Gold Plus Gated by EmblemHealth
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Gold Plus Gated
- Insurance Company
- EmblemHealth
In Network Benefits
- Office Co-pay
- $40 ($0 first 3 visits)
- Specialist Co-pay
- $60
- Hospital Co-pay
- $150 after deductible
- Emergency Room
- $300 after deductible
- Referrals Needed
- Yes
- Rx: Generic/Brand/High Brand
- $15 (deductible waived)/$30/$70
- In-Network Deductible (single/family)
- $550/$1,100
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $4,500/$9,000
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
- Vision and Dental
- HSA Eligible
- No
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