Your important plan documents below include coverage and costs for medical product and services and prescription drugs that will start on January 2024.
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Important Plan Documents
- 2024
Members 2024 Important
Plan Documents
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EmblemHealth VIP Gold (HMO)
Bronx, Kings (Brooklyn), Queens and New York
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Richmond (Staten Island) and Nassau
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Suffolk
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Westchester
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EmblemHealth VIP Gold Plus (HMO)
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EmblemHealth VIP Rx Saver (HMO)
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EmblemHealth VIP Dual Reserve (HMO D-SNP)
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EmblemHealth VIP Rx Saver (HMO)
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EmblemHealth VIP Dual (HMO D-SNP)
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EmblemHealth VIP Gold (HMO) & EmblemHealth VIP Gold Plus (HMO)
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EmblemHealth VIP Dual Reserve (HMO D-SNP)
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EmblemHealth VIP Comprehensive/Preventive Dental
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Bronx
Last Updated: 08/12/2024 -
Kings (Brooklyn)
Last Updated: 08/12/2024 -
Nassau
Last Updated: 08/12/2024 -
New York
Last Updated: 08/12/2024 -
Queens
Last Updated: 08/12/2024 -
Richmond (Staten Island)
Last Updated: 08/12/2024 -
Suffolk
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Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
Last Updated: 08/12/2024 -
Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
Last Updated: 08/12/2024
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Bronx and New York
Last Updated: 09/11/2024 -
Kings (Brooklyn) and Queens
Last Updated: 09/11/2024
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Bronx
Last Updated: 08/14/2024 -
Kings (Brooklyn)
Last Updated: 08/14/2024 -
Nassau
Last Updated: 08/14/2024 -
New York
Last Updated: 08/14/2024 -
Queens
Last Updated: 08/14/2024 -
Richmond (Staten Island)
Last Updated: 08/14/2024 -
Suffolk
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Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
Last Updated: 08/14/2024 -
Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
Last Updated: 08/14/2024
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Medicare Pharmacy Directory (National Medicare Performance Network)
(National Drug Plan (PDP), VIP Dual (HMO D-SNP), and VIP Dual Reserve (HMO D-SNP), select EmblemHealth Group Access Rx (PPO) plans and VIP Premier (HMO) group plans with standard pharmacy benefit)
Last Updated: 08/16/2024 -
Medicare Pharmacy Directory (Medicare Preferred Performance Network)
(VIP Rx Saver (HMO), VIP Gold (HMO), VIP Gold Plus (HMO), and select VIP Premier (HMO) group plans)
Last Updated: 08/16/2024
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2024 EmblemHealth HMO and D-SNP Drug Formulary
Last Updated: 09/01/2024
Prior Authorization
Prior Authorization means that you will need to get approval from your plan before you fill your prescriptions. If you do not get an approval, your plan may not cover the drug. Below is a list of drugs that require prior authorization.
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2024 EmblemHealth Medicare Part D Prior Authorization (HMO)
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EmblemHealth VIP Rx Carveout (HMO) – Group
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EmblemHealth VIP Premier (HMO) – Group
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EmblemHealth Group PPO – Group Access Rx/Access Rx National (PPO)
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EmblemHealth National Drug Plan (PDP) CNY/EmblemHealth National Drug Plan (PDP)
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MAPD Application
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Dual HMO D-SNP Enrollment Application
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Nondiscrimination Policy for Medicare | Disaster Events Policy for Medicare
Last Updated 01/01/2024
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