Our qualified health plans offer a range of benefits to help you stay healthy with access to top doctors in our Select Care Network. You must stay in-network to receive coverage.
Individual and Family Plans
Serviced by the Select Care Network
Compare Plans
We offer a range of plans through New York’s health insurance marketplace as well as other coverage options for individuals and families.
Financial assistance: You may be eligible for tax credits to help with premiums and out-of-pocket costs when enrolling through NY State of Health (NYSOH).
Bronze |
Silver |
Gold |
Platinum |
Catastrophic |
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A smart choice if you want to pay less for premiums and don’t seek frequent medical care. Monthly Premium: In-Network Deductible: |
A good balance if you go to the doctor regularly but want a low premium. Monthly Premium: In-Network Deductible: |
Consider this if you go to the doctor often and want a low deductible. Monthly Premium: In-Network Deductible: |
An option if you receive frequent care and don’t want a deductible. Monthly Premium: In-Network Deductible: |
For individuals under age 30 and those who qualify for financial assistance. Monthly Premium: In-Network Deductible |
| Highlight Differences | ||||
| Monthly Premiuminfo | ||||
| LowestLowModerateHighLowest for those meeting eligibility requirements | ||||
| Deductibleinfo | ||||
| $3,800 individual/$7,600 family$2,100 individual/$4,200 family$600 individual/$1,200 family$0 individual/$0 family$9,200 individual/$18,400 family | ||||
| Maximum Out-of-Pocketinfo | ||||
| $9,200 individual/$18,400 family$9,200 individual/$18,400 family$7,900 individual/$15,800 family$2,000 individual/$4,000 family$9,200 individual/$18,400 family | ||||
| Summary of Benefits and Coverageinfo | ||||
| Marketplace Plans Off-Exchange PlansMarketplace Plans Off-Exchange PlansMarketplace Plans Off-Exchange PlansMarketplace Plans Off-Exchange PlansMarketplace Plans Off-Exchange Plans |
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| Networkinfo | ||||
| 19 counties19 counties19 counties19 counties19 counties | ||||
| Referralsinfo | ||||
| Required for specialist visitsRequired for specialist visitsRequired for specialist visitsRequired for specialist visitsRequired for specialist visits | ||||
| Out-of-Network Coverageinfo | ||||
| No coverage for nonemergency servicesNo coverage for nonemergency servicesNo coverage for nonemergency servicesNo coverage for nonemergency servicesNo coverage for nonemergency services | ||||
| Preventive Careinfo | ||||
| Covered in fullCovered in fullCovered in fullCovered in fullCovered in full | ||||
| Primary Care Provider (PCP) Visitsinfo | ||||
| $50 copay after deductible with up to three copay visits** before deductible$30 copay after deductible with one copay visit** before deductible$25 copay after deductible$15 copayThree no-cost PCP visits, then 0% coinsurance after deductible | ||||
| Specialist Visitsinfo | ||||
| $75 copay after deductible with up to three copay visits** before deductible$65 copay after deductible with one copay visit** before deductible$40 copay after deductible$35 copay0% coinsurance after deductible | ||||
| Telemedicineinfo | ||||
| Covered in fullCovered in fullCovered in fullCovered in full0% coinsurance after deductible | ||||
| Urgent Careinfo | ||||
| $75 copay after deductible$70 copay after deductible$60 copay after deductible$55 copay0% coinsurance after deductible | ||||
| Emergency Roominfo | ||||
| $500 copay after deductible$500 copay after deductible$150 copay after deductible$100 copay0% coinsurance after deductible | ||||
| Pharmacyinfo | ||||
| $10 copay for generic drugs after deductible$15 copay for generic drugs before deductible$10 copay for generic drugs before deductible$10 copay for generic drugs0% coinsurance after deductible | ||||
| Gym Reimbursementinfo | ||||
| Reimbursement up to $400 per calendar year if qualifiedReimbursement up to $400 per calendar year if qualifiedReimbursement up to $400 per calendar year if qualifiedReimbursement up to $400 per calendar year if qualifiedReimbursement up to $400 per calendar year if qualified | ||||
| Pediatric Dental and Visioninfo | ||||
| Coverage up to age 19Coverage up to age 19Coverage up to age 19Coverage up to age 19Coverage up to age 19 | ||||
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Convenient Care Where You Live and Work
To enroll in an EmblemHealth plan serviced by the Select Care Network, you must live in the eligible service area:
Albany, Broome, Columbia, Delaware, Dutchess, Fulton, Greene, Montgomery, Orange, Otsego, Putnam, Rensselaer, Saratoga, Schenectady, Schoharie, Sullivan, Ulster, Warren, or Washington counties.
If you live in New York City, Long Island, Westchester, or Rockland County, explore Essential Plan, Medicaid, and other coverage options. Visit our Individual and Family Plans page for more information.
The EmblemHealth Difference
Your health and well-being depends on more than just going to the doctor. That’s why we offer you additional wellness benefits to help keep you feeling your best.
**Free, with no obligation to enroll.
Frequently Asked Questions
Get the answers you need to make the most of your plan.
You can enroll in an EmblemHealth individual and family plan during open enrollment. This yearly period begins in November for coverage starting Jan. 1 of the next calendar year. NY State of Health (NYSOH) determines when the open enrollment period starts and ends in New York state.
Outside of open enrollment, you may still be able to enroll in coverage if you have certain qualifying life events, like getting married, having a baby, losing other health coverage, or experiencing a change in your household income.
In advance of open enrollment each year, EmblemHealth and NYSOH will mail renewal notices to plan members with information on when to renew and what documentation needs to be provided (for example, pay stubs, tax returns, or other proof of income). Information about financial help and monthly premiums will also be included.
Beginning Jan. 1, 2025, pregnant and postpartum* members enrolled in an individual and family plan** through NYSOH will have cost-sharing waived for most services. Cost-sharing waivers are contingent on federal funding and may change or end during the plan year.
Cost-sharing will still apply for the following services:
- Inpatient hospital and birthing center services for delivery.
- All inpatient services (e.g., hospital, rehabilitation, mental health/substance use disorder, and hospice).
- Emergency care in a hospital.
- Physician, nurse practitioner, and midwife services for delivery.
- Ambulance services.
- Pediatric vision and dental services.
*The postpartum period lasts 12 months following any pregnancy.
** Excluding those enrolled in a Catastrophic plan.
Yes, as of Jan. 1, 2025, prescription insulin is covered with a $0 cost-share for members enrolled in individual and family plans. Copays, coinsurance, and deductibles will also be waived for members with a diabetes diagnosis who are enrolled in an individual and family plan*** through NYSOH, for the following:
- Primary care office visits for the diagnosis, management, and treatment of diabetes.
- One office visit to perform an annual dilated retinal examination.
- One office visit to perform an annual diabetic foot exam.
- Diabetic self-management education services.
- Laboratory procedures and tests for the diagnosis and management of diabetes.
- Diabetic equipment and related supplies for the treatment of diabetes when prescribed by your doctor or another professional who is legally authorized to prescribe, including:
- Acetone reagent strips.
- Acetone reagent tablets.
- Alcohol or peroxide by the pint.
- Alcohol wipes.
- All insulin preparations.
- Automatic blood lance kit.
- Cartridges for the visually impaired.
- Diabetes data management systems.
- Disposable insulin and pen cartridges.
- Drawing-up devices for the visually impaired.
- Equipment for use of the insulin pump, including batteries.
- Glucagon for injection to increase blood glucose concentration.
- Glucose acetone reagent strips.
- Glucose kit.
- Glucose monitor (with or without special features for visually impaired), control solutions, and strips for home glucose monitor.
- Glucose reagent tape.
- Glucose test or reagent strips.
- Injection aides.
- Injector (Busher) automatic.
- Insulin cartridge delivery.
- Insulin infusion devices.
- Insulin pump.
- Lancets.
- Oral agents such as glucose tablets and gels.
- Oral antidiabetic agents used to reduce blood sugar levels.
- Syringe with needle; sterile 1 cc box.
- Urine testing products for glucose and ketones.
- Additional supplies, as the New York State Commissioner of Health shall designate by regulation as appropriate for the treatment of diabetes.
Note: Cost-sharing may apply to other services provided during the same visit as diabetic services.
*** Excluding members enrolled in a Catastrophic plan.
