EmblemHealth Bronze Plus H.S.A

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 28 New York counties, including the five New York City 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
  • Generic Drugs
  • telemedicine

Benefit Summary

Referrals info Not required for specialist visits
Deductible info $5,500 individual/$11,000 family
Out-of-pocket maximuminfo $6,550 individual/$13,100 family
Out-of-networkinfo coverage  No coverage for non-emergency services
Primary care doctorinfo 50% after deductible
Preventive careinfo    Fully covered
Specialist info 50% after deductible
Urgent care 50% after deductible
Pharmacy  50% after deductible
Telemedicine info Fully covered
Gym  Reimbursement up to $400 per plan year if qualified 
Dental Pediatric dental care
Vision Pediatric vision benefits

Cost Calculator

Since our Small Group Plans offer network-only coverage, members are responsible for the total cost of non-emergency care they receive outside their plan’s provider network.

 

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.


EmblemHealth Bronze Plus HSA is underwritten by HIP Health Plan of New York. Coverage is subject to all terms, conditions, limitations and exclusions set forth in the contract. Refer to HIP policy form number 155-23-SGOFFHIXCONTRACT (04/17).

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