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$0 Premium Essential Plan

Help Renewing Your Plan

HIP HMO Preferred Gold Plan

Individual and Family Plans
Serviced by the Millennium Network

Plan Benefits

Our qualified health plans offer a range of benefits to help you stay healthy with access to top doctors in our Millennium Network. You must stay in-network to receive coverage.

  • Preventive Care

    No-cost annual checkups, routine screenings, immunizations, and more.

  • Prescription Drugs

    Coverage for the medicines your doctor prescribes.

  • Dental

    Pediatric dental coverage through DentaQuest for children up to age 19.

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.
$5,025 individual/$10,050 family $3,750 individual/$7,500 family $1,200 individual/$2,400 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.
$12,000 individual/$24,000 family $9,600 individual/$19,200 family $12,000 individual/$24,000 family $4,000 individual/$8,000 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 Network: Health care professionals and facilities (doctors, hospitals, labs, etc.) that contract with EmblemHealth. They provide covered products and services to members. 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 Preventive care 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
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.

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 Network: Health care professionals and facilities (doctors, hospitals, labs, etc.) that contract with EmblemHealth. They provide covered products and services to members. 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 Preventive care 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®.
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.

Convenient Care Where You Live and Work

To enroll in an EmblemHealth individual and family plan serviced by the Millennium Network, you must live in the eligible service area:

The five boroughs of New York City, Long Island, and Westchester and Rockland counties. Depending on income and other factors, you may also be eligible for a $0 premium Essential Plan or Medicaid coverage options.

We offer individual and family plans serviced by the Select Care Network if you live in the service area indicated on the map.

Helpful Resources

Our plans offer access to top healthcare professionals and conveniently located pharmacies.

The EmblemHealth Difference

Your health and well-being depends on more than just going to the doctor. That’s why we offer you additional wellness benefits to help keep you feeling your best.

Neighborhood Care

Visit us for help with your plan or take a free† wellness class.

Vitality WellSpark

Join group health coaching, watch helpful videos, and more.

Gym Reimbursement

Get $200 every six months, up to $400 per year.

Vision Discounts

Save on glasses, contact lenses, eye exams, and more.

†Free, with no obligation to enroll.

Frequently Asked Questions

Get the answers you need to make the most of your plan.

You can enroll in an EmblemHealth individual and family plan during open enrollment. This yearly period begins in November for coverage starting Jan. 1 of the next calendar year. NY State of Health (NYSOH) determines when the open enrollment period starts and ends in New York state.

Outside of open enrollment, you may still be able to enroll in coverage if you have certain qualifying life events, like getting married, having a baby, losing other health coverage, or experiencing a change in your household income.

In advance of open enrollment each year, EmblemHealth and NYSOH will mail renewal notices to plan members with information on when to renew and what documentation needs to be provided (for example, pay stubs, tax returns, or other proof of income). Information about financial help and monthly premiums will also be included.

There is help available to pay for coverage through NYSOH. Once you submit your application for coverage, NYSOH will determine what assistance you may be eligible for based on the information you’ve provided. Financial help is available in two ways: advance premium tax credits (APTC) and cost-sharing reductions (CSR).

If you qualify for an APTC, your monthly premium will be lower. If you qualify for a CSR, your premium and cost-sharing for care will be reduced. To qualify for either form of assistance, you must apply for and enroll in coverage through NYSOH.

Additional Enrollment Resources

WE’RE HERE FOR YOU

Need help finding the right plan?

Call us at 866-230-1071 (TTY: 711), 8 a.m. to 8 p.m., seven days a week.

Or request a call.

Ready to enroll?