Who's eligible: Individuals and families living within the 28 New York counties. Children and young adults can stay on a parent’s plan until age 26.
Financial assistance: Tax credits available for qualified individuals to help with premiums and out-of-pocket costs when enrolling on the NY State of Health Marketplace.
Contact Sales
866-230-1071
| Referralsinfo | Required for specialist visits |
| Deductibleinfo | $4,000 individual/$8,000 family |
| Out-of-pocket maximuminfo | $4,000 individual/$8,000 family |
| Out-of-networkinfocoverage | No coverage for non-emergency services |
| Primary care physicianinfo | 3 free sick visits then $45 before deductible |
| Preventive carenfo | Fully covered |
| Specialist | $65 before deductible |
| Urgent care | $75 before deductible |
| Pharmacy | $10 generic drugs before deductible |
| Telemedicineinfo | Fully covered |
| Acupuncture | Fully covered |
| Gym | Reimbursement up to $400 per calendar year if qualified |
| Dental | Adult and pediatric dental care |
| Vision | Adult and pediatric vision benefits |
The Gold Value plan is on EmblemHealth’s Select Care Network. Members are responsible for the total cost of non-emergency care they receive outside their plan’s provider network.
Since our Individual/Family and Essential 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.
*The letter "D" after a plan name indicates that the plan is available directly from EmblemHealth, rather than through the NY State of Health Marketplace.
