Your important plan documents below include coverage and costs for medical products and services and prescription drugs that will start on January 1, 2026.
Medicare
Important Plan Documents
- 2026
- 2025
Members 2026 Important Plan Documents
What are you looking for?
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EmblemHealth VIP Gold (HMO)
Nassau
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Suffolk and Westchester
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Kings
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EmblemHealth VIP Gold Plus (HMO)
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EmblemHealth VIP Dual Reserve (HMO D-SNP)
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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
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EmblemHealth VIP Dual Enhanced (HMO D-SNP)
Bronx, Kings, New York, and Queens
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Nassau, Richmond, Suffolk, and Westchester
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EmblemHealth VIP Gold (HMO) and EmblemHealth VIP Gold Plus (HMO)
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EmblemHealth VIP Value (HMO-POS)
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EmblemHealth VIP Dual Reserve (HMO D-SNP)
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EmblemHealth VIP Dual (HMO D-SNP)
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EmblemHealth VIP Dual Enhanced (HMO D-SNP)
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EmblemHealth VIP Comprehensive/Preventive Dental
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Bronx
Last Updated: 10/01/2025 -
Kings (Brooklyn)
Last Updated: 10/01/2025 -
Nassau
Last Updated: 10/01/2025 -
New York
Last Updated: 10/01/2025 -
Queens
Last Updated: 10/01/2025 -
Richmond (Staten Island)
Last Updated: 10/01/2025 -
Suffolk
Last Updated: 10/01/2025 -
Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
Last Updated: 10/01/2025 -
Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
Last Updated: 10/01/2025
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Bronx and New York
Last Updated: 10/01/2025 -
Kings (Brooklyn) and Queens
Last Updated: 10/01/2025
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Bronx
Last Updated: 10/01/2025 -
Kings (Brooklyn)
Last Updated: 10/01/2025 -
Nassau
Last Updated: 10/01/2025 -
New York
Last Updated: 10/01/2025 -
Queens
Last Updated: 10/01/2025 -
Richmond (Staten Island)
Last Updated: 10/01/2025 -
Suffolk
Last Updated: 10/01/2025 -
Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
Last Updated: 10/01/2025 -
Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
Last Updated: 10/01/2025
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Medicare HMO Dental Directory
Last Updated: 10/01/2025
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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: 10/01/2025
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EmblemHealth HMO Drug Formulary
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EmblemHealth HMO D-SNP Drug Formulary
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City of New York PDP Drug Formulary
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Employer Group 4 Tier Drug Formulary
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HMO and PPO Employer Group 5 Tier Drug Formulary
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.
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EmblemHealth Medicare Part D Prior Authorization (HMO)
Coming Soon
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EmblemHealth City of New York/GHI Standard/Enhanced Medicare Prescription Drug Plan (PDP)
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EmblemHealth Group Access Rx (PPO)
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EmblemHealth National Drug Plan (PDP)
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EmblemHealth VIP Premier (HMO)
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EmblemHealth VIP Rx Carveout (HMO)
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MAPD Application
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Dual HMO D-SNP Enrollment Application
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OTC Reimbursement Form
Reimbursement for OTC purchases in extraordinary circumstances.
Members 2025 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, 2025.
What are you looking for?
-
EmblemHealth VIP Gold (HMO)
Bronx, Queens and New York
-
Richmond (Staten Island) and Nassau
-
Suffolk and Westchester
-
Kings
-
EmblemHealth VIP Gold Plus (HMO)
-
EmblemHealth VIP Rx Saver (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
-
EmblemHealth VIP Gold (HMO) and EmblemHealth VIP Gold Plus (HMO)
-
EmblemHealth VIP Rx Saver (HMO)
-
EmblemHealth VIP Dual Reserve (HMO D-SNP)
-
EmblemHealth VIP Dual (HMO D-SNP)
-
EmblemHealth VIP Dual Enhanced (HMO D-SNP)
-
EmblemHealth VIP Comprehensive/Preventive Dental
-
Bronx
Last Updated: 10/01/2025 -
Kings (Brooklyn)
Last Updated: 10/01/2025 -
Nassau
Last Updated: 10/01/2025 -
New York
Last Updated: 10/01/2025 -
Queens
Last Updated: 10/01/2025 -
Richmond (Staten Island)
Last Updated: 10/01/2025 -
Suffolk
Last Updated: 10/01/2025 -
Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
Last Updated: 10/01/2025 -
Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
Last Updated: 10/01/2025
-
Bronx and New York
Last Updated: 10/01/2025 -
Kings (Brooklyn) and Queens
Last Updated: 10/01/2025
-
Bronx
Last Updated: 10/01/2025 -
Kings (Brooklyn)
Last Updated: 10/01/2025 -
Nassau
Last Updated: 10/01/2025 -
New York
Last Updated: 10/01/2025 -
Queens
Last Updated: 10/01/2025 -
Richmond (Staten Island)
Last Updated: 10/01/2025 -
Suffolk
Last Updated: 10/01/2025 -
Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
Last Updated: 10/01/2025 -
Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
Last Updated: 10/01/2025
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Medicare HMO Dental Directory
-
Medicare Pharmacy Directory (National Medicare Performance Network)
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), select EmblemHealth Group Access Rx (PPO) plans and, EmblemHealth VIP Premier (HMO) group plans with standard pharmacy benefit)
Last Updated: 10/01/2025 -
Medicare Pharmacy Directory (Medicare Preferred Performance Network)
EmblemHealth (VIP Rx Saver (HMO), EmblemHealth VIP Gold (HMO), EmblemHealth VIP Gold Plus (HMO), and select EmblemHealth VIP Premier (HMO) group plans)
Last Updated: 10/01/2025
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2025 EmblemHealth HMO Drug Formulary
Last Updated: 10/01/2025 -
2025 EmblemHealth HMO D-SNP Drug Formulary
Last Updated: 10/01/2025
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.
-
2025 EmblemHealth Medicare Part D Prior Authorization (HMO)
Last Updated: 10/01/2025
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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
-
OTC Reimbursement Form
Reimbursement for OTC purchases in extraordinary circumstances.
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Thank you for your interest in EmblemHealth. To request a Formulary, EOC, or Provider/Pharmacy Directory, please call Customer Service at 877-344-7364 (TTY: 711). From Oct. 1 to March 31, you can call us seven days a week from 8 a.m. to 8 p.m. From April 1 to Sept. 30, you can call us Monday through Saturday from 8 a.m. to 8 p.m. We will be happy to help you.
Last Updated 10/03/2025
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