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EmblemHealth Health Insurance Review

28 Customer Comments & Reviews - see all comments
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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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28 Customer Comments & Reviews

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Brandon H
8/16/2021
Please don't think about this company for a second. I have been fighting for a refund due to lapsed coverage for almost 6 months now. They are impossible to reach and when you do its a new person every single time. Every time i call i get a new person that needs to "follow up" with someone. This is the biggest scam i have ever faced in my life. The "lovely lady" (i used another word that i cannot use here) i just spoke with hung up on me when i wanted to take a survey 10000% agree with the other review about paperless statements, they dont give a and will send you paper multiple times a month. Anyone associated with this company is rotten to the core


elliotmatz1
7/19/2021
Emblem can't even get simple phone communication with customers right. I tried calling today to ask why I am still getting statements in the mail, when I opted to go 100% online. I have re-checked my preferences on the portal 5 times, and ALL are marked for email. Yet I still get a paper monthly statement in the mail. I called three times, and three times went through all the menus and identification questions to get to a person to ask why I am still getting paper statements. THREE TIMES, AFTER GOING THROUGH ALL OF THE PHONE MENUS, I WAS BEING TRANSFERRED TO A CUSTOMER SERVICE PERSON, AND THREE TIMES I ENDED UP WITH A BUSY SIGNAL, WITH NO WAY TO GET OUT OF IT. THIS IS BUSH LEAGUE.... Read More


kathryn.howard28
3/17/2021
In my opinion, this company is garbage. If you are thinking about choosing them for your business, I strongly recommend you do not. I wanted to know why when I checked the cost estimator prior to my service (when logged into my account) the total out-of-pocket cost was listed as $85 + $37 for out-patient and when the (in-network) clinic filed the claim, the total billed for services and physician was over $1100 that emblem are refusing to cover. Jordana said the estimator just accounted for the physician cost and not the services and Lisa just kept repeating that that was the bill because it was done at a facility. She told me to log in to my account and look at my summary benefits.... Read More


J
Joy s
2/11/2021
Always on hold for over an hour and half and when they pick up, they drop your call and have to call them all over again. It happens every week....


austrial3728
1/28/2021
I signed up for dental because the dentist at my last cleaning said I needed $2000+ in work. Enter Emblem Health. Emblem Health: We don't have a record of your enrollment. You'll need to call your HR. Benefeds: We recent your enrollment and you should be good to go in 24 hours. Repeat conversation EIGHT times. Every single time Emblem Health tells me my information is not in the system and to call Benefeds. I ask to speak to someone in enrollment because obviously there is a disconnect and I'm told that if the information had been sent then it would be in the system. Turns out they do in fact have an enrollment department who did in fact have my information but they refused to... Read More


kenc2016
11/18/2020
EMBLEM HEALTH IS NOT COVERING FLU SHOTS!!!! I just went to get my flu shot at the same place I went last year. They said that the flu shot was not being covered. I called Emblem Health and they had NO ANSWER except that we are working on this problem. WHOEVER HEARD OF AN INSURANCE COMPANY NOT COVERING A FLU SHOT??? I am switching out of this awful insurance ASAP.


gertner
7/1/2020
This is one more bad experience (of several) that I have had dealing with GHI - Emblem Health. My doctor requested exams for a serious health concern - date of service 12/31/2019. The payment was denied, and the lab has billed me. In early May, I learned that Emblem was requesting further information from the doctor who requested the exam. The information was provided within 24 hours. On May 15, I called Emblem and I learned that the information was received but was never sent to the appeal department. I was promised the review process would begin immediately. Two weeks later, I called again and learned that the review process was initiated only on May 19. Then, I was given a Reference... Read More


Kevin S
12/26/2019
Stay as far away as possible from Emblem Health.. I have been promised 3 times that my claim would be taken care of and have had to waste hours talking to "advocates". Yet I still receive bills. My coverage claims I can see a NP yet I keep getting billed for the NP being a specialist.. 3 times I called customer service and 3 managers claimed this issue would be resolved. When I call customer service irate they just hang up


Lothar B
10/17/2019
Called Emblem for an oral surgeon and they kept me on hold 15 minutes supposedly because they wanted to get me the "latest" listings of doctors. The gave me 3. NOT ONE accepted Emblem and all said Denta Quest which emblem uses is the worst. Emblem could not find me one doctor. All 3 nearly dropped the phone when I said I have Emblem.


R
Robert
10/11/2019
They are the worst! I pay a lot for there insurance and they deny my coverage after the emergency room admitted me for congestive heart failure. They sent me a letter to appeal, I was on the phone for over an hour with someone that speaks the worst English I have ever herd, I think they had me calling Malaysia or something .. I am going back to Oxford. Beware of this Bad Company



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  • Get Coverage as soon as Tomorrow!
  • Short term coverage is ideal if you missed enrollment, can't afford traditional insurance, are between jobs, just graduated or retired early.
  • Covers: ER & hospitals coverage, Doctors, Labs, Urgent Care & More
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  • No long term commitment. Budget Friendly.