Find benefit summaries, formularies (list of covered drugs), and all necessary forms to get the most out of your EmblemHealth coverage.
Looking for Medicare forms and documents?
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Find all available forms including authorization forms, claim forms and more.
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Health Insurance Claim Form - EmblemHealth, HIP, GHI
This form is used when seeking reimbursement for non-participating providers.
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Dental Claim Form - GHI
This form allows you to submit a dental claim having visited a nonparticipating dentist. All participating network dentists must submit claims forms directly to GHI for processing.
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Patient and Physician Statement Claim Form - HIP
Patient and Physician Statement Claim Form for HIP members
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Pharmacy Benefit Services Prescription Drug Claim Form - EmblemHealth
This form allows you to submit claims for EmblemHealth prescriptions.
Quick Start Guides
Get easy online access to your Quick Start Guide to help you get the most out of your health plan.
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EmblemHealth Consumer Direct EPO
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EmblemHealth Consumer Direct PPO
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EmblemHealth Child Health Plus
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EmblemHealth Enhanced Care Medicaid
Individual and Family Plan Documents
Access easy-to-read summaries of the most important things to know about your plan.
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EmblemHealth Silver Value Benefit Summary
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EmblemHealth Silver Value Summary of Benefits and Coverage
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EmblemHealth Silver Value Subscriber Contract
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EmblemHealth Gold Value Benefit Summary
Group Plan Documents
Access easy-to-read summaries of the most important things to know about your plan.
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EmblemHealth Platinum Premier Benefit Summary
2019 Direct from EmblemHealth (Non-standard)
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EmblemHealth Platinum Premier Summary of Benefits and Coverage
2019 Direct from EmblemHealth (Non-standard)
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EmblemHealth Platinum Premier Subscriber Certificate
2019 Direct from EmblemHealth (Non-standard)
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EmblemHealth Platinum Premier Dental
2019 Direct from EmblemHealth (Non-standard)
Formularies
承保药物清单
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2019 年基本健保计划药物名册
我们在纽约州官方健康保险的基本健保计划会员下涵承保的药物清单。It is up to date as of September 1, 2019.
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2019 年合格健保计划药物名册
我们在纽约州官方健康保险的合格健保计划会员下涵承保的药物清单。It is up to date as of September 1, 2019.
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2019 年大型团体药物名册
这是大型团体处方药（超过 50 种合格药物）的会员最常用的首选药物名册。
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2019 年小型团体药物名册
这是小型团体处方（生效日期：2019年7月1日）会员最常用的首选药物名册。
Member Handbooks
Your member handbook tells you how your plan coverage works to get the medical care you need and avoid out-of-pocket costs.
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Enhanced Care (Medicaid)
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增强护理优越计划 (HARP)
