EmblemHealth VIP Part B Saver (HMO)

You will pay $0 each month for the plan — a “$0 premium.” With EmblemHealth VIP Part B Saver, you will pay $25 to see your primary care doctor and $50 to see specialists. You can also get up to $500 in annual savings toward your Part B premium. 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: Albany, Bronx, Broome, Columbia, Delaware, Dutchess, Greene, Kings, Nassau, New York, Orange, Putnam, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Suffolk, Sullivan, Ulster, Warren, Washington, Westchester

 

Plan Options Premium
EmblemHealth Part B Saver (HMO) $0.00
EmblemHealth Part B Saver with Dental (HMO) $12.50
EmblemHealth Part B Saver with SilverSneakers (HMO) $15.00
EmblemHealth Part B Saver with Dental and SilverSneakers (HMO) $27.50

Plan Highlights

Healthy Living PATH Program 24 Hour Health Information Line

If you have any questions, please call 800-447-9169 daily from 8a.m. to 8p.m.

Benefit Summary

Type of Care Copay
Primary care doctor visit  $25
Specialist doctor visit  $50
Preventive care (Services that keep you healthy) $0
Urgently needed services  $50
Emergency room $90
Inpatient hospital coverage $495 per day 1-3, $0 each additional day
Lab Services $0 or $20
X-Rays $40



 

Type of Care Copay
Foot care   $40
Dental services (no annual dollar limit) Preventive Covered Comprehensive optional supplemental benefit
Hearing aid $630 every 3 years
Routine eyewear $240 every year
24-Hour nurse hotline Yes

Teladoc™
$45

SilverSneakers®
Optional supplemental benefit available
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 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

Tier 1 Preferred Generic Drugs No Deductible $0 25% of the cost $3.60 or 5% of the cost
Tier 2 Generic Drugs $435
$18 25% of the cost $3.60 or 5% of the cost
Tier 3 Preferred Brand Drugs $435 $45 25% of the cost $8.95 or 5% of the cost
Tier 4 Non-Preferred Drugs $435 $95 25% of the cost

 

$3.60, $8.95 or 5% of the cost

 

Tier 5 Specialty Drugs $435 25% 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.

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Last Updated 10/1/19

Y0026_ 127364 Accepted 10/1/19