Small Group Plans Available for Sale in New York

EmblemHealth has a range of products to suit the needs of any group, including yours. The Gold, Silver and Bronze small group plans all offer the same high quality benefits, but the metal levels differ in how much the premium will cost and the amount charged for out-of-pocket costs. Most plans have a deductible. The deductible is the amount of eligible cost that must be paid during a calendar year before EmblemHealth begins paying for any covered services, with the exception of preventive care.

Take a look at the products below to find the plan that best fits your group’s particular health care needs and budget.

Off-Exchange

HMO Products

EmblemHealth HMO 35/55 is the Silver option. With this plan, most facility services are subject to the annual deductible and coinsurance and most office visits are subject to copays. Upon reaching the out-of-pocket maximum, all covered benefits will be paid in full by EmblemHealth.

  • An HMO plan with in-network benefits only.
  • Primary Care Physician (PCP) selection is required: specialist visits require referrals from PCP.
  • Benefits include comprehensive medical, hospital, and prescription drug coverage.
  • No cost sharing for in-network preventive care services, including immunizations, routine exams, women’s preventive health services and prostate screening. These services are covered in full.

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EmblemHealth HMO 40/60 is the Gold option. With this plan, there are higher copays but no annual deductible. Upon reaching the out-of-pocket maximum, all covered benefits will be paid in full by EmblemHealth.

Other plan benefits:

  • This is an HMO plan with in-network benefits only.
  • Primary Care Physician (PCP) selection is required, and specialist visits require referrals from your PCP.
  • Benefits include comprehensive medical, hospital, and prescription drug coverage.
  • There is no cost sharing for in-network preventive care services, including immunizations, routine exams, women’s preventive health services and prostate screening. These services are covered in full.

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The EmblemHealth HMO 40/60 Plan is underwritten by HIP Health Plan of New York and provides in-network benefits only. Except for emergency hospital care, no out-of-network services are covered. Coverage is limited to all terms, conditions, limitations and exclusions set forth in the certificate of coverage. Refer to HIP policy form number 155-23-SGOFFHIXCERT (04/13)

EmblemHealth HMO HD6300 is the Bronze option. With this plan, members are responsible for a higher deductible, which is offset by 0% cost sharing after the deductible has been met. Upon reaching the out-of-pocket maximum, all covered benefits will be paid in full by EmblemHealth.

Other plan features:

  • This is an HMO plan with in-network benefits only.
  • Primary Care Physician (PCP) selection is required, and specialist visits require referrals from your PCP.
  • Benefits include comprehensive medical, hospital, and prescription drug coverage, which are subject to the plan deductible.
  • There is no cost sharing for in-network preventive care services, including immunizations, routine exams, women’s preventive health services and prostate screening. These services are covered in full.

Want to learn more about this plan?

Review Summary of Benefits

Show me all EmblemHealth small group plans


The EmblemHealth HMO HD3600 Plan is underwritten by HIP Health Plan of New York and provides in-network benefits only. Except for emergency hospital care, no out-of-network services are covered. Coverage is limited to all terms, conditions, limitations and exclusions set forth in the certificate of coverage. Refer to HIP policy form number 155-23-SGOFFHIXCERT (04/13)

Healthy NY is a state-sponsored HMO plan designed to make health coverage more affordable for eligible small groups. This plan is available to certain small businesses that meet eligibility guidelines and income requirements established by New York State. With this plan, the deductible must be met before the plan will start paying for any covered medical services with the exception of preventive care and prescription drugs. Upon reaching the annual out-of-pocket maximum, all covered benefits will be paid in full by EmblemHealth.

Other plan features:

  • This is an HMO plan with In-network benefits only.
  • Primary Care Physician (PCP) selection is required, and specialist visits require referrals from your PCP.
  • Benefits include comprehensive medical, hospital, and prescription drug coverage.
  • There is no cost sharing for in-network preventive care services, including immunizations, routine exams, women’s preventive health services and prostate screening.
  • Prescription drugs are subject to a copay but not a deductible.

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The EmblemHealth Healthy New York Plan is underwritten by HIP Health Plan of New York and provides in-network benefits only. Except for emergency hospital care, no out-of-network services are covered. Coverage is limited to all terms, conditions, limitations and exclusions set forth in the certificate of coverage. Refer to HIP policy form number 155-23-SGOFFHIXHNYCERT (04/13)

Off-Exchange

EPO Products

EPO HD3600 is a Bronze plan with a deductible. Once the deductible is met, there is no additional cost sharing for medical care. Upon reaching the annual out-of-pocket maximum, all covered benefits will be paid in full by EmblemHealth.

Other plan features:

  • This is an EPO plan with in-network benefits only, with access to EmblemHealth’s EPO National Network.
  • This is a high deductible plan that offers tax savings with an HSA.
  • No Primary Care Physician (PCP) is required, and no referrals are needed to see a doctor.
  • Benefits include comprehensive medical, hospital, and prescription drug coverage, which are subject to the plan deductible.
  • No cost sharing for in-network preventive care services, including immunizations, routine exams, women’s preventive health services and prostate screening.

Want to learn more about this plan?

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The EmblemHealth EPO HD6300 Plan is underwritten by Group Health Incorporated (“GHI”) and provides in-network benefits only. Except for emergency hospital care, no out-of-network services are covered. Coverage is limited to all terms, conditions, limitations and exclusions set forth in the certificate of coverage. Refer to GHI policy form number HCR-OX-100 (04/13)

EPO Select 35/55 is an EPO Silver Plan. With this plan, most facility services are subject to the annual deductible and coinsurance, and most office visits are subject to copays. Upon reaching the annual out-of-pocket maximum, all covered benefits will be paid in full by EmblemHealth.

Other plan features:

  • In-network coverage only, with access to EmblemHealth’s Prime Network.
  • No Primary Care Physician (PCP) is required, and no referrals are needed to see a doctor.
  • Benefits include comprehensive medical, hospital, and prescription drug coverage.
  • There is no cost sharing for in-network preventive care services, including immunizations, routine exams, women’s preventive health services and prostate screening.

Want to learn more about this plan?

Review Summary of Benefits


The EmblemHealth EPO Select 35/55 Plan is underwritten by HIP Insurance Company of New York and provides in-network benefits only. Except for emergency hospital care, no out-of-network services are covered. Coverage is limited to all terms, conditions, limitations and exclusions set forth in the certificate of coverage. Refer to HIP policy form number 151-23-SGOFFHIXCERT (04/13)