The documents below include coverage information, forms, and costs for covered products and services.
Medicare Advantage
Important Plan Documents
- 2026
2026 Important Plan Documents
Annual Notice of Changes
Individual Plans
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EmblemHealth VIP Gold (HMO)
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EmblemHealth VIP Dual (HMO D-SNP)
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EmblemHealth VIP Dual Enhanced (HMO D-SNP)
Dental
Enrollment Applications and Forms
Enrollment Applications
Forms
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To submit claims for medical care and services.
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Reimbursement for OTC purchases in extraordinary circumstances.
Evidence of Coverage
Individual Plans
Employer Group Plans
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Last Updated: 10/24/2025
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Last Updated: 10/24/2025
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Last Updated: 10/24/2025
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Last Updated: 06/03/2026
Pharmacy
Directory
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EmblemHealth VIP Gold (HMO), EmblemHealth VIP Gold Plus (HMO) , EmblemHealth VIP Value (HMO-POS), EmblemHealth VIP Dual (HMO D-SNP), EmblemHealth VIP Dual Enhanced (HMO D-SNP) EmblemHealth VIP Dual Reserve (HMO D-SNP), EmblemHealth VIP Premier (HMO), EmblemHealth National Drug Plan (PDP), and EmblemHealth Group Access Rx (PPO) plans.
Last Updated: 09/10/2026
Formularies
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Last Updated: 09/01/2026
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Last Updated: 09/01/2026
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Last Updated: 09/01/2026
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Last Updated: 09/01/2026
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Last Updated: 09/01/2026
Prior Authorization
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Last Updated: 09/01/2026
Step Therapy
Provider Directories
VIP Bold Network
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Last Updated: 08/28/2026
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Last Updated: 08/28/2026
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Last Updated: 08/28/2026
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Last Updated: 08/28/2026
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Last Updated: 08/28/2026
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Last Updated: 08/28/2026
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Last Updated: 08/28/2026
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(Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
Last Updated: 08/28/2026 -
(Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
Last Updated: 08/28/2026
VIP Reserve Network
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Last Updated: 08/27/2026
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Last Updated: 08/27/2026
VIP Prime Network
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Last Updated: 08/27/2026
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Last Updated: 08/27/2026
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Last Updated: 08/27/2026
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Last Updated: 08/27/2026
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Last Updated: 08/27/2026
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Last Updated: 08/27/2026
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Last Updated: 08/27/2026
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(Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
Last Updated: 08/27/2026 -
(Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
Last Updated: 08/27/2026
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Thank you for your interest in EmblemHealth. To request a Formulary, Evidence of Coverage, 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 08/21/2026
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