The GHI FEHB Program

Standard Option Plan

This is our in-network plan, which means you can get care from our large network of quality doctors, including specialists, without a referral. Simply choose one of our network doctors and make an appointment.

In most cases, your only out-of-pocket cost will be a copay. For dependent children under age 26, copays are eliminated for all office visits, including but not limited to allergy, physical and speech therapy, specialist, laboratory and radiology services.

Enrollment: 1-800-624-2414, (TDD: 711), Monday to Friday, 8 a.m. to 6 p.m. (closed on weekends.)

Customer Service: call the number on the back of your member ID card, Monday to Friday, 8 a.m. to 6 p.m. (closed on weekends.)

Enrollment Codes and Rates 2019

The Standard Option Plan serves New York City plus most New York counties, as well as Northern New Jersey.


These plans are only available to individuals who live or work in certain counties. Please see Federal RI 73-007 for the counties included in the service area.

 

Non-Postal Premium

Postal Premium

Biweekly

Monthly

Biweekly

Type of Enrollment

Enrollment Code

Gov’t Share

Your Share

Gov’t Share

Your Share

Category 1 Your Share

Category 2 Your Share

All of New York and Northern New Jersey

Standard Option Self Only

804

230.18 美元

197.19 美元

498.72 美元

427.25 美元

193.99 美元

184.40 美元

Standard Option Self Plus One

806

492.27 美元

501.81 美元

1,066.59 美元

1,087.25 美元

494.97 美元

474.46 美元

Standard Option Self and Family

805

525.32 美元

511.51 美元

1,138.19 美元

1,108.28 美元

504.21 美元

482.33 美元

 

Non-Postal rates apply to most non-Postal employees. If you are in a special enrollment category, refer to the Guide to Federal Benefits for that category or contact the agency that maintains your health benefits enrollment.


Postal Category 1 rates
 apply to career employees covered by the National Postal Mail Handlers Union (NPMHU), National Association of Letter Carriers (NALC) and Postal Police bargaining units.


Postal Category 2 rates
 apply to other non-APWU, non-PCES, non-law enforcement Postal Service career employees, including management employees, and employees covered by the National Rural Letter Carrier’s Association bargaining unit.


Special Guides to Benefits are published for American Postal Workers Union (APWU) employees (see RI 20-2A) including Material Distribution Center, Operating Services and Information Technology/ Accounting Services employees and Nurses; Postal Service Inspectors and Office of Inspector General (OIG) law enforcement employees (RI 70-2IN); Postal Career Executive Service (PCES) employees (see RI 70- 2EX); and non-career employees (see RI 70-8PS).


Career APWU employees hired before 2011年五月23日 will have the same rates as the Category 2 rates shown below. In the Guide to Benefits for APWU Employees (RI 70-2A) this will be referred to as the “Current” rate; otherwise, “New” rates apply.


For further assistance, Postal Service employees should call:

Human Resources, Shared Service Center, 1-877-477-3273, option 5 (TTY: 1-866-260-7507)


Postal rates do not apply to non-career postal employees, postal retirees, or associate members of any postal employee organization who are not career postal employees. Refer to the applicable Guide to Federal Benefits.    

Plan Details

Summary of Benefits and Coverage:

GHI EPO Standard Option

If you have questions about your plan benefits or would like to request a free printed copy of the SBC, please call the number on the back of your member ID card, from 8 am to 8 pm, seven days a week (excluding major holidays). If you have a hearing or speech impairment and use a TDD, call 711.

Benefits at-a-glance: GHI FEHB High Option and Standard Option

 

Standard Option

 

网络内

网外

 

医疗护理

PCP office visit

$50 copay
$10 copay dependent children

不承保

   

Specialist office visit

$50 copay
$10 copay dependent children      

不承保

   

Diagnostic lab/X-ray

$50 copay
$10 copay dependent children

不承保

   

预防保健

Routine physical exam

$0 copay

不承保

   

Well child care

$0 copay

不承保

   

Women’s wellness services

$0 copay

不承保

   

其他服务

Outpatient mental health

$0 copay

不承保

   

紧急护理

$75 copay

不承保

   

Ambulance

You pay all charges after $100

不承保

   

处方药物

$15 generic/$50 brand/$100 non-formulary copay/25% coinsurance up to $200 maximum per script for specialty drugs

不承保

   

Hospital Services

Inpatient care

$500 copay per day/$1000 maximum

不承保

   

急诊室

$200 copay (waived if admitted)

$200 copay (waived if admitted)

   

Ambulatory surgery

$150 copay

不承保

   

For complete details about the benefits available through these plans, please read the Federal RI 73-007.

医疗人员网络

凭借我们强大的优质医生网络,您可以从该地区许多领先的医生、临床医生和设施(包括医院和紧急护理中心)获得治疗。

You can find network doctors throughout the neighborhoods of all five boroughs of New York City, plus in Nassau, Suffolk, Westchester, Rockland and Orange counties.

With a GHI plan you have coverage at top-ranked area hospitals, including:

• Lenox Hill Hospital

• Memorial Sloan-Kettering Cancer Center

• Montefiore Medical Center

• North Shore-Long Island Jewish Health System

• NYU Hospital Center

• Staten Island University Hospital

• St. Barnabas Hospital Health Center

• And many more

Need to see a doctor?

To find a doctor in your plan’s network, click the Find a Doctor link below.

You can use a handy Map and Directions tool to locate a doctor’s office when you click on his or her name in our directory. Note that this tool is also available via smartphone!

Looking for Teladoc information?

 

In your secure member portal, myEmblemHealth, you have convenient access to your personal information, including benefits and valuable health management tools.

Stay on top of your benefits

When you sign in, you can:

  • Review your health benefits.
  • View your prescription history.
  • Look up covered drugs and locate a pharmacy.
  • Find claims information (such as claim or prior approval status, the amount paid toward your deductible and much more).
  • Order ID cards.
  • Download forms.
  • Update personal information, such as your email address.

Assess and track your health

With myEmblemHealth, you can take a more active role in your health by using a range of online self-management tools like the following:

  • Health Assessment (HA) — Get a customized picture of your health, and receive recommendations to improve unhealthy behavior that affects your quality of life and your health status. We also encourage your adult covered dependents to complete their own HA.
  • Personal Health Record (PHR) — Keep your health records well-organized right in one secure place. Copies of your PHR can be printed and shared with your doctors.
  • Treatment Cost Calculator – Estimate your share of costs for many common conditions and services, based on your particular benefits and coverage information.

Go green and get rid of clutter

Having all your health plan information online is a great way to get rid of clutter, stay organized and keep on top of your health at your convenience. By going paperless, you can conveniently access your personal message center to read plan communications, while helping to save trees!

Get the following items and more electronically:

  • Explanations of benefits (EOBs)
  • Notifications regarding when your claims are processed
  • Personalized information about your health
  • Your plan newsletter
  • Timely communications about your coverage and benefits

Enrollment and customer service

If you are a prospective member and have questions about enrollment, call 1-800-624-2414, Monday to Friday, 8 am to 6 pm (closed on weekends.) Use the Interactive Voice Response System after business hours. If you have a hearing or speech impairment and use a TDD, call 711.

If you are a current plan member, call the number on the back of your member ID card, Monday to Friday, 8 am to 6 pm (closed on weekends.)

Choosing GHI FEHB

If you’d like to join a GHI FEHB plan in which you’re not currently enrolled, simply fill out the enrollment form available from your agency’s Human Resources office. Make sure to include the GHI FEHB plan enrollment codes as shown on the Enrollment Codes and Rates section.

FEHB Drug Comparison Tool

Use our drug comparison tool to estimate your out-of-pocket prescription drug costs. Enter the medications you take and we'll show you your monthly out-of-pocket costs.

Click here to access it through ExpressScripts.   


  • Brochure

    最后更新日期:2019年09月05日
  • Summary of Benefits and Coverage - Standard Option

    最后更新日期:2019年09月05日
  • Federal RI 73-001

    最后更新日期:2019年09月05日

Provider Coverage

凭借我们强大的优质医生网络,您可以从该地区许多领先的医生、临床医生和设施(包括医院和紧急护理中心)获得治疗。

A partner in wellness

The Right Care, Right in Your Neighborhood

AdvantageCare Physicians are the newest addition to the EmblemHealth family and are now one of the largest primary and specialty care practices in New York City. With 37 locations throughout New York City and Long Island, you can find a convenient location near home or work.