Designed with Your Employees in Mind

Expertly designed plan options that respond to the business needs of employers or groups with more than 100 full-time equivalent eligible employees. 

To get the right EmblemHealth coverage for your employees, call 877-411-3625 or send us your information and we will email or call you back at your convenience.

Our plans include:

  • Access to our Prime Networkinfo or National Networkinfo, with over 27,200 and 24,400 primary care providers, respectively.
  • Cost-sharing options to meet the needs of the businesses we serve.
  • Access to AdvantageCare Physicians, one of the largest physician practices in the New York metropolitan area.
  • Health and wellness resources to educate and support members with specific health conditions.
  • Discounts on health products such as weight-loss programs and laser-vision care.

Health Essentials Plus

  • Three $40 copay primary or specialist office visits each calendar year.
  • Access to our National Network.

HIP Prime HMO

  • A community-rated plan.
  • Cost-sharing options to help lower premiums.
  • Preventive dental coverage and reduced rates for specialty dental services.
  • Access to our Prime Network.

EmblemHealth HMO Plus

  • Telemedicine and acupuncture included.
  • A community-rated plan.
  • Has an upfront deductible.
  • Access to our Prime Network.

EmblemHealth Preferred Plus

  • Includes features of the EmblemHealth HMO Plus plan with tiered benefit options.
  • Members who choose a preferred primary care doctor pay a lower copay.
  • Access to our Prime Network.

 

Health Essentials Plus

HIP Prime HMO

EmblemHealth HMO Plus

EmblemHealth Preferred Plus

Telemedicine

Not available

Buy-up^

Included

Included

Dentalinfo

Buy-up^

Buy-up^

Buy-up^

Buy-up^

Dental Discount

Buy-up^

Included

Not available

Not available

Vision

Not available

Includedinfo

Not available

Not available

Acupuncture

Not available

Buy-up^

Included

Included

Pharmacy

Included

Buy-up^

Included

Included

Gym

Included

Buy-up^

Included

Included

 

EmblemHealth PPO

  • Visit health care professionals in and out of our network.
  • Referrals are not required to see a specialist.
  • Access to our National Network.

EmblemHealth EPO

  • Ability to customize cost-sharing for in-network services.
  • Referrals are not required to see a specialist.
  • Access to our National Network.

InBalance PPO

  • Ability to customize cost-sharing for in- and out-of-network options.
  • Referrals are not required to see a specialist.
  • Access to our National Network.

InBalance EPO

  • Cost-sharing options through deductibles and coinsurance.
  • Referrals are not required to see a specialist.
  • Access to our National Network.

EmblemHealth EPO Value

  • Telemedicine and acupuncture included.
  • Referrals are not required to see a specialist.
  • Members outside the tristate area have access to a national network.
  • Access to our Prime Network.

 

PPO

EPO

InBalance PPO

InBalance EPO

EPO Value

Telemedicine

Buy-up^

Buy-up^

Buy-up^

Buy-up^

Included

Dentalinfo

Buy-up^

Buy-up^

Buy-up^

Buy-up^

Buy-up^

Dental Discount

Buy-up^

Buy-up^

Buy-up^

Buy-up^

Not available

Vision

Buy-up^

Buy-up^

Buy-up^

Buy-up^

Not available

Acupuncture

Buy-up^

Buy-up^

Buy-up^

Buy-up^

Included

Pharmacy

Buy-up^

Buy-up^

Buy-up^

Buy-up^

Included

Gym

Buy-up^

Buy-up^

Buy-up^

Buy-up^

Included

 

ConsumerDirect PPO

  • High-deductible health plan with lower premiums.
  • Visit health care professionals in and out of our network.
  • Referrals are not required to see a specialist.
  • Access to our National Network.

ConsumerDirect EPO

  • High-deductible health plan with lower premiums.
  • In-network-only EPO plan.
  • Referrals are not required to see a specialist.
  • Access to our National Network.

EmblemHealth EPO Value HDHP (coming soon)

  • High-deductible health plan with lower premiums.
  • Members outside the tristate area have access to a national network.
  • Referrals are not required to see a specialist.
  • Access to our Prime Network.

 

 

ConsumerDirect PPO

 

ConsumerDirect EPO

 

EmblemHealth EPO Value HDHP

(Coming soon)

Telemedicine

Not available

Not available

Not available

Dentalinfo

Not available

Not available

Not available

Dental Discount

Not available

Not available

Not available

Vision

Not available

Not available

Not available

Acupuncture

Not available

Not available

Not available

Pharmacy

Buy-up^

Buy-up^

Included

Gym

Not available

Not available

Not available

 

A cost-effective plan with preventive and complex procedures paid in full. Find out how this unique plan gives your employees the coverage they need at a price you’ll like. And you get full access to our network of more than 8,000 dentists, plus out-of-network coverage.

EmblemHealth Preferred Dental

EmblemHealth Preferred Dental is an affordable dental plan that pays for dental services in full.

What are the main ingredients for the perfect dental plan?

  • Full dental coverage — for preventive and complex procedures — from network dentists
  • A robust network of over 8,000 dentists and specialists in New York and New Jersey
  • The freedom to choose an out-of-network dentist
  • Affordable cost sharing and premiums

How about all of the above! We’ve designed EmblemHealth Preferred Dental with all these great features to make it easy for you to get the care you need when you need it.

Your choice for your needs:

  • EmblemHealth Preferred Dental is available to groups with 101 or more employees.
  • A wide range of employee contribution levels are available, including a voluntary option where the employee pays 100%.
  • Our unique paid-in-full approach for all in-network covered services makes Preferred Dental an attractive voluntary option.
  • Administrative services only (ASO) and flexible funding arrangements are available to large groups. And you have your choice of benefit designs. (See the “What It Covers” tab.)
  • With the rollover maximum feature, you can qualify to rollover dollars for use in the following year.

EmblemHealth dental plans are underwritten by Group Health Incorporated (GHI). EmblemHealth insurance plans are underwritten by Group Health Incorporated (GHI), HIP Health Plan of New York (HIP) and HIP Insurance Company of New York. Refer to GHI policy form numbers PLD-1103-C, PLD-1104-C et al.

labor unions

Working hand-in-hand with labor

For decades, we’ve provided hardworking New Yorkers with affordable, customizable plans and programs. Today, more than ever, labor unions count on us to meet the diverse health care needs of their members.

higher education

Tailored coverage options that make the grade

We are the smarter choice for higher education faculty and staff. Our plans address tough issues like keeping retirees’ benefits up to par and coverage for adjunct faculty members.

EmblemHealth offers a full complement of funding arrangements including: Community Rating for groups with fewer than 51 eligible enrollees, Experience Rating for groups with 51 or more eligible enrollees, and Deferred Premium Arrangements for eligible groups with Retrospective Experience Rating that have more than 500 eligible enrollees.

We now offer a funding arrangement called Premium Rewards that enables groups with 100 or more employees enrolled in an EmblemHealth EPO or PPO plan to earn back a percentage of their premium dollars if their actual claim costs are lower than expected.

Administrative Services Only (ASO)

EmblemHealth offers groups of 250 or more members ASO arrangements for hospital, medical, dental and pharmacy benefits, enhancing cash flow by allowing the group to reimburse EmblemHealth solely on the basis of paid claims plus administrative fees.

Groups may choose to participate in case management services from EmblemHealth, taking advantage of our medical management and member assistance through all aspects of these types of complex cases. Groups may also supplement their benefit program with EmblemHealth's disease management programs, through which we identify claims for conditions ranging from cardiac health to diabetes to asthma, and work with members and their physicians to improve adherence to treatment plans, resulting in improved medical treatment and lower claims experience.