EmblemHealth VIP Rx Saver (HMO)

You will pay $5 to see your primary care doctor and $35 to see specialists. This plan does not have an annual deductible on Tier 1, Tier 2, and Tier 3 drug. In addition, you will get benefits Medicare does not cover, like comprehensive dental, hearing aids, vision, and a SilverSneakers® membership.

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

 

Your level of extra help Premium
0% $49.00
25% $39.90
50% $30.70
75% $21.60
100% $12.40

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 (Services that keep you healthy) $5
Specialist doctor visit $35
Preventive care $0
Urgently needed services $50
Emergency room $90
Inpatient hospital coverage $350 per day 1-5,$0 each additional day
Lab Services $0 or $15
X-Rays $40
Type of Care Copay
Foot care $40
Dental services (no annual dollar limit) Comprehensive and preventive.
Hearing aid $1,800 every 3 years
Routine eyewear $240 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-$3,980

You Pay

COVERAGE GAP 

Over $3,980

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 $18 25% of the cost $3.60 or 5% of the cost
Tier 3 Preferred Brand Drugs No Deductible $45 25% of the cost $8.95 or 5% of the cost 
Tier 4 Non-Preferred Drugs $395 $95 25% of the cost $3.60, $8.95 or 5% of the cost 
Tier 5 Specialty  Drugs $395 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.

 

 


Last Updated 10/1/19

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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Y0026_ 127364 Accepted 10/1/19