EmblemHealth VIP Gold (HMO)

You will pay $0 to see your primary care doctor and $25 to see specialists. You will also get benefits Medicare does not cover, like comprehensive dental, hearing aids, vision, and a SilverSneakers® membership.

 

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

 

Your level of extra help Premium
0% $242.00
25% $232.90
50% $223.70
75% $214.60
100% $205.40

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: $25
Preventive care (Services that keep you healthy): $0
Urgently needed services: $35
Emergency room: $90
Inpatient hospital coverage: $290 per day 1-7, $0 each additional day
Lab Services $0 or $15
X-Rays: $25 or 20% of the cost
Type of Care Copay
Foot care: $25
Dental services (no annual dollar limit): Comprehensive and preventive
Hearing aid: $2,400 every 3 years
Routine eyewear: $300 every year
24-Hour nurse hotline: Yes
Teladoc: $45
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-$3,785

You Pay
COVERAGE GAP
Over $3,785

You Pay
CATASTROPHIC
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 $10 25% of the cost $3.60 or 5% of the cost
Tier 3 Preferred Brand Drugs $200 $40 25% of the cost $8.95 or 5% of the cost 
Tier 4 Non-Preferred Drugs $200 $95 25% of the cost $3.60, $8.95 or 5% of the cost 
Tier 5 Specialty Drugs $200 29% of the cost 25% of the cost $3.60, $8.95 or 5% of the cost 

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 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

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Last Updated: 10/1/19

Y0026_ 127364 Accepted 10/1/19