Which groups are eligible: Small businesses with 1 to 100 full-time equivalent (FTE) employees and a primary business address in New York State.
Which employees are eligible: Qualifying individuals and families living in one of 28 New York counties, including the five New York City boroughs, Westchester, Long Island, and regions stretching north of Albany. Children and young adults can stay on a parent’s plan until age 26, or through age 29 for an added cost.
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| Referralsinfo | Required for specialist visits |
| Deductibleinfo | $6,300 individual/$12,600 family |
| Out-of-pocket maximum info | $6,300 individual/$12,600 family |
| Out-of-networknfo coverage | No coverage for non-emergency services |
| Primary care physicianinfo | 3 free sick visits then $35 before deductible |
| Preventive careinfo | Fully covered |
| Specialist info | $70 before deductible |
| Urgent care | $75 before deductible |
| Pharmacy | $10 generic drugsinfo before deductible |
| Telemedicineinfo | Fully covered |
| Acupuncture | Fully covered for up to 12 visits/plan year |
| Gym | Reimbursement up to $400 per plan year if qualified |
| Dental | Adult and pediatric dental care before deductible |
| Vision | Free vision exams; eyewear covered before deductible |
Since our Small Group Plans offer network-only coverage, members are responsible for the total cost of non-emergency care they receive outside their plan’s provider network.
Use the FAIR Health Calculator* to estimate the cost of non-emergency medical services and procedures by zip code.
*FAIR Health, Inc. is an independent nonprofit organization that uses actual provider charges when calculating fees. FAIR Health ensures that its fee information is accurate and complete. Please review the privacy policy and terms and conditions posted on the FAIR Health website.
With our robust network of quality doctors, you can get care from many of the region’s leading doctors, clinicians and facilities, including hospitals and urgent care centers.
EmblemHealth Silver Value is underwritten by HIP Health Plan of New York. Coverage is subject to all terms, conditions, limitations and exclusions set forth in the contract. Refer to HIP policy form number 155-23-SGOFFHIXCONTRACT (04/17).
