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, Weschester, Dutchess, Putnam, Sullivan, Ulster

 

Plan Option Premium
EmblemHealth VIP Value (HMO) $0.00
EmblemHealth VIP Value HMO with Dental $11.50
EmblemHealth VIP Value HMO with Silver Sneakers $15.00
EmblemHealth VIP Value HMO with Dental & Silver Sneakers $26.50

Plan Highlights

Benefit Summary

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 $360 per day 1-5. $0 for each additional day
Diagnostic services/labs/imaging $0 or 20% of the cost *



 

Foot care   $50
Dental services (no annual dollar limit) Comprehensive optional supplemental benefit; Preventive Covered
Hearing aid Not covered
Routine eyewear $450 allowance every year
24-Hour nurse hotline Yes

SilverSneakers®
Optional supplemental benefit
Prescription drug Yes

Medicare Pharmacy

Having the medications 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 medications 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 EMBLEMHEALTH FORMULARY (LIST OF COVERED DRUGS) IS ORGANIZED INTO FIVE TIERS (LEVELS):

 

     DEDUCTIBLE (The amount you pay before your plan starts to pay) INITIAL COVERAGE $0-$3,655 COVERAGE GAP $3,655 CATASTROPHIC  Over $5,100
  You Pay You Pay You Pay You Pay
Tier 1 Preferred Generic Drugs No Deductible 
$0 37% of the total cost The greater of 5% or $3.40
Tier 2 Generic Drugs No Deductible $18 37% of the total cost The greater of 5% or $3.40
Tier 3 Preferred Brand Drugs $250 deductible applies $45 25% of the total cost The greater of 5% or $8.50
Tier 4 Non-Preferred Drugs $250 deductible applies $95 37%/25% of the total cost

The greater of 5% or $3.40 for generic or $8.50 for brand

 

Tier 5 Specialty Drugs $250 deductible applies 28% of the total cost 37%/25% of the total cost The greater of 5% or $3.40 for generic or $8.50 for brand

What drugs are covered in this plan?

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.

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.



HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract. 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 10/1/18

Y0026_127476 Accepted 10/1/18

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Last Updated 09/24/19

Y0026_127476 Accepted 10/1/18