EmblemHealth high deductible health plans (HDHPs) feature lower premiums based on a higher than usual annual deductible and offer a separate health savings account (HSA ) that members own and can use for future medical expenses with tax-free dollars.

Plan Overview

Choice

We respect that different people have different needs. That's why we offer members a choice of affordable, quality plans with extensive benefit packages that provide real value:

Four plans to choose from and a selection of deductibles to meet member needs.

Affordability

Members pay no out-of-pocket costs for covered preventive care in-network, including routine physicals, screenings, immunizations, mammograms, gynecological exams, well-baby care and more. These services are covered in full and not subject to the plan's annual deductible. ¹

Low network pharmacy copay. $0 for generic, $20 for preferred, and $40 for nonpreferred prescription drugs after the plan's annual deductible is met.

Triple tax savings .Membercontributions to HSA s are tax free, withdrawals for qualified medical expenses are tax free, and the money saved in the account earns interest tax free. Members may contribute up to the amount of their deductible. Any money not used in a given year rolls over to the next year.

Quality

Quality doctors. Our National network includes more than half the "Top Docs" from New York Magazine's list, and virtually every acute care hospital in the region great hospitals like Memorial Sloan-Kettering, Montefiore Medical Center, Lenox Hill Hospital, North Shore- Long Island Jewish Health System, and Albany Medical Center. Health and Wellness Programs. We help members stay healthy with*:

Timely reminders about flu shots and diagnostic testing, such as mammograms and prostate exams.

Quit-smoking programs.

A Nurse Advice Line that members may call 24/7 to speak with a Registered Nurse.

Discounts on health-related services such as weight-loss programs, laser vision, and acupuncture.²

Confidential, professional counseling, education and referral services through our 24/7 toll-free Employee Assistance Program (EAP) hotline.

Access to Care

Our National Network offers access to many of the tristate area’s leading physicians, other medical practitioners and acute care hospitals as well as access to physicians and hospitals across all 50 states.

Ease

Less paperwork.With EmblemHealth ConsumerDirect EPO, there are generally no claim forms to file. Our network providers do the work for you.

24/7 customer service.Easy-to-use online tools, available at our secure web site, www. emblemhealth.com, make it easy for members to manage their account activity, balances, and savings growth. In addition, members may access provider listings, eligibility, claims status, benefits, and more online or by calling our automated phone system.

Respect

At EmblemHealth, we understand the things that matter to members about their health care coverage—including respect for their time, intelligence, and money.

Plan Details

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Services	in-network
Office Visit	Deductible & Coinsurance
Annual Physical Check-up	Covered in Full
Preventive Mammography, Pap Smear, Prostate Screening	Covered in Full
Well-Baby and Well-Child Care	Covered in Full
Inpatient Hospital Services	Deductible & Coinsurance
Skilled Nursing Facility Care	Deductible & Coinsurance
Hospice Care - Inpatient and Outpatient	Deductible & Coinsurance
Ambulatory Surgery Facility	Deductible & Coinsurance
Home Health Care	Deductible & Coinsurance
Chiropractic Care	Deductible & Coinsurance
Diagnostic Lab and Radiology	Deductible & Coinsurance
Emergency Room Facility	Deductible & Coinsurance
Inpatient Mental Health Care	Deductible & Coinsurance
Outpatient Mental Health Care	Deductible & Coinsurance
Inpatient Chemical Dependency Care	Deductible & Coinsurance
Outpatient Chemical Dependency Care	Deductible & Coinsurance
Prescription Drugs	Deductible & Coinsurance

1 Some services are subject to precertification.
2 EmblemHealth cannot ensure that a particular vendor will remain in the program. These programs are not covered services underwritten by Group Health Incorporated ("GHI") as part of the EmblemHealth ConsumerDirect EPO.

The EmblemHealth ConsumerDirect EPO program is underwritten by Group Health Incorporated ("GHI") and provides in-network benefits only. Except for emergency hospital care, no out-of-network services are covered. Coverage is subject to all terms, conditions, limitations, and exclusions set forth in the contract and certificate of insurance. Refer to GHI policy form numbers PLH-SGC -997, et. al.

	Plan Options
	SMALL BUSINESS
	MEDIUM & LARGE BUSINESS
	INDIVIDUALS
	CITY, STATE AND FEDERAL MEMBERS
	MEDICARE
	MEDICARE SUPPLEMENT INSURANCE
	STATE SPONSORED PROGRAMS - Medicaid - Family Health Plus - Child Health Plus
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