GHI HMO

With GHI HMO, you get a wide range of covered services from GHI HMO network doctors and hospitals for a small copay. With this plan, you choose a regular doctor who will manage and oversee your care, including administering referrals to network specialists and arranging for hospital stays.

GHI HMO is available to City active employees and non-Medicare eligible retirees living in the five boroughs of New York City and the following New York State counties: Albany, Broome, Columbia, Delaware, Dutchess, Fulton, Greene, Montgomery, Nassau, Orange, Otsego, Putnam, Rensselaer, Rockland, Saratoga, Schenectady, Schoharie, Suffolk, Sullivan, Ulster, Warren, Washington and Westchester.

GHI HMO Medicare Senior Supplement covers the same services for Medicare-eligible retirees as the GHI HMO plan for active employees and non-Medicare retirees. It includes coverage for deductibles, coinsurance and services not covered by Medicare Parts A and B.

You are encouraged to use in-network doctors. If out-of-network doctors are used, only Medicare coverage is applicable and treatment is subject to Medicare deductibles and coinsurance.

You can enhance your GHI HMO Medicare Senior Supplement plan with Medicare Part D benefits for prescriptions received at network pharmacies and home delivery service.

Customer Service: 877-244-4466, seven days a week (excluding major holidays), 8 am to 8 pm.

Plan Details

GHI HMO offers you:

  • Coverage for a comprehensive range of in-network services
  • Choice of doctors in private practice or at physician group practices (PGPs)
  • $0 copay at an AdvantageCare Physicians provider or Montefiore faculty-based center
  • No claims forms or other paperwork to fill out

Your In-Network Costs

  • PCP office visit: $15 copay
  • Specialist office visit: $15 copay
  • Diagnostic lab: $0 copay
  • X-ray: $15 copay
  • Routine physical exam: $15 copay
  • Well child care: $0
  • Outpatient mental health: $15 copay
  • Urgent care: $15 copay
  • Ambulatory surgery: $0
  • Ambulance: $0
  • Inpatient care: $0
  • Anesthesia: $0
  • Emergency room: $35 copay (waived if admitted)
     

Additional Riders

You can add the following benefit to your GHI HMO plan through a payroll or pension deduction:

  • Prescription drugs (for generic and brand drugs from network retail drug stores and home delivery service)


The information in this section is intended to provide general information and highlights regarding the GHI HMO plan. It does not provide a complete benefit description. GHI HMO plan coverage is subject to all terms, conditions and limitations contained in the certificate of insurance. Refer to GHI policy form PGHMO1387.

Plan Details


Provider Coverage

With our robust network of quality doctors, you can get care from many of the region’s leading doctors, clinicians and facilities, including hospitals and urgent care centers.

A Partner in Wellness

The Right Care, Right in Your Neighborhood

AdvantageCare Physicians are the newest addition to the EmblemHealth family and are now one of the largest primary and specialty care practices in New York City. With 37 locations throughout New York City and Long Island, you can find a convenient location near home or work. 

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