Silver Plus HSA

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, all counties in New Jersey, and all counties in Connecticut. 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
  • acupuncture

Benefits Summary

Referralsinfo Not required for specialist visits
Deductibleinfo $2,600 individual/$5,200 family
Out-of-pocket maximuminfo $5,800 individual/$11,600 family
Out-of-networkinfo coverage No coverage for non-emergency services
Primary care physicianinfo $30 after deductible
Preventive careinfo Fully covered
Specialist $50 after deductible  
Urgent care $75 before deductible
Pharmacy $15 generic drugsinfo before deductible
Telemedicineinfo Fully covered
Acupuncture Fully covered for up to 12 visits per plan year
Gym  Reimbursement up to $400 per plan year if qualified
Dental  Adult and pediatric dental care before deductible
Vision Free vision exams; eyewear covered before deductible

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 Silver 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).