Your important plan documents below include coverage and costs for medical product and services and prescription drugs that will start on January 2023.
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Important Plan Documents
- 2023
Members 2023 Important Plan Documents
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EmblemHealth VIP Essential (HMO)
Richmond (Staten Island) and Nassau
Last Updated: 10/01/2022 -
Suffolk Last Updated: 10/01/2022
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Orange, Rockland, Sullivan, Westchester and Ulster
Last Updated: 10/01/2022 -
EmblemHealth VIP Gold (HMO)
Bronx, Kings (Brooklyn), Queens and New York
Last Updated: 10/01/2022 -
Richmond (Staten Island) and Nassau
Last Updated: 10/01/2022 -
Suffolk Last Updated: 10/01/2022
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Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester
Last Updated: 10/01/2022 -
EmblemHealth VIP Gold Plus (HMO)
Last Updated: 10/01/2022 -
EmblemHealth VIP Dual (HMO D-SNP)
Bronx, Kings (Brooklyn), Queens and New York
Last Updated: 10/01/2022 -
Suffolk Last Updated: 10/01/2022
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Albany, Broome, Columbia, Delaware, Dutchess, Greene, Nassau, Orange, Putnam, Rensselaer, Richmond (Staten Island), Rockland, Saratoga, Schenectady, Sullivan, Ulster, Warren, Washington and Westchester
Last Updated: 10/01/2022 -
EmblemHealth VIP Rx Saver (HMO)
Last Updated: 10/01/2022 -
EmblemHealth VIP Dual Reserve (HMO D-SNP)
Last Updated: 10/01/2022
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EmblemHealth VIP Essential (HMO) and 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 Reserve Classic (HMO)
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EmblemHealth VIP Dual Reserve (HMO D-SNP)
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Bronx
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Kings (Brooklyn)
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Nassau
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New York
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Queens
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Richmond (Staten Island)
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Suffolk
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Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
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Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
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Bronx and New York
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Kings (Brooklyn) and Queens
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Bronx
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Kings (Brooklyn)
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Nassau
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New York
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Queens
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Richmond (Staten Island)
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Suffolk
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Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
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Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
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Medicare Pharmacy Directory (Broad 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)
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Medicare Pharmacy Directory (Preferred Value Network)
(VIP Essential (HMO), VIP Rx Saver (HMO), VIP Gold (HMO), VIP Gold Plus (HMO), VIP Reserve Classic (HMO) and select VIP Premier (HMO) group plans)
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2023 EmblemHealth HMO and D-SNP Drug Formulary
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2023 Recent Changes to EmblemHealth's HMO Drug Formulary
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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2023 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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Nondiscrimination Policy for Medicare | Disaster Events Policy for Medicare
Last Updated 01/01/2023
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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.
Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.