At EmblemHealth, we know how important it is for you to have access to quality doctors and health care services right where you live and work. One of the most exciting partners of EmblemHealth is AdvantageCare Physicians (ACPNY) – one of the largest primary and specialty care practices in the New York metropolitan area. EmblemHealth provides all our members the latest plan & health information, including GHI Insurance information. We are dedicated to helping you stay healthy, get well, and live better. Urgent Care: $50 copay Diagnostic/Lab: $25 copay MRI/CAT/Hi-Tech Radiology: $50 copay Physical Therapy: $25 copay Emergency Room: $150 copay. Out-of-Network Cost. There will be no changes to your current out-of-pocket costs. You will still pay any applicable out-of-network cost-sharing plus the difference between the provider’s fee and GHI. Note: This Provider Directory includes participating providers in all specialties. Your specific Benefit Plan may not cover all services given by participating providers. Please look at your Certificate or Group Contract to find out if a particular service is covered under your Benefit Plan.
Where to Find One
When you need to see a doctor after office hours or on weekends for non-emergency care such as a sore throat or other minor health problem, visit one of our network urgent care centers for treatment. Where you go for care matters - know your treatment options.
Network Urgent Care Center Locations
Looking for an urgent care center? Sign in to our provider search tool or access as a visitor and select 'Hospital, Facility or Urgent Care Center.'
No Referrals Needed for Urgent Care
Please note that no referrals are needed to visit a network urgent care center. We suggest you visit an urgent care center instead of an emergency room, when possible. Going to a network urgent care center will lower your copayments and cut your time waiting to be seen.
Of course, if you think you are having a medical emergency - when there is blood loss, unconsciousness or a threat to life - you should call 911 or go to the nearest emergency room. Please refer to your Member Handbook to better understand what an emergency is.
For additional information, please contact customer service.
Tier 1 (Preferred generic drugs): $10 copay per 30-day supply
Tier 2 (Preferred brand drugs): $15 copay per 30-day supply
Tier 3 (Non preferred generic and brand drugs): $100 copay per 30-day supply
Tier 4 (Specialty drugs): 25% coinsurance per 30-day supply
Home Delivery (Preferred Drugs)
Tier 1 (Preferred generic drugs): $5 copay per 30-day supply
Tier 2 (Preferred brand drugs): $7.50 copay per 30-day supply
Tier 3 (Non preferred generic and brand drugs): $50 copay per 30-day supply
Tier 4 (Specialty drugs): 25% coinsurance per 30-day supply
Benefit Limits
The member pays copays and coinsurance as listed above for drug costs between $0 and $2,960. After reaching $2,960, the member is covered for generic and brand drugs, until the member qualifies for catastrophic coverage.
Catastrophic
Cigna Urgent Care Copay
Catastrophic coverage is when a member reaches $3,700 of true out-of-pocket (TrOOP) costs for the calendar year. The member will then pay either a $3.30 copay for generic ($8.25 copay for brand drugs), or a 5% coinsurance, whichever is the greater amount.