2024 Bronze Premier | EmblemHealth

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EmblemHealth Bronze Premier

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

Which employees are eligible: Qualifying individuals and families living in one of the 28 New York counties, including the five NYC boroughs, Westchester, Long Island, and regions stretching north of Albany. Children and young adults can stay on a parent’s plan until age 26, or through age 29 for an added cost.

  • DENTAL
  • VISION
  • TELEMEDICINE
  • Generic Drugs

Benefits Summary

Referralsinfo Not required for specialist visits
Deductibleinfo $7,100 individual/$14,200 family
Out-of-pocket maximuminfo $9,450 individual/$18,900 family
Out-of-networkinfo coverage No coverage for non-emergency services
Primary care physicianinfo 1 free visit then 50% after deductible  
Preventive careinfo Fully covered
Specialist 50% after deductible
Urgent care 50% after deductible
Pharmacy $50 generic drugs
Telemedicineinfo Fully covered
Gym  Reimbursement up to $400 per plan year if qualified
Dental Pediatric dental care
Vision Pediatric vision benefits

 

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.

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.