EmblemHealth Basic (Catastrophic)

Who's eligible: Individuals and families living within the 28 New York counties. Children and young adults can stay on a parent’s plan until age 26. 

 

Financial assistance: Tax credits available for qualified individuals to help with premiums and out-of-pocket costs when enrolling on the NY State of Health Marketplace.

  • dental
  • vision
  • telemedicine

Benefits Summary

Referralsinfo Required for specialist visits
Deductibleinfo $8,150 individual/$16,300 family
Out-of-pocket maximuminfo $8,150 individual/$16,300 family
Out-of-networkinfo coverage  No coverage for non-emergency services
Primary care physicianinfo 3 free sick visits then 0% after deductible
Preventive carenfo Fully covered
Specialist 0% after deductible
Urgent care 0% after deductible
Pharmacy 0% after deductible
Telemedicineinfo 0% after deductible
Gym  Reimbursement up to $400 per calendar year if qualified
Dental Pediatric dental care
Vision Pediatric vision benefits

Find a Provider

The Basic (Catastrophic) plan is on EmblemHealth’s Select Care Network. Members are responsible for the total cost of non-emergency care they receive outside their plan’s provider network.


  • Benefit Summary - On Exchange

  • Benefit Summary - Off Marketplace

  • Summary of Benefits and Coverage - On Marketplace

  • Summary of Benefits and Coverage - Off Marketplace

  • Subscriber Contract - On Marketplace

  • Subscriber Contract - Off Marketplace

  • Dental Benefits Summary - Off Marketplace

Cost Calculator

Since our Individual/Family and Essential 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 Basic 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-IONHIXHMO (04/17). For the child-only plan, refer to HIP policy form number 155-23-ICOHIXHMO (04/17).

EmblemHealth Basic D* 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-IONHIXHMOCAT (04/17). For the child-only plan, refer to HIP policy form number 155-23-IOFFHIXCHILDCONT (04/17).
 

*The letter "D" after a plan name indicates that the plan is available directly from EmblemHealth, rather than through the NY State of Health Marketplace.