Medical

As part of an exchange, employees have the ability to choose health insurance and benefit plans that fit their needs and budget from an ever growing range of choices.

ANTHEM OVERVIEW

Anthem is dedicated to delivering better care to our members, providing greater value to our customers and helping improve the health of our communities.

Network availability & ELIGIBILITY

ANTHEM

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
To enroll in PPO/EPO plans employees can Live/work/reside anywhere in the US. PPO/EPO* BlueCard BlueCard BlueCard
To enroll in Blue Access plans employees can Live/work/reside anywhere in the US. Blue Access* BlueCard BlueCard BlueCard
To enroll in Connection plans employees Can live/work/reside anywhere in the US. Connection** BlueCard BlueCard BlueCard
PPO/EPO & Blue Access Gated (G) plans – employees can live/reside in the 28-county service area.*
Connection Gated (G) plans – employees must live/reside in the 9-county service area.
*Anthem PPO/EPO & Blue Access service area consists of five boroughs, Nassau, Suffolk, Westchester, Rockland, Orange, Putnam, Dutchess, Ulster, Sullivan, Delaware, Clinton, Essex, Albany, Columbia, Fulton, Green, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington counties (other New York areas and national access BlueCard Network). *
**Anthem Connection service area consists of five boroughs, Nassau, Suffolk, Westchester and Rockland counties. No network access in Orange, Putnam, Dutchess, Ulster, Sullivan, Delaware, Clinton, Essex, Albany, Columbia, Fulton, Green, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington counties (other New York areas and national access BlueCard Network).

Pediatric Dental

ANTHEM

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
ANTHEM Dental Complete Dental Complete Dental Complete Dental Complete

Pediatric Vision

ANTHEM

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
ANTHEM Blue View Vision Blue View Vision Blue View Vision Blue View Vision

Formularies & Rx Networks
  • PPO/EPO Plans: Traditional Formulary, Base Rx Network
  • Blue Access Plans: Select Formulary, Base Rx Network
  • Connection Plans: Select Formulary, Advantage Rx Network (Advantage Rx Network excludes Walgreens & Duane Reade)
Prescription Mail Order
  • When a member uses CarelonRx.com to order a 90-day supply of a drug they will pay 2.5 months of copays.
Telemedicine
  • Is available through the Sydney Health mobile app or livehealthonline.com from their computer. Virtual visits are covered at no charge for non-HSA plans, this includes virtual behavioral health visits. HSA plans will be subject to $59 copay towards the deductible for medical visits.
Added Values
  • Gym reimbursement – 50 visits per a 6-month period and earn $200
    • Spouse/Domestic Partner and Dependents 18+ are also eligible for the $400 gym reimbursement per year
  • Acupuncture is a covered benefit
  • LASIK benefit:
    • Premier LASIK Network – Save on LASIK when you choose a featured provider
    • TruVision – save on LASIK eye surgery at over 1,000 locations
    • $500 wellness incentives available through the Sydney Health mobile app for completing certain activities throughout the year (annual physical, mammograms, health assessments, colonoscopy, etc)

 

Emblemhealth Overview

EmblemHealth is one of the nation’s largest not-for-profit health insurers, serving more than three million people in New York City and the tristate area. For the past 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, healthcare is more complex than ever. That’s why EmblemHealth remains committed to finding new ways to deliver quality care at affordable prices.

Network availability & ELIGIBILITY

EMBLEMHEALTH

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
To enroll in Select Care plans
employees must live/work/reside in
NY.		 Select Care* N/A N/A N/A
*EmblemHealth Select Care service area consists of five boroughs, Nassau, Suffolk, Westchester, Rockland, Orange, Putnam, Dutchess, Ulster, Sullivan, Albany, Broome, Columbia, Delaware, Fulton, Greene, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington.

Pediatric Dental

EMBLEMHEALTH

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
EmblemHealth Healthplex Healthplex Healthplex N/A

Pediatric Vision

EMBLEMHEALTH

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
EmblemHealth EyeMed EyeMed EyeMed EyeMed

Rx Network
  • Includes Walgreens, Duane Reade, Rite Aid and Walmart
Prescription Mail Order
  • A member can use Express Scripts to order a 90-day supply of a drug and they will pay 2.5 months of copays. Register on-line at https://www.express-scripts.com
Telemedicine
  • There is no charge for Teladoc services excluding HSA plans, there is a $0 copay after the deductible is met. AdvantageCare Physicians Centers are also available to schedule virtual visits. Medly Pharmacy medication delivery service is available at no cost
Added Values
  • Gym reimbursement
    • Member – with 50 visits can receive $200 per 6-month calendar year period.
    • Spouse – with 50 visits can receive $100 per 6-month calendar year period

OXFORD OVERVIEW

Oxford serves millions of people from their earliest years through their working lives and into retirement. What unites them is their mission to help people live healthier lives and make the health system work better for everyone.

Oxford is working to play their part in creating a more sustainable healthcare system: one that works better for everyone.

Network availability & ELIGIBILITY

Oxford

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
Liberty plans – employees can live anywhere in the continental US. Liberty* Liberty Liberty Core
Freedom plans – employees can live anywhere in the continental US. Freedom** Freedom Freedom Choice Plus
Metro plans – employees must live/work in NY and NJ. Metro*** Metro N/A N/A
*Oxford Liberty service area consists of five boroughs, Nassau, Suffolk, Westchester, Rockland, Orange, Putnam, Dutchess, Ulster and Sullivan counties (other New York
areas and national access Core Network).
**Oxford Freedom service area consists of five boroughs, Nassau, Suffolk, Westchester, Rockland, Orange, Putnam, Dutchess, Ulster and Sullivan counties (other New York
areas and national access Choice Plus Network).
***Oxford Metro service area consists of five boroughs, Nassau, Suffolk, Westchester, Rockland, Orange, Putnam, Dutchess, Ulster and Sullivan counties.

Pediatric Dental

Oxford

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
Oxford National Options PPO 20 National Options PPO 20 National Options PPO 20 National Options PPO 20

Pediatric Vision

Oxford

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
Oxford UnitedHealthcare Vision Network UnitedHealthcare Vision Network UnitedHealthcare Vision Network UnitedHealthcare Vision Network

Rx Network
  • Includes Walgreens, Duane Reade, Rite Aid and Walmart
Prescription Mail Order
  • When a member uses OptumRx to order a 90-day supply of a drug they will pay 2.5 months of copays. Register on-line at https://www.optumrx.com
Telemedicine
  • Oxford – Members can access virtual doctor visits on myuhc.com or through the UnitedHealthcare mobile app. Virtual visits are covered at no charge excluding HSA plans have a $49 charge per virtual visit and no charge after deductible.
Added Values
  • Sweat Equity – Fitness Reimbursement
    • 50 visits per a 6-month period and earn $200
    • Covered spouse and eligible dependents (age 13+) earn $100 for 50 visits per 6-month period
    • Up to $400 in earning potential per sub per year ($200 every 6 months)50 visits per a 6-month period and earn $200
  • Rewards Core – all plans except Liberty Motion (M) plan members can earn up to $300/year for reaching program goals and completing one-time reward activities
  • Real Appeal – a personalized coach to help guide and customize steps to fit weight loss, personal preferences, medical history and goals. 24/7 online support
  • One Pass Select – Gym Discount Program – a subscription-based fitness & well-being program that supports a healthier life
    • Access to 16,000 gyms nationwide, no long-term contracts or annual registration fees (not limited to 1 gym/1 city)
    • Add up to 4 family members (18+), 10% monthly discount, can change tiers monthly
  • Calm Health app – a mobile app that provides programs and tools to help support your mental health and well-being
  • Wellos app – a mobile-based wellness app designed to engage and encourage healthy and sustainable behavior changes based on health goals
  • Vision Benefit – access to the national UnitedHealthcare Vision Network
    • One $10 exam every 12 months
    • $130 frame allowance/30% discount on overage
    • $125 contact lens allowance/$40 allowance for fitting and evaluation
  • Care Cash (not available on HSA plans) – preloaded debit card that helps pay toward cost-sharing for eligible network visits $200 a year for member only; $500 a year for family
  • Premium Rewards (only on PR plans) – up to $1,000 per member per year – tracking steps, health survey, annual checkup, biometric screening
    • Rewards deposited directly into health savings accounts or used toward a Visa® gift card

UnitedHealthcare Overview

UnitedHealthcare’s wide range of plans offer a whole-person approach to health with benefits like wellness programs, behavioral health support and care management services.

Network availability & ELIGIBILITY

UnitedHealthcare

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
Choice plans – employees can live anywhere in the continental US. Choice* Choice Choice Choice
*UnitedHealthcare Choice consists of Orange, Putnam, Dutchess, Ulster, Sullivan counties (other New York areas and national access also use Choice Network.

Pediatric Dental

UnitedHealthcare

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
UnitedHealthcare National Options PPO 20 National Options PPO 20 National Options PPO 20 National Options PPO 20

Pediatric Vision

UnitedHealthcare

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE
UnitedHealthcare UnitedHealthcare Vision Network UnitedHealthcare Vision Network UnitedHealthcare Vision Network UnitedHealthcare Vision Network

Rx Network
  • Includes Walgreens, Duane Reade, Rite Aid and Walmart; Choice members have access to CVS.
Prescription Mail Order
  • When a member uses OptumRx to order a 90-day supply of a drug they will pay 2.5 months of copays. Register on-line at https://www.optumrx.com
Telemedicine
  • Members can access virtual doctor visits on myuhc.com or through the UnitedHealthcare mobile app. Virtual visits are covered at no charge excluding HSA plans have a $49 charge per virtual visit and no charge after deductible.
Added Values

UHC Rewards

  • Up to $300 per member per year – tracking steps, health survey, annual checkup, biometric screening

Real Appeal – a personalized coach to help guide and customize steps to fit weight loss, healthy lifestyle habits, medical history and goals. 24/7 online support
One Pass Select – Gym Discount Program – a subscription-based fitness & well-being program that supports a healthier life

  • Access to 16,000 gyms nationwide, no long-term contracts or annual registration fees (not limited to 1 gym/1 city)
  • Add up to 4 family members (18+), 10% monthly discount & can change tiers monthly

EAP Core Benefits – provides support and resources to help you, and your family, with a range of issues, including: Stress, mental health, relationships at home or work, legal and financial concerns and substance use issues
Care Cash (not available on HSA plans) – preloaded debit card that helps pay toward cost-sharing for eligible network visits $200 a year for the member only; $500 a year for family
Premium Rewards (only on PR plans) – up to $1,000 per member per year – tracking steps, health survey, annual checkup, biometric screening.

  • Rewards are deposited directly into health savings accounts or used toward a Visa® gift card