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RxDC Plan Sponsor Data Collection Form

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Prescription Drug Data Collection (RxDC) Form

EmblemHealth Prescription Drug Data Collection (RxDC) Plan Sponsor Data Collection Report Coverage Year 2023

Please complete and submit this form by May 3, 2024 for any EmblemHealth medical plan purchased for Coverage Year 2023 (full year or any portion of the year). Please reach out to your Senior Account Executive with any questions about completing this form.

*Seven-digit group number (e.g. 11XXXXX)

The two percentages of medical premium paid by employer and medical premium paid by employee must equal 100%.

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.