EmblemHealth has a new partner in place to administer your vision benefits — EyeMed Vision Care with CPS Optical. EyeMed Vision Care with CPS Optical offer a comprehensive network including independent and retail providers, world-class customer service and exceptional value for you and your dependents through additional discounts and savings.
EmblemHealth VIP Essential (HMO) H3330-032 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by EmblemHealth Medicare HMO available to residents in New York. This plan includes additional Medicare prescription drug (Part-D) coverage. The EmblemHealth VIP Essential (HMO) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). Note: This Provider Directory includes participating providers in all specialties. Your specific Benefit Plan may not cover all services given by participating providers. Please look at your Certificate or Group Contract to find out if a particular service is covered under your Benefit Plan.
You don’t need to do anything as a result of this change. EmblemHealth, EyeMed and CPS are working to make sure this transition is seamless, so when your group’s new vision plan starts on January 1, 2017, you will have everything you need to receive your vision care.
Effective January 1, 2017, your current vision benefits will change as shown below, once every 12 months. You will receive your new DC37 Med Team ID card during December, 2016. No other benefits are changing under the DC37 Med Team program.
When you get your care from an optometrist in network, you are covered for:
- Examinations. You are covered for one routine eye examination to check if you need corrective lenses. You are not covered for medical treatment of eye disease or injury under this benefit, but you are covered for medical treatment under your regular insurance benefit. Your copay will be $0.
- Eyeglasses: One pair of glasses which includes the lenses and the frame.
- Spectacle Lenses: The fitting and dispensing of one pair of spectacle lenses.
- Standard spectacle lenses include:
- Glass or plastic lenses
- Single vision, bifocal or trifocal lenses
- Tinting of lenses
- Non-standard lens options include:
- Standard progressive lenses: $50 copay
- Premium progressive lenses: $50 copay plus 80% of retail minus $120
- Ultraviolet treatment: $15 copay
- Standard plastic scratch coating: $15 copay
- Standard polycarbonate lenses: $40 copay ($0 copay for children under 19)
- Standard anti-reflective coating: $45 copay
- Frames: We will pay an allowance of up to $130 for one frame. If you choose a frame that costs more than this allowance, you pay the difference in cost to the provider.
- Contact Lenses: EmblemHealth will not cover both eyeglasses and contact lenses in the same benefit cycle, but you can get contact lenses instead of glasses during any given cycle. Once contact lenses have been selected and fitted, they may not be exchanged for eyeglasses. You are covered for the fit and follow up of standard contact lenses. You are not covered for the fit and follow up of premium contact lenses. Your contact lenses are covered at 100% up to your allowance of $130. If you choose contact lenses that cost more than your allowance, you pay the difference to the provider.
Keep in mind that you are not covered for services received from a provider who is not a Participating Vision Provider.
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EmblemHealth VIP Value (HMO) H3330-036 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by EmblemHealth Medicare HMO available to residents in New York. This plan includes additional Medicare prescription drug (Part-D) coverage. The EmblemHealth VIP Value (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out of pocket. This can be a extremely nice safety net.
EmblemHealth VIP Value (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
EmblemHealth Medicare HMO works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for EmblemHealth VIP Value (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from EmblemHealth Medicare HMO and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from EmblemHealth Medicare HMO except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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2021 EmblemHealth Medicare HMO Medicare Advantage Plan Costs
| Name: |
|---|
| Plan ID: | H3330-036 |
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| Provider: | EmblemHealth Medicare HMO |
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| Year: | 2021 |
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| Type: | Local HMO |
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| Monthly Premium C+D: | $0 |
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| Part C Premium: | $0 |
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| MOOP: | $7,550 |
|---|
| Part D (Drug) Premium: | $0 |
|---|
| Part D Supplemental Premium | $0 |
|---|
| Total Part D Premium: | $0 |
|---|
| Drug Deductible: | $295.0 |
|---|
| Tiers with No Deductible: | 1 |
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| Gap Coverage: | No |
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| Benchmark: | not below the regional benchmark |
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| Type of Medicare Health: | Enhanced Alternative |
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| Drug Benefit Type: | Enhanced |
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| Similar Plan: | H3330-038 |
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EmblemHealth VIP Value (HMO) Part-C Premium
EmblemHealth Medicare HMO plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
H3330-036 Part-D Deductible and Premium
EmblemHealth VIP Value (HMO) has a monthly drug premium of $0 and a $295.0 drug deductible. This EmblemHealth Medicare HMO plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by EmblemHealth Medicare HMO above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
EmblemHealth Medicare HMO Gap Coverage
In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This EmblemHealth Medicare HMO plan does not offer additional coverage through the gap.
H3330-036 Formulary or Drug Coverage
EmblemHealth VIP Value (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2021 EmblemHealth VIP Value (HMO) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | Not covered |
|---|
| Endodontics | Not covered |
|---|
| Extractions | Not covered |
|---|
| Non-routine services | Not covered |
|---|
| Periodontics | Not covered |
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| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
|---|
| Restorative services | Not covered |
|---|
Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | 20% coinsurance |
|---|
| Diagnostic tests and procedures | $0-45 copay |
|---|
| Lab services | $0-15 copay |
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| Outpatient x-rays | $35 copay |
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Doctor Visits
| Primary | $15 copay per visit |
|---|
| Specialist | $50 copay per visit |
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Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
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| Urgent care | $65 copay per visit (always covered) |
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Foot Care (podiatry services)
| Foot exams and treatment | $50 copay |
|---|
| Routine foot care | $50 copay |
|---|
Ground Ambulance
Hearing
| Fitting/evaluation | Not covered |
|---|
| Hearing aids - inner ear | Not covered |
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| Hearing aids - outer ear | Not covered |
|---|
| Hearing aids - over the ear | Not covered |
|---|
| Hearing exam | $50 copay |
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Inpatient Hospital Coverage
$393 per day for days 1 through 5
$0 per day for days 6 through 90 |
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Medical Equipment/Supplies
| Diabetes supplies | $0 copay |
|---|
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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Medicare Part B Drugs
| Chemotherapy | 10-20% coinsurance |
|---|
| Other Part B drugs | 10-20% coinsurance |
|---|
Mental Health Services
| Inpatient hospital - psychiatric | $1,871 per stay |
|---|
| Outpatient group therapy visit | $40 copay |
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| Outpatient group therapy visit with a psychiatrist | $40 copay |
|---|
| Outpatient individual therapy visit | $40 copay |
|---|
| Outpatient individual therapy visit with a psychiatrist | $40 copay |
|---|
MOOP
Option
Optional supplemental benefits
Outpatient Hospital Coverage
Package #1
| Deductible |
|---|
| Monthly Premium | $12.50 |
|---|
Package #2
| Deductible |
|---|
| Monthly Premium | $15.00 |
|---|
Preventive Care
Preventive Dental
| Cleaning | $0 copay |
|---|
| Dental x-ray(s) | $0 copay |
|---|
| Fluoride treatment | $0 copay |
|---|
| Oral exam | $0 copay |
|---|
Rehabilitation Services
| Occupational therapy visit | $40 copay |
|---|
| Physical therapy and speech and language therapy visit | $40 copay |
|---|
Skilled Nursing Facility
$0 per day for days 1 through 20
$184 per day for days 21 through 100 |
|---|
Transportation
Vision
| Contact lenses | $0 copay |
|---|
| Eyeglass frames | $0 copay |
|---|
| Eyeglass lenses | $0 copay |
|---|
| Eyeglasses (frames and lenses) | $0 copay |
|---|
| Other | Not covered |
|---|
| Routine eye exam | $35 copay |
|---|
| Upgrades | Not covered |
|---|
Wellness Programs (e.g. fitness nursing hotline)
Reviews for EmblemHealth VIP Value (HMO) H3330
| 2019 Overall Rating |
|---|
| Part C Summary Rating |
|---|
| Part D Summary Rating |
|---|
| Staying Healthy: Screenings, Tests, Vaccines |
|---|
| Managing Chronic (Long Term) Conditions |
|---|
| Member Experience with Health Plan |
|---|
| Complaints and Changes in Plans Performance |
|---|
| Health Plan Customer Service |
|---|
| Drug Plan Customer Service |
|---|
| Complaints and Changes in the Drug Plan |
|---|
| Member Experience with the Drug Plan |
|---|
| Drug Safety and Accuracy of Drug Pricing |
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Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
|---|
| Breast Cancer Screening |
|---|
| Colorectal Cancer Screening |
|---|
| Annual Flu Vaccine |
|---|
| Improving Physical |
|---|
| Improving Mental Health |
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| Monitoring Physical Activity |
|---|
| Adult BMI Assessment |
|---|
Managing Chronic And Long Term Care for Older Adults
| Total Rating |
|---|
| SNP Care Management |
|---|
| Medication Review |
|---|
| Functional Status Assessment |
|---|
| Pain Screening |
|---|
| Osteoporosis Management |
|---|
| Diabetes Care - Eye Exam |
|---|
| Diabetes Care - Kidney Disease |
|---|
| Diabetes Care - Blood Sugar |
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| Rheumatoid Arthritis |
|---|
| Reducing Risk of Falling |
|---|
| Improving Bladder Control |
|---|
| Medication Reconciliation |
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| Statin Therapy |
|---|
Emblem Health Urgent Care Copay Card
Member Experience with Health Plan
| Total Experience Rating |
|---|
| Getting Needed Care |
|---|
| Customer Service |
|---|
| Health Care Quality |
|---|
| Rating of Health Plan |
|---|
| Care Coordination |
|---|
Member Complaints and Changes in EmblemHealth VIP Value (HMO) Plans Performance
| Total Rating |
|---|
| Complaints about Health Plan |
|---|
| Members Leaving the Plan |
|---|
| Health Plan Quality Improvement |
|---|
| Timely Decisions About Appeals |
|---|
Health Plan Customer Service Rating for EmblemHealth VIP Value (HMO)
| Total Customer Service Rating |
|---|
| Reviewing Appeals Decisions |
|---|
| Call Center, TTY, Foreign Language |
|---|
EmblemHealth VIP Value (HMO) Drug Plan Customer Service Ratings
| Total Rating |
|---|
| Call Center, TTY, Foreign Language |
|---|
| Appeals Auto |
|---|
| Appeals Upheld |
|---|
Does Emblemhealth Cover Urgent Care
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
|---|
| Complaints about the Drug Plan |
|---|
| Members Choosing to Leave the Plan |
|---|
| Drug Plan Quality Improvement |
|---|
Member Experience with the Drug Plan
| Total Rating |
|---|
| Rating of Drug Plan |
|---|
| Getting Needed Prescription Drugs |
|---|
Drug Safety and Accuracy of Drug Pricing
Emblem Health Urgent Care Copay Assistance
| Total Rating |
|---|
| MPF Price Accuracy |
|---|
| Drug Adherence for Diabetes Medications |
|---|
| Drug Adherence for Hypertension (RAS antagonists) |
|---|
| Drug Adherence for Cholesterol (Statins) |
|---|
| MTM Program Completion Rate for CMR |
|---|
| Statin with Diabetes |
|---|
Ready to Enroll?
Emblem Health Urgent Care Copay Program
Va Health Care Copay
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for EmblemHealth VIP Value (HMO)
(Click county to compare all available Advantage plans)
| State: | New York
|
|---|
| County: | Dutchess,Nassau,New York,Orange,Putnam,
Queens,Richmond,Rockland,Suffolk,
Sullivan,Ulster,Westchester, |
|---|
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Does Urgent Care Take Emblemhealth
Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
