Compare Plans

We offer a range of plans through New York’s health insurance marketplace as well as other coverage options for individuals and families.

Financial assistance: You may be eligible for tax credits to help with premiums and out-of-pocket costs when enrolling through NY State of Health (NYSOH).

Bronze

Silver

Gold

Platinum

A smart choice if you want to pay less for premiums and don’t seek frequent medical care.

Monthly Premium:

In-Network Deductible:
High

A good balance if you go to the doctor regularly but want a low premium.

Monthly Premium:

In-Network Deductible:
Moderate

Consider this if you go to the doctor often and want a low deductible.

Monthly Premium:

In-Network Deductible:
Low

An option if you receive frequent care and don’t want a deductible.

Monthly Premium:

In-Network Deductible:
Lowest
Monthly Premium The amount you have to pay each month for your plan.
Lowest Low Moderate High
Deductible The amount you pay before your plan starts to pay.
$4,125 individual/$8,250 family $2,450 individual/$4,900 family $775 individual/$1,550 family $0 individual/$0 family
Maximum Out-of-Pocket The most you will pay for covered health care services from in-network providers in any year.
$10,150 individual/$20,300 family $10,150 individual/$20,300 family $10,150 individual/$20,300 family $2,000 individual/$4,000 family
Summary of Benefits and Coverage The Summary of Benefits and Coverage (SBC) document shows you what your cost-sharing will be, if any, for the listed covered health care services.
Marketplace Plans*
Off-Exchange Plans 		Marketplace Plans*
Off-Exchange Plans 		Marketplace Plans*
Off-Exchange Plans 		Marketplace Plans*
Off-Exchange Plans
Network <b>Network:</b> Health care professionals and facilities (doctors, hospitals, labs, etc.) that contract with EmblemHealth. They provide covered products and services to members.<br><br> To enroll in plans serviced by the Millennium Network, you must live in one of the five boroughs of New York City, Long Island, or Westchester and Rockland counties.
9 counties 9 counties 9 counties 9 counties
Referrals A recommendation by a physician that an enrollee receive care from a specialty physician or facility.
Required for specialist visits Required for specialist visits Required for specialist visits Required for specialist visits
Out-of-Network Coverage Our individual and family plans are HMO plans that provide access to doctors and other health care professionals who participate in the network. Members are responsible for the total cost of nonemergency care they receive outside their plan’s network. Please refer to your contract for specific benefit coverage.
No coverage for nonemergency services No coverage for nonemergency services No coverage for nonemergency services No coverage for nonemergency services
Preventive Care <a href="/content/emblemhealth/en_us/home/live-well/prevention.html">Preventive care</a> is routine care to keep you well. This includes an annual physical, hearing exams, Pap smears, mammograms, immunizations, etc.
Covered in full** Covered in full** Covered in full** Covered in full**
Primary Care Provider (PCP) Visits A primary care provider (PCP) knows your health history and recommends preventive care to keep you well.
$50 copay after deductible with up to three copay visits*** before deductible $30 copay after deductible with one copay visit*** before deductible $25 copay after deductible $15 copay
Specialist Visits This is a visit to a doctor who treats a specific concern or condition. A referral is needed from your regular doctor to see a specialist.
$75 copay after deductible with up to three copay visits*** before deductible $65 copay after deductible with one copay visit*** before deductible $40 copay after deductible $35 copay
Telemedicine Virtual, nonemergency care available 24/7 through Teladoc<sup>®</sup>.
Covered in full Covered in full Covered in full Covered in full
Urgent Care Care at a facility that handles nonemergency medical issues like minor cuts or strains, colds, or flu after your primary care provider’s normal business hours.
$75 copay after deductible $70 copay after deductible $60 copay after deductible $55 copay
Emergency Room Care you get in an emergency room. Your ER cost-sharing will be waived if admitted to the hospital, but inpatient cost-sharing may still apply.
$500 copay after deductible $500 copay after deductible $150 copay after deductible $100 copay
Pharmacy In-network pharmacy coverage to buy prescription drugs at retail locations like CVS, Walgreens, and Duane Reade, or by mail order.
$10 copay for generic drugs after deductible $15 copay for generic drugs before deductible $10 copay for generic drugs before deductible $10 copay for generic drugs
Gym Reimbursement $200 every six months, up to $400 per year. To qualify, you must complete 50 workouts within a six-month period at fitness centers of your choice.
Reimbursement up to $400 per calendar year if qualified Reimbursement up to $400 per calendar year if qualified Reimbursement up to $400 per calendar year if qualified Reimbursement up to $400 per calendar year if qualified
Pediatric Dental and Vision Pediatric dental care and pediatric vision benefits covered for children up to age 19.
Coverage up to age 19 Coverage up to age 19 Coverage up to age 19 Coverage up to age 19
Health Savings Account (H.S.A) Compatible A pre-tax savings account that can be used to pay for qualified medical expenses.
Yes No No No

*Plans through NY State of Health (NYSOH).

**Preventive services are not subject to cost-sharing (copayments, deductibles, or coinsurance) when performed by a network provider and provided in accordance with the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA), or if the items or services have an “A” or “B” rating from the U.S. Preventive Services Task Force (USPSTF), or if the immunizations are recommended by the Advisory Committee on Immunization Practices (ACIP), or when required by state law.

***Predeductible visit(s) apply to any combination of PCP, specialist, allergy testing and treatment, chiropractic services, second opinions, applied behavioral analysis (ABA) treatment, or outpatient mental health/substance use disorder.