    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. Call 877-344-7364/TTY: 711 for more information. 

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2019. 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

    VIP Prime Network
    Bronx
    Kings
    Nassau
    New York
    Orange and Rockland
    Queens
    Richmond
    Suffolk
    Westchester
    Hudson Valley (Dutchess, Putnam, Sullivan and Ulster)

    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. Call 877-344-7364/TTY: 711 for more information. 

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2019. 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 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 medicines s 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 (list of covered drugs) is organized into five tiers (levels):


    DEDUCTIBLE
    (The amount you pay before your plan starts to pay)
    INITIAL COVERAGE
    $0-$3,605
    COVERAGE GAP
    Over $3,605
    CATASTROPHIC
    Over $5,100
      You Pay You Pay You Pay You Pay
    Tier 1 Preferred Generic Drugs No Deductible $0 37% of the cost 5% of the cost
    Tier 2 Generic Drugs No Deductible $10 37% of the cost 5% of the cost
    Tier 3 Preferred Brand Drugs $200 $40 25% of the cost 5% of the cost
    Tier 4 Non-Preferred Brand Drugs $200 $95 37%/25% of the cost 5% of the cost
    Tier 5 Specialty Brand/Generic Drugs $200 29% of the cost 37%/25% of the cost 5% of the cost

    You will pay the above cost-sharing when you use preferred pharmacies. You pay more when you use standard pharmacies. You may pay less if you get extra help.

    Four Stages of Drug Coverage

    DEDUCTIBLE

    The deductible is the amount you pay before your plan starts to pay. This deductible is for retail and home delivery.

    • 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 until your total drug costs, including deductible, reach $3,605. The total drug costs paid by both you and our Part D plan will help you reach the coverage gap.

    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 $3,605. After you enter the coverage gap, you pay 25%of the plan’s cost for covered brand name drugs and 37%of the plan’s cost for covered generic drugs until your costs total $5,100. This dollar amount is the end of the coverage gap.

    CATASTROPHIC STAGE

    The coverage gap (also called the “donut hole”) starts after the total yearly drug cost (along with what our plan has paid and what you have paid) reaches $3,605.

    While in the coverage gap in 2019, you’ll pay 25% of the plan’s cost for brand-name drugs and 37% of the plan’s cost for generic drugs. You enter the catastrophic coverage phase once your yearly true out-of-pocket cost (Troop) reaches $5,100. The costs paid by you, and the manufacturer discount payment for brand-name drugs count toward your true out-of-pocket costs and help you get out of the coverage gap. Not everyone will reach the coverage gap.

    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. Call 877-344-7364/TTY: 711 for more information. 

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2019. 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.

  • 2019 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.


    Summary of Benefits

    Summary of Benefits Download (PDF)
    Summary of Benefits - VIP Gold HMO

    Evidence of Coverage

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

    Nondiscrimination Policy


    2019 Annual Notice of Change

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

    Nondiscrimination Policy


    Comprehensive and Preventive Dental Benefits


    Download Directories

    VIP Prime Network 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

    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 Coming Soon

    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. Call 877-344-7364/TTY: 711 for more information. 

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2019. 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

    Medicare beneficiaries may also enroll in EmblemHealth Medicare Plan through the CMS Medicare Online Enrollment Center located at www.medicare.gov.


    Make an In-Home Appointment

    Call us at 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.

    Visit us at a Seminar

    Call us to make an appointment or for questions about a seminar near you at 800-447-9169 (TTY: 711), 8 am to 8 pm, seven days a week to:


    Call to Enroll

    You may enroll in an EmblemHealth Medicare Advantage Plan for 2019 over the phone beginning October 15th by calling us toll-free at 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

    2019 EmblemHealth Medicare Enrollment Form

    2019 EmblemHealth Medicare Advantage Application for All Plans Except EmblemHealth VIP Dual (HMO SNP)


    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. Call 877-344-7364/TTY: 711 for more information. 

    The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2019. 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.