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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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Alex G
6/13/2019
I have had a truly terrible time with EmblemHealth care on several fronts.


Mooda L
3/4/2019
All I want is a number of their Compliance Department, it does not exist. I have spent almost 2 hours just trying to follow up that the appropriate paper work has been received so a list of bills paid in the last 3 years by Emblem can be received to close an estate. I finally after talking to 6 individuals , 3 dead ends, and at least 6 numbers some which were wrong and/or disconnected got a Nancy in Medicare department who said to fax it to the general Medicare Enrollment number, I asked for her supervisor, this is not very transparent practices. I know my Mom for years before she died complained how they would give her the run around all the time, now I understand it was not just her,... Read More


nmouldovan
1/27/2019
In the last few months, I have contacted Emblem Health of New York a number of times by phone regarding claims different providers have submitted for me, waiting to be paid by Emblem Health. Emblem Health always tells me that the provider hasn't submitted Medicare's EOB for my claim and won't pay until they receive the Medicare EOB. When I call Emblem Health to assist me with this matter, they call the provider who sends them Medicare's EOB for my claim and it seems to conveniently get lost. The providers have also sent the claims requested plus the Medicare EOB certified mail, to make certain someone at Emblem Health of New York signs for it and again Emblem Health representatives tell... Read More


M
Molly N
9/20/2018
Emblem Health loves to nickel and dime their customers. While paying for a Platinum plan for my family, they're also making us pay co-pays because we didn't select on their website our primary care doctor in advance of an annual wellness visit. It's not about the money, it's the lack of integrity. When will healthcare companies employ humans who are capable of rational thought? The their billing system is broken beyond belief.


D
Danielle G
7/25/2018
If i could give negative stars I would. Emblem Health is basically a group of criminals that try to constantly get money out of your pocket. I received a service in 2016 and my account was paid in full. Then yesterday, July 24, 2018, they decided to reopen my account and increase my deductible by $200. When I called the doctor's office, they said that my insurance was "reevaluated". When I called to file an appeal, Emblem said my insurance was inactive. I always have an issue with Emblem Health. They are unreliable, incompetent and have ZERO compassion for their members. The woman I spoke to was laughing in the background. DO NOT USE THEM!! They do not care about their patients!


K
KimET
6/27/2018
If you care about health and wellness do not choose Emblem Heath. After having great success with knee injections (they keep my painful arthritic knees from swelling for a few years- no NSAIDS) Emblem stopped covering the injections. They offered "better" alternatives, that I have tried and didn't work, instead of the injections that truly do. I'm in pain with swollen knees and limping.


J
jane
12/30/2017
DO NOT SIGN UP WITH EMBLEM HEALTH. IT IS A SCAM. I'm a new client, and the company sent a bill and told me to pay it online. But the site did not allow me to pay the bill online--it did not recognize my member ID number. I tried calling for days to get a human being on the phone so I could pay my bill. The company put me on hold for HOURS. It was a nightmare waste of time, just trying to pay my bill. When I finally got a human after waiting for HOURS on the phone, after several DAYS OF TRYING TO REACH A HUMAN, a rep told me to add two numbers (01) to my member ID for it to work. Nowhere on the bill did it way to add these two numbers!!! Unreal. So I added the two numbers and managed to pay... Read More


N
Nicole B
10/19/2017
This is the worst health insurance plan I have ever had the displeasure of paying for. I pay money I can’t even afford every month for a premium that literally gives me no coverage. My doctor upped my prescription because I OBVIOUSLY need a higher prescription and it was denied because for some reason the plan only covers a certain dosage. Meanwhile these pills probably actually cost .05 cents, but oh no, to pay out of pocket for a 60 day supply is $500. I called my doctors office the same day the prescription was sent in, (Oct 11th) the same day the pharmacy called and told me I needed pre-auth. I also called Emblem this day, who told me the doctor needed to call in the authorization.... Read More



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