Members 2026 Important Plan Documents

Your important plan documents below include coverage and costs for medical products and services and prescription drugs that will start on January 1, 2026.

What are you looking for?

 

2026 Annual Notice of Changes

  • EmblemHealth VIP Gold (HMO)

    Nassau

  • Suffolk and Westchester       

  • Kings

  • EmblemHealth VIP Gold Plus (HMO)

  • EmblemHealth VIP Dual Reserve (HMO D-SNP)

  • EmblemHealth VIP Dual (HMO D-SNP)

    Bronx, Kings, New York, and Queens

  • EmblemHealth VIP Dual (HMO D-SNP)

    Nassau, Richmond, Suffolk, Capital Region, and

    Hudson Valley

  • EmblemHealth VIP Dual Enhanced (HMO D-SNP)

    Bronx, Kings, New York, and Queens

  • Nassau, Richmond, Suffolk, and Westchester

 

2026 Evidence of Coverage

 

2026 Comprehensive and Preventive Dental Benefits

  • EmblemHealth VIP Comprehensive/Preventive Dental

 

2026 Medicare HMO Provider Directory - VIP Bold Network

  • Bronx

    Last Updated: 12/08/2025
  • Kings (Brooklyn)

    Last Updated: 12/08/2025
  • Nassau

    Last Updated: 12/08/2025
  • New York

    Last Updated: 12/08/2025
  • Queens

    Last Updated: 12/08/2025
  • Richmond (Staten Island)

    Last Updated: 12/08/2025
  • Suffolk

    Last Updated: 12/08/2025
  • Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)

    Last Updated: 12/08/2025
  • Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)

    Last Updated: 12/08/2025
 

2026 Medicare HMO Provider Directory - VIP Reserve Network

  • Bronx and New York

    Last Updated: 12/03/2025
  • Kings (Brooklyn) and Queens

    Last Updated: 12/03/2025
 

2026 Medicare HMO Provider Directory - VIP Prime Network

  • Bronx

    Last Updated: 12/09/2025
  • Kings (Brooklyn)

    Last Updated: 12/09/2025
  • Nassau

    Last Updated: 12/09/2025
  • New York

    Last Updated: 12/09/2025
  • Queens

    Last Updated: 12/09/2025
  • Richmond (Staten Island)

    Last Updated: 12/09/2025
  • Suffolk

    Last Updated: 12/09/2025
  • Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)

    Last Updated: 12/09/2025
  • Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)

    Last Updated: 12/09/2025
 

2026 Dental Directory

  • Medicare HMO Dental Directory

    Last Updated: 12/23/2025
 

2026 Pharmacy Directory

  • Medicare Pharmacy Directory

    EmblemHealth VIP Value (HMO-POS), EmblemHealth VIP Gold (HMO), EmblemHealth VIP Gold Plus (HMO), EmblemHealth (National Drug Plan (PDP), EmblemHealth VIP Dual (HMO D-SNP), EmblemHealth VIP Dual Enhanced (HMO D-SNP) and EmblemHealth VIP Dual Reserve (HMO D-SNP), EmblemHealth Group Access Rx (PPO) plans and, EmblemHealth VIP Premier (HMO) group plans

    Last Updated: 12/23/2025
 

2026 Formularies

List of Covered Drugs

  • EmblemHealth HMO Drug Formulary

    Last Updated: 01/01/2026
  • EmblemHealth HMO D-SNP Drug Formulary

    Last Updated: 01/01/2026
  • City of New York PDP Drug Formulary

    Last Updated: 01/01/2026
  • Employer Group 4 Tier Drug Formulary

    Last Updated: 01/01/2026
  • HMO and PPO Employer Group 5 Tier Drug Formulary

    Last Updated: 01/01/2026
 

2026 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.

  • EmblemHealth Medicare Part D Prior Authorization (HMO)

 

2026 Step Therapy

Step Therapy means you may need to try a different or more common drug first. Below is a list of drugs that require step therapy.

  • EmblemHealth Medicare Part B Step Therapy

    Coming Soon

 

2026 Evidence of Coverage for Group Plans

  • EmblemHealth VIP Rx Carveout (HMO) – Group

    Last Updated: 10/23/2025
  • EmblemHealth VIP Premier (HMO) – Group

    Last Updated: 10/23/2025
  • EmblemHealth Group PPO – Group Access Rx/Access Rx National (PPO)

    Last Updated: 10/23/2025
  • EmblemHealth National Drug Plan (PDP) CNY/EmblemHealth National Drug Plan (PDP)

 

2026 Annual Notice of Changes for Group Plans

 

2026 Enrollment Applications

 

2026 Forms

  • OTC Reimbursement Form

    Reimbursement for OTC purchases in extraordinary circumstances.

  • Health Insurance Claim Form

    To submit claims for medical care and services.