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HIPaccess® I
HIPaccess I Plan: Offers referral-free choices.
The HIPaccess I plan is a referral-free health plan with features beyond a traditional HMO plan. Members can see specialists without a referral from their Primary Care Physician (PCP). Members select a PCP to handle their basic health care, but they can visit specialists on their own or with the help of their PCP, whichever they prefer.
Features of the HIPaccess I plan include:
Referral-free plan.
Little or no paperwork.
In-network coverage only.
The HIPaccess I plan is offered through the Prime network and the expanded Premium network. Choose the network option that works best for your organization.
You can also customize a plan to fit your group's needs by choosing from a wide range of cost-sharing options and benefit riders.
HIPaccess I Details
| Services | in-network |
|---|---|
| Office Visits | Copayment |
| Office visits and diagnostic copay for dependent children |
Copayment | Annual Physical Check-up | No Copayment for Preventive Care Services Provided During Annual Physical Exam |
| Preventive Mammography, Pap Smear, Prostate Screening | No Copayment |
| Well-Baby and Well-Child Care | No Copayment |
| Inpatient Hospital Services | Copayment |
| Skilled Nursing Facility Care | No Copayment May be subject to maximum number of days per calendar year |
| Hospice Care - Inpatient and Outpatient | No Copayment Subject to maximum number of days |
| Ambulatory Surgery Facility | Copayment |
| Home Health Care | Copayment Subject to maximum number of visits per calendar year |
| Chiropractic Care | Copayment |
| Diagnostic Lab | Provider’s office: Included in office copayment Outpatient facility: No copayment |
| Diagnostic Radiology | Provider’s office: Included in office copayment Outpatient facility: No copayment |
| Emergency Room Facility | Copayment |
| Inpatient Mental Health Care | Copayment Unlimited |
| Outpatient Mental Health Care | Copayment Unlimited |
| Inpatient Substance Use Disorder | Copayment Unlimited |
| Outpatient Substance Use Disorder | Copayment Unlimited |
| Vision Exam, Frames And Lenses For Children |
Refractive eye exam: Copayment Eyeglasses: Copayment Subject to coverage period (number of months) |
| Prescription Drugs | Copayment |
1 Some services are subject to prior approval.
2 EmblemHealth participating providers are contracted to provide care to our members; they are not employees, agents,
servants or representatives of EmblemHealth.
3 This summary is provided for information only; it does not contain complete details of the Plan which are available only
in the Contract or Certificate of Coverage and Schedule of Benefits, and it does not constitute an Agreement.
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