The documents below include coverage information, forms, and costs for covered products and services.
Medicare Advantage
Important Plan Documents
- 2026
2026 Important Plan Documents
Annual Notice of Changes
Individual Plans
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EmblemHealth VIP Gold (HMO)
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EmblemHealth VIP Dual (HMO D-SNP)
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EmblemHealth VIP Dual Enhanced (HMO D-SNP)
Enrollment Applications and Forms
Enrollment Applications
Forms
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To submit claims for medical care and services.
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Reimbursement for OTC purchases in extraordinary circumstances.
Evidence of Coverage
Individual Plans
Pharmacy
Directory
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EmblemHealth VIP Gold (HMO), EmblemHealth VIP Gold Plus (HMO) , EmblemHealth VIP Value (HMO-POS), EmblemHealth VIP Dual (HMO D-SNP), EmblemHealth VIP Dual Enhanced (HMO D-SNP) EmblemHealth VIP Dual Reserve (HMO D-SNP), EmblemHealth VIP Premier (HMO), EmblemHealth National Drug Plan (PDP), and EmblemHealth Group Access Rx (PPO) plans.
Formularies
Prior Authorization
Step Therapy
Provider Directories
VIP Bold Network
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(Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
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(Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
VIP Reserve Network
VIP Prime Network
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(Albany, Broome, Columbia, Delaware, Greene, Rensselaer, Saratoga, Schenectady, Warren and Washington)
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(Dutchess, Orange, Rockland, Putnam, Sullivan, Ulster and Westchester)
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Thank you for your interest in EmblemHealth. To request a Formulary, Evidence of Coverage, or Provider/Pharmacy Directory, please call Customer Service at 877-344-7364 (TTY: 711). From Oct. 1 to March 31, you can call us seven days a week from 8 a.m. to 8 p.m. From April 1 to Sept. 30, you can call us Monday through Saturday from 8 a.m. to 8 p.m. We will be happy to help you.
Last Updated 06/25/2026
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