The VIP Rx Carveout (HMO) plan is a great fit for Medicare-eligible retirees. It offers quality coverage with low out-of-pocket costs. With this plan, you choose a regular doctor who will manage and oversee your care, including administering referrals to network specialists and arranging for hospital stays. VIP Rx Carveout (HMO) members receive their prescription drug coverage through their union.
VIP Rx Carveout (HMO)
Quick Links
Customer Service: 877-344-7364, 8 am to 8 pm, seven days a week.
Plan Details
VIP Rx Carveout (HMO) Medicare plan helps Medicare-eligible retirees meet their medical needs. You get:
- Access to VIP Prime network of providers.
- A primary care physician (PCP) to partner in your health.
- $0 copays for many services.
- Care Management programs and wellness rewards.
- $0 fitness benefit that includes 15,000+ fitness locations nationwide.
Your in-network costs:
- PCP office visit: $0 copay.
- Specialist office visit: $30 copay.
- Diagnostic lab/X-ray: $0 copay.
- Routine physical exam: $0 copay.
- Immunizations like flu, COVID-19, and pneumonia: $0 copay.
- Outpatient mental health: $5 copay.
- Ambulatory surgery: $0 copay.
- Ground Ambulance: $50 copay.
- Inpatient hospital care: $250 copay Days 1-3; $0 copay Days 4 and beyond. $0 copay for Inpatient care in the Centers of Excellence.
- Anesthesia: $0 copay.
- Emergency room: $100 copay (waived if admitted within 1 day).
- Annual routine hearing exam: $15 copay.
- Annual routine vision exam: $15 copay.
- Skilled nursing facility, Medicare-covered: $0 copay for days 1-20, $164 copay for days 21-100. 100 days per benefit period.
- Home health care, Medicare-covered: $0 copay.
- Private duty nursing: $0 copay.
- Durable medical equipment: 20% coinsurance.
In order to sign up for the VIP Rx Carveout (HMO) Medicare plan, you must:
- Have Medicare Parts A and B
- Continue to pay your Medicare Part B premium and remain enrolled in Part A
- Live in the plan’s Medicare-approved service area, which includes New York City (the Bronx, Brooklyn, Manhattan, Queens and Staten Island), Nassau, Suffolk, Rockland, Orange, and Westchester counties.
Health Insurance Plan of Greater New York (HIP) is a Medicare Advantage organization with a Medicare contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments and restrictions may apply.
The information in this section is intended to provide general information and highlights regarding the VIP Rx Carveout (HMO) plan. It does not provide a complete benefit description. VIP Rx Carveout (HMO) plan coverage is subject to all terms, conditions and limitations contained in the certificate of insurance.
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.