Pharmacy Benefits

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Our Plans for Small Businesses

InBalance EPO

No copays for kids for office visits and diagnostics

In-network only coverage

An affordable plan with special cost-sharing features

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.

ConsumerDirect EPO

An affordable plan with cost-sharing features for other services

In-network only coverage

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.

Compatible with a triple tax-advantaged Health Savings Accounts (HSAs) or Health Reimbursement Arrangements (HRAs)

EmblemHealth HealthEssentials EPO

A low-cost plan covering in-hospital services billed by a network hospital

Preventive services covered in full, including well-child care; but all other physician-billed services are not covered

Available in our Downstate region including New York City, Westchester, Rockland and Long Island

Pharmacy benefit covers generic drugs (not brand-name drugs) at a small copay

Access to our National network of hospitals, including the leading acute care hospitals in the tristate area

Optional Riders

Optional Riders Overview

The above plans include the following options.

Age 29 Law Rider extends the age of dependency to age 30 (end of month), allowing the group's eligible members' dependents to remain covered under the member's plan.

Mental Health Parity Make Available Rider eliminates mental health and substance abuse visit limitations, allowing for unlimited visits.

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