Standard Option Plan
This is our in-network plan, which means you can get care from our large network of quality doctors, including specialists, without a referral. Simply choose one of our network doctors and make an appointment.
In most cases, your only out-of-pocket cost will be a copay. For dependent children under age 26, copays are eliminated for all office visits, including but not limited to allergy, physical and speech therapy, specialist, laboratory and radiology services.
Enrollment: 1-800-624-2414, (TDD: 711), Monday to Friday, 8 a.m. to 6 p.m. (closed on weekends.)
Customer Service: call the number on the back of your member ID card, Monday to Friday, 8 a.m. to 6 p.m. (closed on weekends.)
Enrollment Codes and Rates 2019
The Standard Option Plan serves New York City plus most New York counties, as well as Northern New Jersey.
These plans are only available to individuals who live or work in certain counties. Please see Federal RI 73-007 for the counties included in the service area.
|
Non-Postal Premium |
Postal Premium |
|||||
Biweekly |
Monthly |
Biweekly |
|||||
Type of Enrollment |
Enrollment Code |
Gov’t Share |
Your Share |
Gov’t Share |
Your Share |
Category 1 Your Share |
Category 2 Your Share |
All of New York and Northern New Jersey |
|||||||
Standard Option Self Only |
804 |
$230.18 |
$197.19 |
$498.72 |
$427.25 |
$193.99 |
$184.40 |
Standard Option Self Plus One |
806 |
$492.27 |
$501.81 |
$1,066.59 |
$1,087.25 |
$494.97 |
$474.46 |
Standard Option Self and Family |
805 |
$525.32 |
$511.51 |
$1,138.19 |
$1,108.28 |
$504.21 |
$482.33 |
Non-Postal rates apply to most non-Postal employees. If you are in a special enrollment category, refer to the Guide to Federal Benefits for that category or contact the agency that maintains your health benefits enrollment.
Postal Category 1 rates apply to career employees covered by the National Postal Mail Handlers Union (NPMHU), National Association of Letter Carriers (NALC) and Postal Police bargaining units.
Postal Category 2 rates apply to other non-APWU, non-PCES, non-law enforcement Postal Service career employees, including management employees, and employees covered by the National Rural Letter Carrier’s Association bargaining unit.
Special Guides to Benefits are published for American Postal Workers Union (APWU) employees (see RI 20-2A) including Material Distribution Center, Operating Services and Information Technology/ Accounting Services employees and Nurses; Postal Service Inspectors and Office of Inspector General (OIG) law enforcement employees (RI 70-2IN); Postal Career Executive Service (PCES) employees (see RI 70- 2EX); and non-career employees (see RI 70-8PS).
Career APWU employees hired before May 23, 2011 will have the same rates as the Category 2 rates shown below. In the Guide to Benefits for APWU Employees (RI 70-2A) this will be referred to as the “Current” rate; otherwise, “New” rates apply.
For further assistance, Postal Service employees should call:
Human Resources, Shared Service Center, 1-877-477-3273, option 5 (TTY: 1-866-260-7507)
Postal rates do not apply to non-career postal employees, postal retirees, or associate members of any postal employee organization who are not career postal employees. Refer to the applicable Guide to Federal Benefits.
Summary of Benefits and Coverage:
If you have questions about your plan benefits or would like to request a free printed copy of the SBC, please call the number on the back of your member ID card, from 8 am to 8 pm, seven days a week (excluding major holidays). If you have a hearing or speech impairment and use a TDD, call 711.
Benefits at-a-glance: GHI FEHB High Option and Standard Option
|
Standard Option |
|
||
In-network |
Out-of-network |
|
||
Medical Care |
||||
PCP office visit |
$50 copay |
Not covered |
||
Specialist office visit |
$50 copay |
Not covered |
||
Diagnostic lab/X-ray |
$50 copay |
Not covered |
||
Preventive Care |
||||
Routine physical exam |
$0 copay |
Not covered |
||
Well child care |
$0 copay |
Not covered |
||
Women’s wellness services |
$0 copay |
Not covered |
||
Other Services |
||||
Outpatient mental health |
$0 copay |
Not covered |
||
Urgent care |
$75 copay |
Not covered |
||
Ambulance |
You pay all charges after $100 |
Not covered |
||
Prescription drugs |
$15 generic/$50 brand/$100 non-formulary copay/25% coinsurance up to $200 maximum per script for specialty drugs |
Not covered |
||
Hospital Services |
||||
Inpatient care |
$500 copay per day/$1000 maximum |
Not covered |
||
Emergency room |
$200 copay (waived if admitted) |
$200 copay (waived if admitted) |
||
Ambulatory surgery |
$150 copay |
Not covered |
||
For complete details about the benefits available through these plans, please read the Federal RI 73-007.
Provider Network
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.
You can find network doctors throughout the neighborhoods of all five boroughs of New York City, plus in Nassau, Suffolk, Westchester, Rockland and Orange counties.
With a GHI plan you have coverage at top-ranked area hospitals, including:
• Lenox Hill Hospital
• Memorial Sloan-Kettering Cancer Center
• Montefiore Medical Center
• North Shore-Long Island Jewish Health System
• NYU Hospital Center
• Staten Island University Hospital
• St. Barnabas Hospital Health Center
• And many more
Need to see a doctor?
To find a doctor in your plan’s network, click the Find a Doctor link below.
You can use a handy Map and Directions tool to locate a doctor’s office when you click on his or her name in our directory. Note that this tool is also available via smartphone!
Looking for Teladoc information?
In your secure member portal, myEmblemHealth, you have convenient access to your personal information, including benefits and valuable health management tools.
Stay on top of your benefits
When you sign in, you can:
Assess and track your health
With myEmblemHealth, you can take a more active role in your health by using a range of online self-management tools like the following:
Go green and get rid of clutter
Having all your health plan information online is a great way to get rid of clutter, stay organized and keep on top of your health at your convenience. By going paperless, you can conveniently access your personal message center to read plan communications, while helping to save trees!
Get the following items and more electronically:
Enrollment and customer service
If you are a prospective member and have questions about enrollment, call 1-800-624-2414, Monday to Friday, 8 am to 6 pm (closed on weekends.) Use the Interactive Voice Response System after business hours. If you have a hearing or speech impairment and use a TDD, call 711.
If you are a current plan member, call the number on the back of your member ID card, Monday to Friday, 8 am to 6 pm (closed on weekends.)
Choosing GHI FEHB
If you’d like to join a GHI FEHB plan in which you’re not currently enrolled, simply fill out the enrollment form available from your agency’s Human Resources office. Make sure to include the GHI FEHB plan enrollment codes as shown on the Enrollment Codes and Rates section.
Use our drug comparison tool to estimate your out-of-pocket prescription drug costs. Enter the medications you take and we'll show you your monthly out-of-pocket costs.
Brochure
Last updated: 9/5/2019Summary of Benefits and Coverage - Standard Option
Last updated: 9/5/2019Federal RI 73-001
Last updated: 9/5/2019With 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.
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.
