GHI HMO is open to employees and retirees residing in the
following New York counties:
The GHI HMO offers its members the
opportunity to receive health care services at a participating physician's
private office. Each GHI HMO member selects his or her own Primary Care
Physician (PCP). Physician office visits require a $15 co-payment.
As a GHI HMO member, you and each member of
your family will choose a PCP from GHI HMO's list of participating providers.
For adults, the PCP will specialize in either internal medicine or family
practice and, for children, specialization will be in either pediatrics or
family practice. Your PCP will coordinate all health care services, including
referrals that must be arranged for and authorized by your PCP.
GHI HMO members receive full coverage for
inpatient hospital care when arranged for and authorized by their PCP. Most
inpatient care will be provided at a participating hospital where your PCP or
Specialist has admitting privileges, including all participating hospitals in
the GHI HMO service area. Specialized care not available in local participating
hospitals may be referred to GHI HMO's tertiary medical centers. In addition,
medically necessary services not provided by GHI HMO participating hospitals or
affiliated providers will be arranged by your PCP and covered in full.
GHI HMO coverage is comprehensive, and includes:
|routine health care
|allergy tests and treatment
||eye and ear exams|
||second surgical opinions|
|medical social services
|well baby and well child care
||prenatal and postnatal care|
|services of a physician
||services of surgeons|
|services of an anesthesiologist
|skilled nursing care
||mental health care|
|physical therapy and rehabilitation
Eligible dependents are covered to age 19. Unmarried
full-time students are covered to age 23.
Emergency care is covered, provided that the
services are authorized by your GHI HMO PCP. For life-threatening emergencies,
members receive immediate care and then are expected to call their GHI HMO PCP
within 48 hours of receiving care.
Members are covered 24 hours per day, 7 days
a week. Emergency care is covered anywhere in the world. There is a $35
co-payment for each emergency room visit that does not result in an
GHI HMO offers an optional rider for
prescription drug coverage. Retail co-payments are: $8 generic; $16 preferred
brand and $30 non-preferred brand per prescription at participating pharmacies.
Mail order (up to 90 day supply) co-payments are: $16 generic; $32 preferred
brand and $50 non-preferred brand. Prescriptions are dispensed on a generic
basis. Members requesting a brand name drug must pay the difference between the
brand name drug and the generic drug when a generic drug is available, plus the
Please see rate chart for payroll and pension deductions.
See the rate page
For More Information
During the New York City Transfer Period,
representatives will be available Monday to Friday, 8:00 am - 6:00 pm. Employees
or retirees who have questions about this coverage may contact GHI HMO at (877)
244-4466 or (877) 208-7920 (TDD only).
You can also send your questions in writing to:
PO Box 4443
Kingston, NY 12402
Attn: Customer Service
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