Request an Evidence of Coverage (EOC)

Please fill in your details below to request an Evidence of Coverage for Medicare (EOC). If you would prefer to download a PDF version, click below to view our Important Plan Documents page where you can download a copy immediately.

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In case we have any questions about your request, how can we contact you?

At EmblemHealth we are always looking for ways to provide better service to you.

For Members: I understand that the phone numbers I provided on this form may be used by EmblemHealth or any of its contracted parties to contact me about my account, my health benefit plan or related programs, or services provided to me.

For Non-Members: Thank you for your interest in EmblemHealth. To request information, please call customer service at 877-344-7364 (TTY 711). We are open 7 days a week from 8 am to 8 pm. We will be happy to help you.

Last Updated: 10/1/19

Y0026_ 127364 Accepted 10/1/19