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.

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2025 EmblemHealth Annual Notice of Changes

  • 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
 

Evidence of Coverage

 

Comprehensive and Preventive Dental Benefits

  • EmblemHealth VIP Comprehensive/Preventive Dental
 

Medicare HMO Provider Directory - VIP Bold Network

  • Bronx

    Last Updated: 05/09/2025

  • Kings (Brooklyn)

    Last Updated: 05/09/2025

  • Nassau

    Last Updated: 05/09/2025

  • New York

    Last Updated: 05/09/2025

  • Queens

    Last Updated: 05/09/2025

  • Richmond (Staten Island)

    Last Updated: 05/09/2025

  • Suffolk

    Last Updated: 05/09/2025

  • Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)

    Last Updated: 05/09/2025

  • Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)

    Last Updated: 05/09/2025
 

Medicare HMO Provider Directory - VIP Reserve Network

  • Bronx and New York

    Last Updated: 05/09/2025

  • Kings (Brooklyn) and Queens

    Last Updated: 05/09/2025
 

Medicare HMO Provider Directory - VIP Prime Network

  • Bronx

    Last Updated: 05/19/2025

  • Kings (Brooklyn)

    Last Updated: 05/19/2025

  • Nassau

    Last Updated: 05/19/2025

  • New York

    Last Updated: 05/19/2025

  • Queens

    Last Updated: 05/19/2025

  • Richmond (Staten Island)

    Last Updated: 05/19/2025

  • Suffolk

    Last Updated: 05/19/2025

  • Capital Region (Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)

    Last Updated: 05/19/2025

  • Hudson Valley (Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)

    Last Updated: 05/19/2025
 

Dental Directory

  • Medicare HMO Dental Directory

    Last Updated: 05/19/2025
 

Pharmacy 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: 05/20/2025

  • 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: 05/20/2025
 

Formulary

List of Covered Drugs

  • 2025 EmblemHealth HMO Drug Formulary

    Last Updated: 05/01/2025

  • 2025 EmblemHealth HMO D-SNP Drug Formulary

    Last Updated: 05/01/2025
 

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: 05/01/2025
 

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.

  • 2025 EmblemHealth Medicare Part D Step Therapy

    Last Updated: 05/01/2025

  • 2025 EmblemHealth Medicare Part B Step Therapy

    Last Updated: 12/01/2024
 

Evidence of Coverage for Group Plans

  • EmblemHealth VIP Rx Carveout (HMO) – Group

  • EmblemHealth VIP Premier (HMO) – Group

  • EmblemHealth Group PPO – Group Access Rx/Access Rx National (PPO)

  • EmblemHealth National Drug Plan (PDP) CNY/EmblemHealth National Drug Plan (PDP)

 

Enrollment Applications