NYC Health Benefits Program

Important Changes to Your HIP HMO Plan

Effective July 1, 2016


The information in the table below lists the Care, Place and Time to receive medical treatment. The table also includes the cost of in-network services if provided by a Preferred Provider or a non-Preferred Participating Provider, as well as emergency services. 


Hover over items marked with a green dotted underline for a definition of the term.

In-Network Care and Costs





When Enrolled with an

  Preferred Provider

Non-Preferred Participating Provider

Preventive Care



PCP (including Mental Health Providers)



Specialist Care (when referred by a PCP)* $0


Diagnostic/Lab and High-Tech Radiology $0


Physical Therapy $0



* Some services, regardless of PCP selection, have a different copay level, such as emergency, ambulatory surgery and hospital care.


Urgent Care Center $0/$10
(depending on PCP copay)
Emergency Room $50



Scheduling - Some doctors appointments may be scheduled online using ZocDoc


Other Services

Member ID Cards

Preferred PCP 
If you are currently using a preferred PCP, you may continue to use the member ID card you already have.

Non-Preferred PCP
If you are currently using a non-preferred PCP, your new member ID card will be mailed to you approximately 10 days prior to the July 1, 2016 effective date of your new plan. Please begin using it when claiming benefits, and be sure to destroy your previous card once you receive your new one.


If you have any questions about your new HIP HMO Preferred plan, please call Emblem Health Customer Service at 1-800-447-8255, Monday to Friday, 8 am to 6 pm. If you have a hearing or speech impairment and use a TTY/TDD, please call 711. Or, visit


View the HIP HMO Notification Letter 

View a list of HIP HMO Preferred Providers 

Glossary of Terms