Beginning October 1, 2012, Emblem Health will be introducing a brand new, EPO product for small groups. It’s core design is to provide hospital-only coverage (plus a few additional features) for small groups that are looking to secure group benefits while controlling premium costs.

Health Essentials EPO Plan Highlights

-Hospital-only coverage: In-network only – billed by hospitals or ambulatory surgical centers
-Coverage for hospital-related doctor fees: Doctors must be employed by the hospital or facility (doctor-billed subscribers will not be covered)
-In network preventive services covered in full – in or out of the hospital – including services related to the Women’s Preventive Services Mandate of 2012
-Coverage for generic-only prescription drugs
-In network, downstate NY participating hospitals include Montefiore Medical Center, North Shore-LIJ Health System, NY Presbyterian Hospital System, Memorial Sloan-Kettering Cancer
Center, and Albany Medical Center
-Can be written along side other health plans and carriers for small businesses
-Eligibility: Small groups with at least two contracts, and at least 50% plan participation

Downstate New York Q4/2012 Rates


Single: $239.69
Family: $692.48


Single: $239.69
Employee + Spouse: $571.77
Employee + Children: $444.28
Family: $740.42

The full benefits summary for the plan can be found here:

EmblemHealth – Health Essentials EPO – Downstate New York

For more information about this new product or to enroll, contact a New York insurance broker.