Important Plan Documents

2019 Medicare Forms and Documents

Your important plan documents below include coverage and costs for medical products and services and prescription drugs.

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Formulary

List of Covered Drugs

  • 2019 Recent Changes to EmblemHealth's HMO Drug Formulary

  • EmblemHealth HMO Drug Formulary

  • EmblemHealth VIP Dual (HMO SNP) Drug Formulary

  • Prior Authorization

    This means that you will need to get approval from your plan before you fill your certain prescriptions.

  • Step Therapy

    You may need to try a different or more common drug first.

  • 2019 Recent Changes to EmblemHealth's Affinity HMO Drug Formulary

  • EmblemHealth Affinity HMO and HMO SNP Drug Formulary

  • EmblemHealth Affinity - Prior Authorization

    This means that you will need to get approval from your plan before you fill your certain prescriptions.

  • EmblemHealth Affinity - Step Therapy

    You may need to try a different or more common drug first.




  • Evidence of Coverage (EOC)

  • Provider or Pharmacy Directory

  • Formulary (List of Covered Drugs)

Nondiscrimination Policy 

Notice of Nondiscrimination Policy

 

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Last Updated 09/24/19 

Y0026_127476 Accepted 10/1/18