HIP Prime POS | EmblemHealth

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With HIP Prime POS, you get most of the same in-network features as the HIP Prime HMO plan. For example, with this plan you choose a primary care physician (PCP) who will manage and oversee your care, including administering referrals to network specialists and arranging for hospital stays. This plan is offered to City active employees and non-Medicare retirees.

With HIP Prime POS you also have the choice of getting covered care from doctors and health care providers who are out of the network.

Customer Service: 800-447-8255, seven days a week (excluding major holidays), 8 am to 8 pm.


Plan Details

HIP Prime POS gives you low out-of-pocket costs along with the freedom to choose out-of-network providers. You get:

  • Coverage for out-of-network services
  • Coverage of in-network services
  • Low out-of-pocket costs
  • Low copays for in-network services
  • Value-added wellness and disease management programs

Your In-Network Costs

  • PCP office visit: $10
  • Well child care: $0
  • Specialist office visit: $15
  • Diagnostic lab/X-ray: included
  • Routine physical exam: $0
  • Outpatient mental health: $10
  • Urgent care: $10
  • Ambulatory surgery: $100
  • Ambulance: $0
  • Inpatient care: $100
  • Anesthesia: included
  • Emergency room: $100 (waived if admitted)

Additional Riders

City employees can add the following benefit to their HIP Prime POS plan through a payroll or pension deduction:

Prescription drugs ($10 generic and $35 brand drugs from network retail drug stores). Formulary copays are reduced by 50% when utilizing the Mail Order Pharmacy Service for home delivery.

Note: Durable medical equipment and private duty nursing are part of the base POS plan. No rider is needed.

The information in this section is intended to provide general information and highlights regarding the HIP Prime POS plan. It does not provide a complete benefit description. HIP Prime POS Plan coverage is subject to all terms, conditions and limitations contained in the certificate of insurance. Refer to HIP policy form 155-23-GRPHMO (3/99) and 200-23-GRPPOL (9/99).


Plan Documents

Provider Coverage

With our robust network of quality doctors, you can get care from many of the region’s leading doctors, clinicians and facilities, including hospitals and urgent care centers.

A partner in wellness

The Right Care, Right in Your Neighborhood

AdvantageCare Physicians are the newest addition to the EmblemHealth family and are now one of the largest primary and specialty care practices in New York City. With 37 locations throughout New York City and Long Island, you can find a convenient location near home or work.