EmblemHealth Health Insurance Review

#13 in Health Insurance

EmblemHealth is a privately held company that provides affordable and quality health benefits to individuals, families, and businesses. The company delivers personalized health insurance that offer a mix of premium, coverage and out of pocket costs.

What’s Included with EmblemHealth?

  • Chiropractic/physical therapy
  • Behavioral health care services
  • Radiology services
  • Laboratory services
  • Home infusion therapy
  • Prescription drugs
  • Maternity and newborn care
  • Habilitative and rehabilitative services
  • Mental health and substance abuse services
  • Pediatric vision care
  • Inpatient and outpatient hospital services
  • Refractive and diabetic eye exams
  • Special kinds of care

Types of Health Insurance Plans

 

Businesses and Organizations

Yes

Individuals and Families

Yes

Short-Term Health Insurance

Not Stated

Other Plans Offered:

  • Catastrophic Plans
  • The Essential Plan
  • Medicaid
  • FirstSmiles
  • Child Health Plus

Plans Reviewed

Select Care Basic

  • Annual deductibles: $6,850 per individual and $13,700 per family
  • Out-of-pocket limit: $6,850 per individual and $13,700 per family
  • For individuals under the age of 30 and others who qualifies based on their financial needs
  • No co-payments and co-insurance after deductibles
  • 100% coverage for preventive care that includes immunizations, screenings, routine checkups, mammogram, and prostate exam Access to AdvantageCare Physicians

Select Care Bronze

  • Annual deductibles: $3,700 per individual and $7,000 per family
  • Out-of-pocket limit: $6,850 per individual and $13,700 per family
  • 50% co-insurance after deductibles
  • No co-payment after deductibles
  • Access to AdvantageCare Physicians
  • 100% coverage for preventive care that includes mammogram, immunizations, colonoscopy, cervical screening, prostate exam, and routine check-ups

Select Care Silver

  • Annual deductibles: $2,000 per individual and $4,000 per family
  • Out-of-pocket limit: $5,500 per individual and $11,000 per family
  • Co-payment after deductible: $30/$50/$150
  • Co-insurance after deductibles on selected servicesAccess to AdvantageCare Physicians
  • 100% coverage for preventive care services that includes immunizations, routine check-ups, mammogram, cervical screening, colonoscopy, and prostate exam

Select Care Gold

  • Annual deductibles: $600 per individual and $1,200 per family
  • Out-of-pocket limit: $4,000 per individual and $8,000 per family
  • Co-insurance after deductibles on selected services
  • 100% coverage for preventive care services that includes prostate exam, routine check-ups, immunizations, mammogram, cervical screening, and colonoscopy
  • Access to AdvantageCare Physicians

Select Care Platinum

  • No annual deductibles for individuals and families
  • Out-of-pocket limit: $2,000 per individual and $4,000 per family
  • Co-insurance after deductibles on selected services
  • Co-payment after deductibles: $15/$35/$100
  • 100% coverage for preventive care services that includes mammogram, colonoscopy, prostate exam, immunizations, routine check-ups, and cervical screening
  • Access to AdvantageCare Physicians

How Much Does It Save You?

Services Offered

Select Care Basic

Select Care Bronze

Select Care Silver

Select Care Gold

Select Care Platinum

Major Cost-Sharing Provisions

Prescription Drugs

0% co-insurance after deductible

Generic: $10 co-pay

Preferred brand: $35 co-pay

Non-preferred brand: $70 co-pay

Specialty drugs: $70 co-pay

Generic: $10 co-pay

Preferred brand: $35 co-pay

Non-preferred brand: $70 co-pay

Specialty drugs: $70 co-pay

Generic: $10 co-pay

Preferred brand: $35 co-pay

Non-preferred brand: $70 co-pay

Specialty drugs: $70 co-pay

Generic: $10 co-pay

Preferred brand: $30 co-pay

Non-preferred brand: $60 co-pay

Specialty drugs: $60 co-pay

Hospital Admission

0% co-insurance after deductible

50% co-insurance after deductible

$1,500 co-pay per admission after deductible

$1,000 co-pay per admission after deductible

$500 co-pay per admission

Emergency Room Co-pay

5% co-insurance after deductible

50% co-insurance after deductible

$150 co-pay per visit after deductible

$150 co-pay per visit after deductible

$100 co-pay per visit

Primary Care Physician Office Visits

0% co-insurance after deductible

50% co-insurance after deductible

$30 co-pay per visit after deductible

$25 co-pay per visit after deductible

$15 co-pay per visit

Specialists Office Visit

0% co-insurance after deductible

50% co-insurance after deductible

$50 co-pay per visit after deductible

$40 co-pay per visit after deductible

$35 co-pay per visit

Inpatient Hospital Services

Inpatient Physician and Surgical Services

0% co-insurance after deductible

50% co-insurance after deductible

$100 co-pay after deductible

$100 co-pay after deductible

$100 co-pay

Operating and Recovery Room, Lab Tests, X-rays, General Nursing Care, Intensive and Special Care, and Prescribed Drugs

0% co-insurance after deductible

50% co-insurance after deductible

Included in hospital admission co-pay after deductible

Included in hospital admission co-pay after deductible

Included in hospital admission co-pay

Pre-admission Testing

0% co-insurance after deductible

50% co-insurance after deductible

Covered in full

Covered in full

Covered in full

Short-term Speech, Occupational, Physical, and Respiratory Therapy

5% co-insurance after deductible

50% co-insurance after deductible

Included in hospital admission co-pay after deductible (short-term only)

Included in hospital admission co-pay after deductible

(short-term only)

Included in hospital admission co-pay

(short-term only)

Radiation Therapy and Chemotherapy

0% co-insurance after deductible

50% co-insurance after deductible

Subject to PCP office visit co-pay after deductible

Subject to PCP office visit co-pay after deductible

Subject to PCP office visit co-pay

Semi-private Room and Abroad

0% co-insurance after deductible

50% co-insurance after deductible

Included in hospital admission co-pay after deductible

Included in hospital admission co-pay after deductible

Included in hospital admission co-pay

Outpatient Hospital Services

Special Office Visits

0% co-insurance after deductible

50% co-insurance after deductible

Subject to specialist office visit co-pay after deduction

Subject to specialist office visit co-pay after deductible

Subject to specialist office visit co-pay

Well-child Care

Covered in full

Covered in full

Covered in full

Covered in full

Covered in full

PCP Office Visits

0% co-insurance after deductible

50% co-insurance after deductible

Subject to specialist office visit co-pay after deduction

Subject to PCP office visit after deductible

Subject to PCP office visit co-pay

Diagnostic Services (X-ray, Lab Tests, EKGs)

0% co-insurance after deductible

50% co-insurance after deductible

Subject to specialist office visit co-pay after deduction

Subject to specialist office visit co-pay after deductible

Subject to specialist office visit co-pay

Ambulatory Surgery

0% co-insurance after deductible

50% co-insurance after deductible

$100 co-pay after deductible

$100 co-pay after deductible

$100 co-pay

Chiropractic Services

0% co-insurance after deductible

50% co-insurance after deductible

Subject to specialist office visit co-pay after deduction

Subject to specialist office visit co-pay after deductible

Subject to specialist office visit co-pay

Second Medical and Surgical Opinion

0% co-insurance after deductible

50% co-insurance after deductible

Subject to specialist office visit co-pay after deduction

Subject to specialist office visit co-pay after deductible

Subject to specialist office visit co-pay

Prenatal, Postnatal Care in Physician’s Office

Covered in full

Covered in full

Covered in full

Covered in full

Covered in full

Preventive Care

Covered in full

Covered in full

Covered in full

Covered in full

Covered in full

Mental Health and Substance Use Disorder

Mental Health Inpatient Treatment

0% co-insurance after deductible

50% co-insurance after deductible

Subject to specialist office visit co-pay after deduction

(no limit on days per year)

Subject to specialist office visit co-pay after deduction

(no limit on days per year)

Subject to specialist office visit co-pay

(no limit on days per year)

Mental Health Outpatient Treatment

0% co-insurance after deductible

50% co-insurance after deductible

Subject to specialist office visit co-pay after deduction

(unlimited visits per year)

Subject to specialist office visit co-pay after deduction

(unlimited visits per year)

Subject to specialist office visit co-pay

(unlimited visits per year)

Substance Use Disorder Inpatient Detoxification

0% co-insurance after deductible

 

50% co-insurance after deductible

Subject to specialist office visit co-pay after deduction

(no limit on days per year)

Subject to specialist office visit co-pay after deduction

(no limit on days per year)

Subject to specialist office visit co-pay

(no limit on days per year)

Substance Use Disorder Outpatient Rehabilitation Treatment

0% co-insurance after deductible

50% co-insurance after deductible

Subject to specialist office visit co-pay after deduction

(unlimited on days per year)

Subject to specialist office visit co-pay after deduction

(unlimited on days per year)

Subject to specialist office visit co-pay

(unlimited on days per year)

Substance Use Disorder Inpatient Rehabilitation Treatment

0% co-insurance after deductible

50% co-insurance after deductible

Subject to specialist office visit co-pay after deduction

(unlimited on days per year)

Subject to specialist office visit co-pay after deduction

(unlimited on days per year)

Subject to specialist office visit co-pay

(unlimited on days per year)

Special Care

Emergency and Urgent Care

0% co-insurance after deductible

50% co-insurance after deductible

Emergency room: $150 co-pay per visit after deductible

Urgent care facility: $70 co-pay after deductible

Ambulance service: $150 co-pay after deductible

Emergency room: $150 co-pay per visit after deductible

Urgent care facility: $60 co-pay after deductible

Ambulance service: $150

Emergency room: $100 co-pay per visit

Urgent care facility: $55 co-pay

Ambulance service: $100

Pediatric Vision

0% co-insurance after deductible

50% co-insurance after deductible

Subjected to PCP office visit co-pay after deductible and 30% co-insurance after deductible

Subjected to PCP office visit co-pay after deductible and 20% co-insurance after deductible

Subjected to PCP office visit co-pay and 10% co-insurance after deductible

Durable Medical Equipment

0% co-insurance after deductible

50% co-insurance after deductible

30% co-insurance after deductible

20% co-insurance after deductible

10% co-insurance

Infertility Diagnosis and Treatment

No charge

No charge

No charge

No charge

No charge

Family Planning

No charge

No charge

No charge

No charge

No charge

Hearing Aids

0% co-insurance after deductible

50% co-insurance after deductible

30% co-insurance after deductible

20% co-insurance deductible

10% co-insurance

Hospice Care

0% co-insurance after deductible

50% co-insurance after deductible

Subject to PCP office visit co-pay after deductible

Subject to PCP office visit co-pay after deductible

Subject to PCP office visit co-pay

Skilled Nursing Facility Care

0% co-insurance after deductible

50% co-insurance after deductible

Subject to hospital admission co-pay after deductible

Subject to hospital admission co-pay after deductible

Subject to hospital admission co-pay

Dialysis

0% co-insurance after deductible

50% co-insurance after deductible

Subject to PCP office visit co-pay after deductible

Subject to PCP office visit co-pay after deductible

Subject to PCP office visit co-pay

Annual Maximum Limit

Select Care Basic

None

Select Care Bronze

None

Select Care Silver

None

Select Care Gold

None

Select Care Platinum

None

*Only on specific covered services

Summary

EmblemHealth offers great coverage and discounts for each of its health insurance plans. However, this is not offered in all states so be sure to check its availability in your area.

 

 

 

 

 

 

 

 

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