HMO 40-60 Gold by EmblemHealth
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- HMO 40-60 Gold
- Insurance Company
- EmblemHealth
In Network Benefits
- Office Co-pay
- $40 after deductible
- Specialist Co-pay
- $60 after deductible
- Hospital Co-pay
- $1,500 after deductible
- Emergency Room
- $200 after deductible
- Referrals Needed
- Yes
- Rx: Generic/Brand/High Brand
- $15/$35/$75 after $100 deductible
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $5,500/$11,000
Out Of Network Benefits
- Deductible (single/family)
- N/A
- Co-Insurance
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Pediatric Vision and Dental
- Renewal Date
- Annual
- HSA Eligible
- No
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