Gold Premier M

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 5 NYC boroughs, Long Island, or Westchester county. 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

Benefits Summary

Referralsinfo Required for specialist visits
Deductibleinfo $350 individual/$700 family
Prescription drug deductible $0 individual/$0 family
Out-of-pocket maximuminfo $5,300 individual/$10,600 family
Out-of-networkinfo coverage  No coverage for non-emergency services
Primary care physicianinfo 3 free sick visits then $40 before deductible
Preventive careinfo Fully covered
Specialist $60 before deductible
Urgent care $75 before deductible
Pharmacy $0 generic drugsinfo
Telemedicineinfo 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.


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.

EmblemHealth Gold Premier M 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).