The Preferred Plan for City of New York Employees
HIP HMO Preferred
A Health Plan That Adds Up to More
85 years serving the city + generations of satisfied members = 100% confidence in your health plan
Why City Employees Choose
EmblemHealth HIP HMO Preferred
- $0 monthly premiums
- $0 copays at preferred doctors
- Large New York network
- Nationwide coverage
Network counts as of August 2025.
Looking for a complete list of covered drugs? See which prescription drugs your plan covers.
Health and Wellness Resources
Explore programs and services designed to help you stay healthy and connected.
One-on-one customer service and free, personalized health and wellness support.
Coaching from a trained health coach or nurse wellness coach at no extra cost.
Care through Memorial Sloan Kettering Cancer Center and Hospital for Special Surgery.
HMO Preferred Plan Overview
Benefits include $0 copays at preferred doctors and low costs for many in-network common services.
| Benefit | Preferred | Nonpreferred |
|---|---|---|
| Primary care provider (PCP) office visit | $0 | $10 |
| Specialist office visit (requires referral) | $0 | $10 |
| Teladoc Health® telemedicine | $10 | $10 |
| Laboratory Procedures, Diagnostic Testing, and Radiology Services (including X-ray and lab tests) | $0 at offices/facilities $100 at hospital | $10 at offices/facilities $100 at hospital |
| Show More | ||
| Routine physical exam | $0 | $0 |
| Well-child care | $0 | $0 |
| Outpatient physical therapy | $0 | $10 |
| Outpatient mental health | $0 | $10 |
| Urgent care | $50 | $50 |
| Ambulatory surgery | $50 at ambulatory facilities $150 at hospital | $50 at ambulatory facilities $150 at hospital |
| Ambulance | $0 | $0 |
| Inpatient hospital care | $100 | $100 |
| Anesthesia | Included in hospital copay $0 at Center of Excellence | Included in hospital copay $0 at Center of Excellence |
| Emergency room | $150 (waived if admitted) | $150 (waived if admitted) |
| High-tech radiology | $0 at other offices/facilities $100 at hospital | $10 at other offices/facilities $100 at hospital |
| Infusion therapy | $0 at other offices/facilities $100 at hospital | $10 at other offices/facilities $100 at hospital |
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The above is only a brief overview of plan benefits. Out-of-network services are not covered, except for emergency hospital care. Coverage is subject to all terms, conditions, limitation, and exclusions set forth in the certificate of coverage. Refer to HIP policy form 155-23-LGTIERCERT (07-25).
Optional Rider Coverage
You can add the following optional riders to your HIP HMO Preferred plan through a payroll deduction if these benefits are not already provided through your welfare fund:
- Durable medical equipment and private duty nursing.
- Prescription drugs.
Plan Documents
See important documents that explain your benefits, coverage, and prescription drug information.
Summary of Benefits and Coverage
Your Summary of Benefits and Coverage (SBC) summarizes what your plan covers and any cost sharing you may have.
Certificate of Coverage
Your Certificate of Coverage describes the benefits available under the group contract.
Drug List
Below is the list of drugs covered by the HMO Preferred plan for the City of New York. This drug list is also known as a formulary. To find your plan's formulary, simply locate the letter identifiers in the "Formulary" section on the front of your member ID card, which will match one of the options found in parentheses below.
Get In Touch
Already a member? Get the help and resources you need to make the most of your plan.
Need help with your HMO Preferred plan? Our Gold Line team can help you understand your plan and make the most of your benefits.
Get our new app to view your member ID card, find care, check benefits, and manage your plan wherever you go.
Frequently Asked Questions
Find quick answers to common questions about HMO Preferred benefits and coverage.
Why Choose EmblemHealth HMO Preferred
EmblemHealth has served City of New York employees and their families for more than 85 years, helping generations of satisfied members get the care they need.
Today, HMO Preferred continues that tradition by offering quality coverage with low out-of-pocket costs. Members get $0 monthly premiums, $0 copays at preferred doctors, access to care through one of New York’s largest provider networks, and coverage across all 50 states.
Yes, HMO Preferred offers network providers in all 50 states, making it a good fit for City employees who travel frequently, have covered dependents living outside New York, or move out of state. If you receive care in New York state, you’ll use the HIP Prime HMO Network. Outside New York state, you’ll have access to care through the Cigna Health care® PPO Network.
You must receive in-network services in order to be covered. Services you get outside our network won’t be covered, unless it’s an emergency.
The Cigna Health care PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Health care PPO for Shared Administration.
Doctors and Care
It’s easy to find in-network care in New York and across the country using our Find Care tool. HMO Preferred provides access to care through the HIP Prime HMO Network, one of New York's largest provider networks, plus nationwide access through the Cigna Healthcare® PPO Network.
As of August 2025, our national network includes:
- 1 million+ healthcare professionals.
- 285,000+ primary care providers (PCPs).
- 998,000+ specialists.
- 6,000+ hospitals.
Your services must be in-network to be covered, with the exception of emergency hospital care, which is covered both in-network and out-of-network.
The Cigna Healthcare PPO Network refers to the healthcare providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration.
HMO Preferred gives you access to care through one of New York's largest provider networks, the HIP Prime HMO Network. Certain doctors within this network are designated as preferred doctors. Doctors at AdvantageCare Physicians and Corinthian, among others, are preferred.
If you choose a preferred primary care provider (PCP), you'll pay a $0 copay for most services, including specialist visits when a referral is required. If you choose a nonpreferred PCP, you’ll pay a $10 copay for most services, including specialist visits. Your choice of PCP can affect what you pay for many healthcare services.
To find preferred doctors, use the Find Care tool or sign in to the member portal at my.emblemhealth.com and click "Find Care." Look for the star icon next to preferred providers or use the preferred provider filter when searching.
Yes, you'll need a referral from your primary care provider (PCP) to see most specialists.
However, you do not need a referral for:
- Chiropractic care.
- Outpatient mental health services, including therapist visits.
- OB-GYN care.
- Diabetes-related eye exams from an ophthalmologist.
Check your Certificate of Coverage for additional information about referrals and to view your complete benefits.
In some circumstances, you have to get approval before you receive certain services. This is known as prior approval.
Examples of services that may require prior approval include:
- Inpatient nonemergency procedures.
- Outpatient surgery.
- Home healthcare.
- Hospice care.
- Outpatient physical therapy.
- Outpatient occupational therapy.
- Outpatient speech therapy.
See your Certificate of Coverage for more information.
Coverage and Benefits
Yes, EmblemHealth HMO Preferred covers mental health and substance use disorder programs and services. If you need support, confidential help is available 24/7. Call 888-447-2526 (TTY: 711) and then press 9.
HMO Preferred offers two convenient ways to get your prescriptions filled.
Retail Pharmacy
- To use the retail pharmacy service, present your member ID card at any participating pharmacy nationwide. Most major drugstore chains, such as Walgreens, Duane Reade, CVS, Target, and Walmart, are part of your plan.
- The retail pharmacy should be used when filling a prescription for short-term medicines, a 30-day supply or less.
Home Delivery and Refills
- With Amazon Pharmacy, our home-delivery pharmacy, you can have your approved long-term medicines, called maintenance drugs, mailed right to your home.
- Examples of maintenance drugs include those used for high cholesterol, high blood pressure, allergies, and heartburn. There is no difference between prescription drugs delivered by Amazon Pharmacy and those you pick up at your walk-in pharmacy.
During the annual transfer period, you can add the following optional riders to your HMO Preferred plan through a payroll deduction if these benefits are not already provided by your welfare fund:
- Durable medical equipment and private duty nursing.
- Prescription drugs.
Enrollment and Support
Dedicated Gold Line Service
If you have questions about your coverage, benefits, or how your plan works, specially trained Gold Line agents are available to help.
- Call 833-CNY-GOLD (833-269-4653) (TTY: 711) from 8 a.m. to 8 p.m., Monday through Friday, and from 8 a.m. to 1 p.m. on Saturday. Please have your member ID card ready when you call.
- Chat with an agent through our secure member portal at my.emblemhealth.com from 8 a.m. to 6 p.m., Monday through Friday.
You can also visit EmblemHealth Neighborhood Care for in-person help understanding your benefits, finding in-network doctors, resolving billing issues, and more.
Stop by EmblemHealth Neighborhood Care for in-person help and personalized health and wellness guidance.
Visit a location to:
- Get help understanding your benefits and how your plan works.
- Find in-network doctors and specialists.
- Resolve billing or claims issues.
- Join free fitness and wellness classes that support your well-being.
- Participate in nutrition workshops, health education, and family-friendly events.
- Connect with community resources and support programs.
Find a convenient Neighborhood Care location near you.
City of New York employees who want to enroll in HIP HMO Preferred for 2027 can do so during the annual fall transfer period. The transfer period runs from Nov. 1 through Nov. 30, 2026. Save the date. After enrolling, coverage would begin Jan. 1, 2027.
If you're already enrolled in HMO Preferred, you don't need to take any action to keep your coverage.
For more information about the enrollment process, please contact your agency health benefits office, payroll office, union or welfare fund, or Office of Labor Relations.
Yes, you may be able to add eligible dependents outside the annual fall transfer period if you experience a qualifying life event, such as marriage, registering a domestic partnership, or the birth or adoption of a child. City employees should report family status changes within 30 days of the event.
For additional information about eligibility requirements and required documentation, please contact your agency health benefits office, payroll office, union or welfare fund, or Office of Labor Relations.