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Health Benefits
HMOs > GHI HMO



GHI HMO

GHI HMO is open to employees and retirees residing in the following New York counties:

Albany Bronx Broome Columbia
Delaware Dutchess Fulton Greene
Kings Montgomery New York Orange
Otsego Putnam Queens Rensselaer
Richmond Rockland Saratoga Schenectady
Schoharie Sullivan Ulster Warren
Washington Westchester    

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.

Comprehensive Coverage
GHI HMO coverage is comprehensive, and includes:

routine health care office visits
allergy tests and treatment eye and ear exams
laboratory services X-rays
diagnostic tests second surgical opinions
medical social services health education
well baby and well child care prenatal and postnatal care
services of a physician services of surgeons
services of an anesthesiologist emergency services
skilled nursing care mental health care
physical therapy and rehabilitation  chiropractic services
acupuncture  

Eligible dependents are covered to age 19. Unmarried full-time students are covered to age 23.

Emergency Care

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 admission.

Prescription Drugs

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 generic co-payment.

Cost
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:

GHI HMO
PO Box 4443
Kingston, NY 12402
Attn: Customer Service
Visit the Plan Web site

Spotlight

Employee Assistance Programs (EAPs)
EAPs are staffed by professional counselors who can help employees and their eligible dependents handle problems in areas such as stress, alcoholism, drug abuse, mental health, and family difficulties.

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