VIP Rx Carve Out HMO | EmblemHealth

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VIP Rx Carve Out HMO

The VIP Rx Carve Out (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 Carve Out members receive their prescription drug coverage through their union.

Customer Service: 877-344-7364, 8 am to 8 pm, seven days a week.


Plan Details

VIP Rx Carve Out (HMO) Medicare plan helps Medicare-eligible retirees meet their medical needs. You get:

  • Coverage for in-network services.
  • A primary care provider (PCP) to partner in your health.
  • $0 copays for most services.
  • Value-added wellness and disease management programs.
  • A no cost fitness benefit with access to 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
  • Outpatient mental health: $5 copay
  • Ambulatory surgery: $0
  • Ambulance: $50 copay
  • Inpatient care: $250 copay Days 1-3, $0 copay Days 4-90
  • Anesthesia: $0
  • Emergency room: $100 copay (waived if admitted)
  • Routine hearing exam: $15 copay
  • Routine vision exam: $15 copay
  • Skilled nursing facility, non-custodial: $0 copay Days 1-20, $164 copay Days 21-100
  • Home health care, non-custodial: $0 copay
  • Private duty nursing (PDN): $0 copay
  • Durable medical equipment (DME): 20% coinsurance

In order to sign up for the VIP Rx Carve Out (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.

HIP Health Plan of 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 Carve Out (HMO) plan. It does not provide a complete benefit description. VIP Rx Carve Out (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.


The Right Care, Right in Your Neighbborhood

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.