2022 Gold PPO-N | EmblemHealth

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Gold PPO-N

Which groups are eligible: Small businesses with 1 to 100 full-time equivalent (FTE) employees and a primary business address in New York State. Minimum participation rules apply.

Which employees are eligible: Qualifying individuals and families living within the United States have access to in-network and out-of-network coverage across the country. Children and young adults can stay on a parent’s plan until age 26, or through age 29 for an added cost.

  • Generic Drugs

Benefits Summary

Referralsinfo Not Required
Deductibleinfo $1,300 individual/$2,600 family
Prescription drug deductible $0 individual/$0 family
Out-of-pocket maximuminfo $5,500 individual/$11,000 family
Out-of-networkinfo coverage Yes
Primary care physicianinfo 3 free visits, then $25 before deductible
Preventive careinfo Fully covered
Specialist $40 before deductible
Urgent care $75 before deductible
Pharmacy $0 generic drugs
Telemedicineinfo Fully covered
Acupuncture Fully covered
Gym  Reimbursement up to $400 per plan year if qualified
Dental Pediatric dental care
Vision Pediatric vision benefits

Provider Network

With our robust network of quality doctors, you can get care from many of the region’s leading doctors, clinicians and facilities, including hospitals and urgent care centers.


Plan Documents

Cost Calculator

Use the FAIR Health Calculator* to estimate the cost of non-emergency medical services and procedures by zip code.


*FAIR Health, Inc. is an independent nonprofit organization that uses actual provider charges when calculating fees. FAIR Health ensures that its fee information is accurate and complete. Please review the privacy policy and terms and conditions posted on the FAIR Health website.