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HIP HMO Preferred Gold Plan
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Welcome to the
Gold Standard

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Your HIP HMO Now Has a National Network!

At EmblemHealth, we’re helping you create a healthier future. As of Jan. 1, 2026, your plan now has a national network.

If you receive services in New York state, you’ll continue to have access to HIP Prime HMO providers. If your doctor or facility is located outside of New York state – or if you have a dependent who lives outside of New York state – you’ll now be in-network with the Cigna Healthcare PPO network.

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.

map of united states for city of new york hip hmo gold members

National Network in 2026

The EmblemHealth network you know and depend on in New York state — plus coverage in all 50 states, so you can get the care you need wherever you are.

As of August 2025, our national network includes:

  • 1,000,000+ health care professionals.
  • 285,000+ primary care providers (PCPs).
  • 998,000+ specialists.
  • 6,000+ hospitals.

No payroll/pension deduction!

Find an In-Network Doctor

HIP HMO Plan Overview

For PCP and specialist visits, HMO Preferred members have $0 copays at preferred doctors and just $10 at nonpreferred doctors.

Benefit Preferred Nonpreferred
Primary care provider (PCP) office visit $0 $10
Specialist office visit (requires referral) $0 $10
Teladoc Health® telemedicine $10 $10
Lab/X-ray $0 $10
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The above is only a brief overview of plan benefits. Coverage is subject to all terms, conditions, limitations, and exclusions set forth in the certificate of coverage. Refer to HIP form # - 155-23-LGTIERCERT (07-25).

Optional Rider
City employees can add the following option riders to their HIP HMO Preferred plan through a payroll deduction if the benefits are not already provided by their welfare fund:

  • Durable medical equipment and private duty nursing
  • Prescription drugs

Plan Documents

Select plan document type ...
  1. Summary of Benefits and Coverage
  2. Certificate of Coverage
  3. Drug List
 

Your Summary of Benefits and Coverage (SBC) summarizes what your plan covers and any cost-sharing you may have.

  • Summary of Benefits and Coverage (Base Plan)

  • Summary of Benefits and Coverage (Base Plan + DME)

  • Summary of Benefits and Coverage (Standard Rx)

  • Summary of Benefits and Coverage (Grandfathered Rx)

 

Your Certificate of Coverage describes the benefits available under the group contract.

 

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 parenthesis below.

  • Formulary Changes

  • CNY HMO Preferred Plan Base Benefit Formulary (HMOB)

  • CNY HMO Preferred Plan Full Rx 3-Tier Formulary (Gold Rx Standard Plan) (HMO3T)

  • CNY HMO Preferred Plan Full Rx 2-Tier Formulary (Gold Rx Grandfathered Plan) (HMO2T)

Dedicated Gold Line Service

Call our member Gold Line, 833-CNY-GOLD (833-269-4653) (TTY: 711), where our specially trained Gold Line agents will answer your call. We’re available 8 a.m. to 8 p.m., Monday through Friday, and 8 a.m. to 1 p.m. on Saturday.

HIP HMO Preferred Plan Overview

Use In-Network Services

Your plan covers services nationwide. If you receive services in New York state, you’ll continue to have access to HIP Prime HMO providers. If your doctor or facility is located outside of New York state – or if you have a dependent who lives outside of New York state – you’ll now be in-network with the Cigna Healthcare 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.

View in-network doctors and services.

Pharmacy Services

City employees can add the following in-network benefits to their HIP Prime HMO plan through a payroll deduction if the benefits are not already provided by their welfare fund:

  • Durable medical equipment and private duty nursing
  • Prescription drugs on the Premier Formulary (for $5 generic and $15 brand drugs from network retail drug stores). Formulary copays are reduced by 50 percent when utilizing the Mail Order Pharmacy Services for home delivery.

Retail Pharmacy

To use the retail pharmacy service, present your ID card at any participating pharmacy nationwide. Most major drug store chains (e.g., 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 (a 30-day supply or less) medications.

Find a pharmacy.

Set Up Home Delivery and Refills

Using Amazon Pharmacy, our home-delivery pharmacy, you can have your approved long-term medications (maintenance drugs) mailed right to your home.

Examples of maintenance drugs are medications used for high cholesterol, high blood pressure, allergies and heartburn. There is no difference between drugs delivered by Amazon Pharmacy and those you pick up at your walk-in pharmacy.

Click the button below to find out more about the benefits of home delivery and how to enroll in the service.

Choose a primary care physician

One of the first things to do is to pick a primary care physician. The relationship with your primary care doctor is one of the most important you’ll have.

This is the doctor who gives you your everyday care. They help take care of your overall health. They provide preventive care, help treat conditions before they become serious and can provide referrals to see specialists. You need to see an in-network doctor or health care professional to be covered. 

See a preferred doctor for a lower copay

Certain doctors in New York state are preferred doctors. You can see a preferred doctor in the network for a lower copay than other doctors. Doctors at AdvantageCare Physicians and Corinthian, among others are preferred.

If you pick a preferred PCP from our Prime Network, you’ll have a $0 copay for most services, including if you are referred to a specialist in the network. A copay is the set dollar amount you pay for health services each time you use them.

Sign in to your member portal at my.emblemhealth.com and click “Find Care.”

The results of your search will only include doctors available in your selected plan or network (preferred doctors or health care professionals).

We also have non-preferred doctors in the Prime Network. A non-preferred doctor is one who is in our network, but is not a preferred doctor.

If you pick a non-preferred PCP, you’ll have a $10 copay for most services, including seeing a specialist. Your choice of PCP determines your copay for many services.

Consider AdvantageCare Physicians

EmblemHealth offers members affordable health coverage with access to convenient, high-quality care options. That’s why you have access to AdvantageCare Physicians (ACPNY). ACPNY is a primary and specialty care practice serving half a million patients across all five New York boroughs and Long Island. Many offices also have convenient on-site lab and radiology services.

The ACPNY care approach puts you at the center of your health care journey. ACPNY's goal is to make the experience easier for you by offering a range of flexible appointment types, convenient locations, and coordination of care with specialty partners and preferred hospitals. Your ACPNY Care Team works together to ensure seamless continuity of care. Their guidance includes help with refilling prescriptions, getting test results, scheduling your next visit, and much more.

Other Basics About Using Your Plan

You'll need a referral to see specialists

With this plan, you need a written or electronic referral from your primary care doctor before receiving specialist care. A referral is permission from your primary doctor to see a specialist. Specialists are doctors such as allergists or dermatologists who provide services other than primary care. Your primary care doctor will take care of the referral for you.

Some specialists do not need referrals. You do not need a referral for the following specialist services:

  • Chiropractic care.
  • Outpatient mental health services, like therapists.
  • OB-GYN care.
  • Diabetes-related eye exams from an ophthalmologist.

You'll need prior approval for some services

In some circumstances, you have to get approval before you receive certain services. This is known as prior approval. Examples of these services include: inpatient nonemergency procedures, outpatient surgery, home health care, hospice care, and outpatient physical, occupational, and speech therapies.

You'll need to use Quest Diagnostics or Labcorp for lab work

You should ask your doctor to use Quest Diagnostics or Labcorp when lab testing is needed. For details about these services, you can call our Gold Line. You can also go to questdiagnostics.com or labcorp.com to schedule an appointment. Or call Quest directly at 888-277-8772. No appointment? Both accept walk-ins.

Health care assistance

We know this is a lot of information, and we want to make sure that you understand and know the basics about your plan. Your Gold Line agent is available to walk you through your plan details and benefits.

Call 833-CNY-GOLD (833-269-4653; TTY: 711) 8 a.m. to 8 p.m., Monday through Friday, and 8 a.m. to 1 p.m. on Saturday. Have your new Gold member ID card ready when you call. You can also chat with an agent in your secure member portal at my.emblemhealth.com from 8 a.m. to 6 p.m., Monday through Friday.

A Partner in Wellness and Community Support

male patient having an annual medical check-up with an AdvantageCare Physicians primary care provider

AdvantageCare Physicians

One of the largest primary and specialty care practices in New York City with 35+ locations.

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Neighborhood Care

One-on-one customer service and free, personalized health and wellness support.

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Health Coaching

Coaching from a trained health coach or nurse wellness coach, at no extra cost. 

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Centers of Excellence

Access to Memorial Sloan Kettering Cancer Center and Hospital for Special Surgery.

Learn More

Mental Health Support

Mental health resources

Support When You Need It

EmblemHealth's HIP HMO Preferred Plan covers mental health and substance abuse programs and services, with confidential help available 24/7.

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Also of Interest: 
Health Coaching Tailored To Your Needs   |   Serving Our City with Care   |   HIP HMO Preferred Plan Wellness and Rewards Programs