Find a Doctor

Find a Doctor

Sign In

Sign In

$0 Premium Essential Plan

Help Renewing Your Plan

City of New York Employees

Search

Popular Tasks

Contact us

Neighborhood Care

EmblemHealth VIP Value (HMO)

You will pay $0 each month for the plan — a “$0 premium.” With EmblemHealth VIP Value, you will pay $15 to see your primary care doctor, and $50 to see specialists. You will also get benefits Medicare does not cover, like up to $450 yearly in routine eyewear. 

This plan offers Optional Supplemental benefits, where you have the option to add SilverSneakers® fitness and/or comprehensive dental benefits at a low cost.

 

Available in the following counties: New York, Queens, Nassau, Richmond, Suffolk, Orange, Rockland, Weschester, Dutchess, Putnam, Sullivan, Ulster

 

Plan Option Premium
EmblemHealth VIP Value (HMO) $0.00
EmblemHealth VIP Value HMO with Dental $11.50
EmblemHealth VIP Value HMO with Silver Sneakers $15.00
EmblemHealth VIP Value HMO with Dental & Silver Sneakers $26.50

Quick Links

Plan Highlights

Benefit Summary

Primary care doctor visit  $15 
Specialist doctor visit  $50
Preventive care (Services that keep you healthy) $0
Urgently needed services  $65
Emergency room $90
Inpatient hospital coverage $360 per day 1-5. $0 for each additional day
Diagnostic services/labs/imaging $0 or 20% of the cost *



 

Foot care   $50
Dental services (no annual dollar limit) Comprehensive optional supplemental benefit; Preventive Covered
Hearing aid Not covered
Routine eyewear $450 allowance every year
24-Hour nurse hotline Yes

SilverSneakers®		 Optional supplemental benefit
Prescription drug Yes

**A 20% coinsurance (the percentage you pay for health services) may apply when services are provided in an Outpatient Hospital.

Medicare Pharmacy

Having the medications you need is an important part of staying healthy, which is why we take our pharmacy offerings very seriously. We strive to help you make sure you can afford the medications you take. Our formulary gives you access to thousands of them, and our pharmacy network is large enough to provide the choices you need—close to home.

THE EMBLEMHEALTH FORMULARY (LIST OF COVERED DRUGS) IS ORGANIZED INTO FIVE TIERS (LEVELS):

 

     DEDUCTIBLE (The amount you pay before your plan starts to pay) INITIAL COVERAGE $0-$3,655 COVERAGE GAP $3,655 CATASTROPHIC  Over $5,100
  You Pay You Pay You Pay You Pay
Tier 1 Preferred Generic Drugs No Deductible 
 $0 37% of the total cost The greater of 5% or $3.40
Tier 2 Generic Drugs No Deductible $18 37% of the total cost The greater of 5% or $3.40
Tier 3 Preferred Brand Drugs $250 deductible applies $45 25% of the total cost The greater of 5% or $8.50
Tier 4 Non-Preferred Drugs $250 deductible applies $95 37%/25% of the total cost

The greater of 5% or $3.40 for generic or $8.50 for brand

 
Tier 5 Specialty Drugs $250 deductible applies 28% of the total cost 37%/25% of the total cost The greater of 5% or $3.40 for generic or $8.50 for brand

You will pay the above cost-sharing when you use preferred pharmacies. You pay more when you use standard pharmacies. You may pay less if you get extra help.

Four Stages of Drug Coverage

DEDUCTIBLE

The deductible is the amount you pay before your plan starts to pay. This deductible is for retail and home delivery.

There is no deductible for Tier 1 (preferred generic) and Tier 2 (generic) drugs.

There is a $250 deductible for Tier 3 (preferred brand), Tier 4 (non-preferred drug) and Tier 5 (specialty tier) drugs.

INITIAL COVERAGE STAGE

After you’ve reached the deductible, you’ll enter the initial coverage phase.

In this phase, you and the plan share the costs of some of the covered drugs until your total drug costs, including deductible, reach $3,655. The total drug costs paid by both you and our Part D plan will help you reach the coverage gap.

COVERAGE GAP STAGE

The coverage gap (also called the “donut hole”) starts after the total yearly drug cost (along with what our plan has paid and what you have paid) reaches $3,655.

While in the coverage gap in 2019, you’ll pay 25% of the plan’s cost for brand-name drugs and 37% of the plan’s cost for generic drugs. You enter the catastrophic coverage phase once your yearly true out-of-pocket cost (Troop) reaches $5,100. The costs paid by you, and the manufacturer discount payment for brand-name drugs count toward your true out-of-pocket costs and help you get out of the coverage gap. Not everyone will reach the coverage gap.

CATASTROPHIC STAGE

After your yearly out-of-pocket drug costs reach $5,100, you pay the greater of: 5% of the cost or you pay $3.40 for generic (including brand-drugs treated as generic). You pay $8.50 for all other drugs.

What drugs are covered in this plan?

Having the medicines you need is an important part of staying healthy, which is why we take our pharmacy offerings very seriously. We strive to help you make sure you can afford the medicines you take. Our formulary gives you access to thousands of them, and our pharmacy network is large enough to provide the choices you need—close to home.

Drug Cost Calculator

Use our Cost Calculator tool to estimate your prescription drug costs. Enter the prescription drugs you take and we'll show you your monthly drug costs.

 

Medicare Provider Directories

 

Plan Documents

HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. This information is not a complete description of benefits. Call 877-344-7364/TTY: 711 for more information. 

The SilverSneakers® fitness program is provided by Tivity Health, Inc., an independent company. © 2019. All rights reserved.

Last Updated 10/1/18

Y0026_127476 Accepted 10/1/18

You will need the Adobe® Acrobat Reader software to view files in the Portable Document Format (PDF). If you don’t already have it, you can download a copy from Adobe® here.

Last Updated 09/24/19

Y0026_127476 Accepted 10/1/18

We use cookies on this website to give you the best experience and to measure website usage. By continuing to use this website, you consent to these cookies. View our Privacy Policy here.