Geeks News


Wednesday, April 8, 2009

NY's Emblem Health

Many folks do not know who Emblem Health is or where they came from, as they appear to be new on the scene. Well, that is not so, Emblem Health is the new holding company for the merged GHI and HIP plans. Connecticare in CT is also a member company of the new holding company.

Emblem actually has about 92,000 physicians in it's network, and includes a contract with the acclaimed cancer care center, Memorial Sloan Kettering.

In addition to great network statistics, and one with years of stability, Emblem Health has some of the lower premium numbers in the market in 2009. The plans with the "richest" plan designs and lowest premiums are their EPO plans (Exclusive Provider Organization) - you must navigate and stay within the network, as such out-of-network claims are not covered. The good news is you only pay copayments (the $40 EPO is the most well-priced option) for care, however they do have options with deductibles and coinsurance for major medical inpatient and outpatient care - some with $1,000 and others with $2,000. Also on the pharmacy front, they have these plans with 0 copay for generic drugs, $30 for brand name, and $50 for non-formulary medicines.

Also a bonus with Emblem is they boast to have 0 copay for children dependents of employees - so folks like me with 4 small kids would love them, all of the pediatric visits would be free!

I hope this information has given a good update on Emblem Health.


  1. Seems like Emblem Health has good these EPO plans, can you email back the exact names of them and how we can get quotes? Do we just submit our information on and will you do it for us? What states do you do small group plans in? Sorry for all of the questions -

  2. The plans to which you are referencing are the regular EPO options, not the "in-balance EPOs" those are deductible and coinsurance options whereas the standard Emblem Health EPO 40 option for example has benefit like we outline above...0 copays for dependent children 0 copay for generic drugs. Emblem Health has a great price point and a huge network. They need to continue their PR and advertising campaign as the old GHI (the network they predominantly use) was very big (covered the NYFD, NYPD, all of the NY Govt employees etc..)

    I hope this helps, yes please visit our site, you just submit a few small pieces of information and we email back loads of plan designs and prices all can email us, call us, live chat, or whatever is convenient for you. Also we have a live quote engine in just about all 50 states for individual health insurance too!

  3. If I take an Emblem Health EPO product, and have a Cancer issue, I would be able to go to Memorial Sloan Kettering in-network? love the site by the way. very easy to navigate.


  4. Wow Dirk, thanks for the compliments, we work hard at Health Insurance Geeks to inform, and to help. If you have a regular Emblem Health EPO, they are one of the only carriers in the NY market including BCBS, and Aetna, who have facility contracts with Sloan. One thing to be careful of, is you may have physicians there who DO NOT contract with your carrier, so you would have physician charges per an out-of-network benefit or with an EPO they would NOT BE COVERED. EPOs require in-network navigation, and this would not cover all charges in a place like Sloan that are not facility driven, ie actual Provider charges. I hope that helps!

  5. yeah, that helps but epo plans seem like dog shit (pardon the french, although i am not!). i want flexible chris, and also solid benefits in a health plan.....perhaps a ppo! your thoughts are appreciated and so is your quick customer service.

    Yours Truly,

  6. Wow Dirk, you sure dropped an "f" bomb there, we have younger folks reading this blog, so let's keep it G-rated!

    PPO plans are flexible, but at the same rate the most expensive plans. For group plans (the stated with no medical underwriting like NY and NJ for example) "rich" PPO plans with low deductibles and copays/coinsurance terms can encroach upon 900/single member or more. As such, most businesses can't budget that much, and are forced to explore other alternatives.

  7. I was told that although there are no copays for children, there are fees for blood tests and throat cultures. Do you know the details of this?
    My company is planning to switch to Emblem GHI EPO.