The table below summarizes our Medicare HMO/POS suite of products. Special Needs plans are located within the Medicare Special Needs Plans section of this chapter.
HIP Medicare HMO/POS Network and Plan Summary for 2019 |
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| Network | Plan Name | Plan Type | PCP Req'd | Referral Req'd | OON Coverage | In-Network Cost-Sharing | Service Area | Comments |
| VIP Prime Network | EmblemHealth VIP Value | EmblemHealth Medicare HMO | Yes | Yes | No | Copays/ coinsurance |
12 counties | $15 PCP copays Provider should confirm participation as PCP prior to accepting new patients. |
| VIP Prime Network | EmblemHealth VIP Essential | EmblemHealth Medicare HMO | Yes/ | Yes | No | Copays/ coinsurance |
14 counties | $0 PCP copays Provider should confirm participation as PCP prior to accepting new patients. |
| VIP Prime Network | EmblemHealth VIP Gold | EmblemHealth Medicare HMO | Yes | Yes | No | Copays/ coinsurance |
14 counties | $10 Chiropractic copays |
| VIP Prime Network | EmblemHealth VIP Gold Plus | EmblemHealth Medicare HMO | Yes | Yes | No | Copays/ coinsurance |
14 counties | $0 PCP copays $0 Specialist copays |
| VIP Prime Network | EmblemHealth VIP Premier | EmblemHealth Medicare HMO | Yes | Yes | No | Copays/ coinsurance |
14 counties | Employer Group plan. |
| VIP Prime Network | EmblemHealth VIP Rx Carve-out | EmblemHealth Medicare HMO | Yes | Yes | No | Copays/ coinsurance |
14 counties | Employer Group plan. |
| VIP Prime Network | EmblemHealth VIP Rx Saver | EmblemHealth Medicare HMO | Yes | Yes | No | Copays/ coinsurance |
2 counties | $5 PCP copays and Comprehensive dental and fitness benefits with no maximums |
| VIP Prime Network | EmblemHealth VIP Part B Saver | EmblemHealth Medicare HMO | Yes | Yes | No | Copays/ coinsurance/ deductible applies to some services |
14 counties | Optional dental and fitness benefit riders are available at a low cost |
| VIP Prime Network | EmblemHealth VIP Go | EmblemHealth Medicare HMO-POS | No | No | Yes | Copays/ coinsurance/ deductible applies to some services |
14 counties | Out-of-network coverage allowed on many benefits |
| VIP Prime Network | EmblemHealth Affinity Passport Medicare Essentials | Affinity Medicare HMO | Yes | Yes | No | Copays/ coinsurance |
4 counties | $5 PCP copays Dental, Vision and Hearing Coverage Acupuncture Fitness Program (Silver Sneakers) |
| VIP Prime Network | EmblemHealth Affinity Medicare Passport Essentials NYC | Affinity Medicare HMO | Yes | Yes | No | Copays/ coinsurance |
5 counties | $10 PCP copays Dental, Vision and Hearing Coverage Acupuncture Fitness Program (Silver Sneakers) |
OON = out-of-network; PCP = primary care provider.; Req'd = Required
14 county1 = New York City (Bronx, Kings, New York, Queens, Richmond), Nassau, Suffolk, Orange, Rockland, Westchester , Dutchess, Sullivan, Ulster, and Putnam
12 county2 = New York, Queens, Richmond, Nassau, Suffolk, Orange, Rockland, Westchester, Dutchess, Sullivan, Ulster, and Putnam
2 county3=Bronx, Westchester
4 county4= Orange, Rockland, Westchester and Nassau
5county5= New York, Bronx, Kings, Queens and Richmond
Members are covered for urgent and emergency care. HIP covers members in all 50 United States, Canada, Mexico, Puerto Rico, the U.S. Virgin Islands, Guam, and the Northern Mariana Islands. Medicare members have worldwide urgent and emergency coverage.
EmblemHealth Affinity Passport Medicare Essentials (HMO), EmblemHealth Affinity Medicare Passport Essentials NYC (HMO), EmblemHealth VIP Essential (HMO), EmblemHealth VIP Gold (HMO), and EmblemHealth VIP Gold Plus (HMO) members have access to SilverSneakers® membership, an exercise program designed for older adults.
GHI Medicare Network and Plan Summary for 2019 |
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| Network | Plan Name | Plan Type | PCP Req'd | Referral Req'd | OON Coverage | In-Network Cost-Sharing | Service Area | Comments |
| Medicare Choice PPO Network | EmblemHealth Group Access PPO | EmblemHealth Medicare PPO | No | No | Yes | Copays/ coinsurance |
National | Employer Group MAPD plan. Each group contracts individually with the plan for benefit design. Pharmacy benefits excluded. |
| Medicare Choice PPO | GHI Retirees | No | No | |||||
| N/A | EmblemHealth National Drug Plan | EmblemHealth Medicare PDP | N/A | N/A | Yes | Copays/ coinsurance |
National | Part D drug Coverage |
