Who's eligible: Individuals and families living within Albany, Broome, Columbia, Delaware, Dutchess, Fulton, Greene, Montgomery, Orange, Otsego, Putnam, Rensselaer, Rockland, Saratoga, Schenectady, Schoharie, Sullivan, Ulster, Warren, and Washington 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.
Contact Sales
866-230-1071
| Referralsinfo | Required for specialist visits |
| Deductibleinfo | $9,450 individual/$18,900 family |
| Out-of-pocket maximuminfo | $9,450 individual/$18,900 family |
| Out-of-networkinfo coverage | No coverage for non-emergency services |
| Primary care physicianinfo | 3 free visits then 0% coinsurance after deductible |
| Preventive carenfo | Fully covered |
| Specialist | 0% coinsurance after deductible |
| Urgent care | 0% coinsurance after deductible |
| Pharmacy | 0% coinsurance after deductible |
| Telemedicineinfo | $0 copay after deductible |
| Gym | Reimbursement up to $400 per calendar year if qualified |
| Dental | Pediatric dental care |
| Vision | Pediatric vision benefits |
The Catastrophic plan is on EmblemHealth’s Select Network. Members are responsible for the total cost of non-emergency care they receive outside their plan’s provider network.
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.
*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.
