The HIP Prime HMO plan (underwritten by HIP Health Plan of New York, an EmblemHealth company) follows the concept of total prepaid group
practice hospital and medical care, that is, there is no out-of-pocket
cost to the staff member for covered services at numerous participating
medical groups in the Greater New York area. The costs of necessary
emergency treatment obtained outside the covered area are included in
the plan coverage. In addition, prescription drugs are covered with a $5 co-payment when obtained through an EmblemHealth participating pharmacy and prescribed by EmblemHealth physicians or any physician in a covered emergency. Durable medical equipment (DME) is covered in full when obtained through EmblemHealth participating DME vendors and prescribed by EmblemHealth physicians or any physician in a covered emergency. Participants in the HIP Prime HMO plan may select a physician at an EmblemHealth medical centre or from a listing of 31,000 affiliated
physicians for primary care and specialist services. The affiliated physician is visited in his or her private office. If you require specialty care, your primary care physician will refer you to an EmblemHealth specialist. To select an affiliated physician, the HIP Prime HMO participant should call EmblemHealth at 1-800-447-8255, go to the web site at www.emblemhealth.com or call the physician you wish to visit. Most languages may be accessed through Customer Service at 1-800-447-8255. Additional information regarding EmblemHealth providers for the HIP Prime HMO plan will be provided to participants during the annual enrolment campaign and also mailed by EmblemHealth to all participants upon request.
The premium rates and related percentages of salary contribution are shown on the 2013 premium schedule..
Benefits under the HIP Prime HMO plan will remain unchanged in
the renewal period. The package of benefits under the HIP Prime HMO plan is itemized
in the plan summary.
Worldwide emergency care
Participants are covered 100% for emergency treatment
anywhere in the world. The member needs to call his primary care physician.
In some cases air transport would also be covered to return to New York.
Discount prescription drug programme
Prescriptions for maintenance drugs are $2.50 per month through the Express Scripts, Inc. (ESI) home-delivery service, which can be accessed through the Pharmacy section of www.emblemhealth.com. Up to a 90-day supply can be requested. You can order online through the Pharmacy section of www.emblemhealth.com, you can call ESI to place your order (1-877-866-5798), or you can order by mail using a form and addressed envelope that ESI provides.
Participants are covered 100% for a routine annual eye examination at affiliated optometrists. Prescription lenses and frames can be chosen from a select group for a cost of $45 and are available every 24 months. Participants are not required to purchase the eyewear from the same provider rendering the eye examination. Lasik surgery discounts are available through Davis Vision.
With EmblemHealth’s Preventive Dental program, participants in the HIP Prime HMO plan may visit any Careington International
network practitioner to receive dental services. Participants do not need to select a primary dentist and do not need a referral to see a
network specialist. Participants must use practitioners who are part of the Careington International network to receive network discounts
under the program. For more information or to find a local participating dentist,
call Careington International at 1-877-548-4447 or visit www.careington.com.
By visiting a Careington participating network dentist, participants can receive an exam for a $5 co-payment and a routine cleaning for a
$10 co-payment every six months. All other services are available at the Careington network discount rates.
The Preventive Dental program is a discount plan, and does not include reimbursement for dental procedures.
EmblemHealth Internet site for HIP Prime HMO
Subscribers in the HIP Prime HMO plan are encouraged to activate an account on the secure site
myEmblemHealth at www.emblemhealth.com.
Participants using myEmblemHealth can access their benefits and perform the following tasks:
Request an ID card
Change primary care physician
Change phone number and address
View alternative medicine providers (chiropractors, acupuncturists etc.)
View and print the drug formulary
Sign up as a member and view benefits and claims online
Review procedure to receive prescription, if not on the formulary
See Fitness Center locations and discounts