2024 Silver Premier | EmblemHealth

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EmblemHealth Silver Premier

Which groups are eligible: Small businesses with one to 100 full-time equivalent 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.

  • Generic Drugs

Benefits Summary

Referralsinfo Not required for specialist visits
Deductibleinfo $5,600 individual/$11,200 family
Prescription drug deductible $250 individual/$500 family
Out-of-pocket maximuminfo $9,400 individual/$18,800 family
Out-of-networkinfo coverage Yes
Primary care physicianinfo 1 free visit then $35 before deductible
Preventive careinfo Fully covered
Specialist $75 before deductible
Urgent care $100 after deductible
Pharmacy $20 generic drugs
Telemedicineinfo Fully covered
Gym  Reimbursement up to $400 per plan year if qualified
Dental Pediatric dental care
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.