EmblemHealth VIP Essential (HMO)

Depending on where you live, you will pay either $0 each month or a low set amount each month (a premium). You will pay $0 to see your primary care doctor and $45 to see specialists.

This plan provides benefits Original Medicare does not cover, like comprehensive dental, hearing aids, vision and a SilverSneakers® membership.


Available in the following counties: Bronx, Kings, New York, Queens


Your level of extra help
All levels $0.00

Plan Highlights

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  $45
Preventive care (Services that keep you healthy) $0
Urgently needed services  $50
Emergency room $90
Inpatient hospital coverage $492 per day 1-4, $0 each additional day
Lab Services $0 or $15


Type of Care Copay
X-Rays $40
Foot care   $40
Dental services (no annual dollar limit) Comprehensive and preventive.
Hearing aid $1800 every 3 years
Routine eyewear $240 every year
24-Hour nurse hotline Yes
Teladoc $45

Prescription drug 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 s 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 amount you pay before your plan starts to pay)

You Pay



You Pay


Over $3,880

You Pay


Over $6,350

You Pay

Tier 1 Preferred Generic Drugs No Deductible $0 25% of the cost $3.60 or 5% of the cost
Tier 2 Generic Drugs No Deductible $18 25% of the cost $3.60 or 5% of the cost
Tier 3 Preferred Brand Drugs $295 $45 25% of the cost $8.95 or 5% of the cost 
Tier 4 Non-Preferred Drugs $295 $95 25% of the cost $3.60, $8.95 or 5% of the cost 
Tier 5 Specialty Drugs $295 27% of the cost 25% of the cost The greater of 5% or $3.40 for generic or $8.50 for brand 

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 HMO and HMO-POS Provider & Pharmacy 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.

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

Last Updated 10/1/19

Y0026_ 127364

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 12/31/2019

Y0026_ 127364 Accepted 10/1/19