175 HIP HMO Brand Rx
Dual network: HIP HMO in NY · Cigna PPO outside NY (no referral)
No-deductible HIP HMO with full brand-name drug coverage. $30 office copay, $60 specialist, no referrals needed. Three-tier Rx at $25 / $50 / $100 after a $300 prescription deductible. $1,500 inpatient and $500 outpatient surgery copays, $300 emergency room. $7,350 / $14,700 out-of-pocket maximum.
Monthly premiums
- Member
- $1,788.00/mo
- Member & Family
- $4,203.00/mo
The only Local 175 plan that covers brand-name drugs — $116/mo more than generic-only, with no medical deductible at all
Plan details
- Deductible (Individual)
- $0
- Deductible (Family)
- $0
- Out-of-Pocket Max (Individual)
- $7,350
- Out-of-Pocket Max (Family)
- $14,700
- Coinsurance (In-Network)
- 0%
- Primary Care Copay
- $30
- Specialist Copay
- $60
- ER Copay
- $300
Benefits
Rx Coverage
$25 / $50 / $100
Generic / preferred brand / non-preferred brand, after a $300 Rx deductible
Deductible
$0
No medical deductible
Max Out of Pocket
$7,350 / $14,700
In-network; accumulates plan year
Copay
$30 / $60
PCP / Specialist
Referrals
Not required
Non-gated — see a specialist directly
Hospital Admission
$1,500 per admission
Preauthorization required
Outpatient Surgery
$500 copay
Emergency Room
$300 copay
Waived if admitted
Laboratory
Included
Covered by the office visit copay
Coinsurance
0%
Plan pays 100% after copays
Dependents
To Age 26
Work Requirement
Work Required
Plan documents
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