EmblemHealth Silver Value

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
  • acupuncture
  • telemedicine

Benefits Summary

Referralsnfo Required for specialist visits
Deductible info $5,900 individual/$11,800 family
Out-of-pocket maximuminfo $5,900 individual/$11,800 family
Out-of-networkinfocoverage No coverage for non-emergency services
Primary care physicianinfo 3 free sick visits then $35 before deductible 
Preventive care info Fully covered
Specialist $75 before deductible
Urgent care $75 before deductible
Pharmacy $10 generic drugsinfo before deductible
Telemedicineo Fully covered
Acupuncture Fully covered for up to 12 visits/calendar year
Gym Reimbursement up to $400 per calendar year if qualified
Dental Adult and pediatric dental care before deductible
Vision Free vision exams; eyewear covered before deductible

Provider Network

The Silver Value 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 Marketplace

  • 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 Summaries - 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 Silver Value 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 Silver Value 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.