2020 EmblemHealth VIP Dual (HMO SNP)

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2020 EmblemHealth VIP Dual (HMO SNP) | EmblemHealth

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EmblemHealth VIP Dual (HMO D-SNP)

This is a special needs plan (D-SNP) for people enrolled in both Medicare and New York State Medicaid. You may pay as little as $0 each month for this plan based on your Low-Income Subsidy (LIS) level. You pay $0 for covered services in this plan.

You will also get benefits Medicare does not cover, like comprehensive dental, hearing aids, vision, 48 acupuncture visits, a SilverSneakers® membership, and a Medicare card for up to $1,500 in over-the-counter items, depending on where you live.

Available in the following counties: Richmond, Nassau, Orange, Rockland, Westchester, Dutchess, Putnam, Sullivan, Ulster

Your level of extra help	Premium
0%	$36.60
25%	$27.50
50%	$18.30
75%	$9.20
100%	$0.00

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Plan Highlights

$0 monthly premium plan (based on Low Income Subsidy Level)
$100 monthly over-the-counter (OTC) Medicare card
SilverSneakers® fitness program
48 Acupuncture visits yearly
$0 copays for covered services
Comprehensive and preventive dental services
Healthy Living PATH Program 24 Hour Health Information Line

If you have questions, please call: 800-447-9169 daily from 8am to 8pm

Benefit Summary

Type of Care	Copay
Primary care doctor visit:	$0
Specialist doctor visit:	$0
Preventive care (Services that keep you healthy):	$0
Urgently needed services:	$0
Emergency room:	$0
Inpatient hospital coverage:	$0
Lab Services:	$0
X-Rays:	$0

Type of Care	Copay
Foot care:	$0
Dental services (no annual dollar limit):	Comprehensive and preventive
Hearing aid:	$1,500 every 3 years
Routine eyewear:	$300 every two years
24-Hour nurse hotline:	Yes
SilverSneakers^®:	Yes
Prescription drugs:	Yes

Drug Coverage

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.

DEDUCTIBLE (The amount you pay before your plan starts to pay) You Pay	INITIAL COVERAGE $0-$4,020 You Pay	COVERAGE GAP Over $4,020 You Pay	CATASTROPHIC Over $6,350 You Pay
$0	Generics: $0/$1.30/$3.60 Brands: $0/$3.90/$8.95 Depending on your level of Extra Help	Generics: $0/$1.30/$3.60 Brands: $0/$3.90/$8.95 Depending on your level of Extra Help	$0

DEDUCTIBLE

(The amount you pay before your plan starts to pay)

You Pay

INITIAL COVERAGE

$0-$4,020

You Pay

COVERAGE GAP

Over $4,020

You Pay

CATASTROPHIC

Over $6,350

You Pay

Generics: $0/$1.30/$3.60

Brands: $0/$3.90/$8.95

Depending on your level of Extra Help

Generics: $0/$1.30/$3.60

Brands: $0/$3.90/$8.95

Depending on your level of Extra Help

Set up Home Delivery and Refills for Prescription Drugs

Have your prescriptions and refills delivered directly to your home through Express Scripts, Inc. (ESI), our home-delivery pharmacy.

Additional Pharmacy Information

Learn more about how to get money back for a drug, our Medication Management Therapy program, how to get help paying for Part D drugs through the Extra Help program (as known as Low Income Subsidy) and much more.

View Medicare Formularies

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.

Calculate Drug Costs

Summary of Plan Benefits
Evidence of Coverage
LIS Plan Summary
EmblemHealth Medicare Star Ratings
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Comprehensive and Preventive Dental Benefits
Pharmacy Directory
2020 Annual Notice of Changes (Dutchess, Nassau, Orange, Putnam, Richmond, Rockland, Sullivan, Ulster and Westchester)

Medicare HMO and HMO-POS Provider Directories

View Provider Directories

Health Insurance Plan of Greater New York (HIP) is an HMO/HMO-POS/HMO D-SNP plan with a Medicare contract. HIP has a contract with the New York Medicaid Program for HMO D-SNP. 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.

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Last Updated 10/1/19

Y0026_ 127364 Accepted 10/1/19

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.