2022 EmblemHealth VIP Value (HMO) | EmblemHealth

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EmblemHealth VIP Value (HMO)

You will pay $0 each month for the plan — a $0 premium. With EmblemHealth VIP Value, you will pay $15 to see your primary care doctor, and $50 to see specialists. You will also get benefits Medicare does not cover, like up to $450 yearly in routine eyewear. 

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 the following counties: New York, Queens, Nassau, Richmond, Suffolk, Orange, Rockland, Westchester, Dutchess, and Ulster


Provider Network: VIP Bold


Plan Option Premium
EmblemHealth VIP Value (HMO) $0.00
EmblemHealth VIP Value with Dental (HMO) $12.50
EmblemHealth VIP Value with SilverSneakers (HMO) $15.00
EmblemHealth VIP Value with Dental & SilverSneakers (HMO) $27.50


Plan Highlights


If you have questions, please call 800-859-4880 (TTY: 711) daily from 8 am to 8 pm.

Benefit Summary

Type of Care Copay
Primary care doctor visit:  $15 
Specialist doctor visit: $50
Preventive care (services that keep you healthy): $0
Urgently needed services: $65
Emergency room: $90
Inpatient hospital coverage: $393 per day 1-5; $0 each additional day
Lab services: $0 or $15
X-rays: $35


Type of Care Copay
Foot care:  $50
Dental services (no annual dollar limit): Preventive covered; Comprehensive optional supplemental benefit available
Hearing aids: Not covered
Routine eyewear: $450 every year
Teladoc®: $45
24-Hour Nurse Line: Yes

Optional supplemental benefit available
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.

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

You Pay


You Pay

Over $4,275  

You Pay

Over $7,050

You Pay 

Tier 1 Preferred Generic Drugs No Deductible $2 25% of the cost $3.95 or 5% of the cost
Tier 2 Generic Drugs No Deductible $15 25% of the cost $3.95 or 5% of the cost
Tier 3 Preferred Brand Drugs $325 $42 25% of the cost $9.85 or 5% of the cost
Tier 4 Non-Preferred Drugs $325 $95 25% of the cost


$3.95, $9.85 or 5% of the cost


Tier 5 Specialty Drugs $325 27% of the cost 25% of the cost


$3.95, $9.85 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.


Plan Documents

Medicare HMO Provider & Pharmacy Directories

Health Insurance Plan of Greater New York (HIP) is an HMO/HMO D-SNP plan with a Medicare contract and a contract with the New York State Department of Health. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company.

SilverSneakers and the SilverSneakers shoe logotype are registered trademarks of Tivity Health, Inc. © 2021 Tivity Health, Inc. All rights reserved. All rights reserved. Teladoc and related marks are trademarks of Teladoc Health, Inc. and are used by EmblemHealth with permission.

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 Update 10/01/2021

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