Medical and Rx

Medical

Flexible Plan Options to Fit Your Needs

The medical plan options available to you vary based on your role. All options include:

Prescription drug coverage
100% coverage for in-network preventive care
Access to the Montefiore Tier 1 Network for low-cost trusted care

You can enroll in employee-only or family coverage.

Choosing Your Providers

Each time you need care, you choose a provider. The tier the provider participates in will define your out-of-pocket cost.

Note: When you choose Montefiore Tier 1 Network providers—our own doctors, hospitals and specialists—you’re getting high-quality care you can trust from the team that knows our patients and communities best.

They’re held to the same standards of excellence that guide the care we deliver every day.
You’ll pay the lowest copays and out-of-pocket costs available in our medical plans.
Your providers can easily share information through our electronic medical records, leading to better coordination of care.

The chart below provides guidance on finding a provider within the Montefiore Tier 1 and Anthem Networks.

Choosing Your Providers Chart

	Montefiore Tier 1 Network	Anthem Network	Out-of-Network
Consider this network if	You are enrolled in one of our three medical plan options and want to pay the lowest amount for trusted, world-class care from Montefiore providers.	You are enrolled in one of our three medical plan options and choose to use a provider in the Anthem Network.	You are enrolled in the PPO medical plan option and choose to use a provider that does not participate in Montefiore Tier 1 or Anthem Networks. Note: The HDHP with HSA and EPO do not cover any out-of-network care.
Out-of-pocket cost	$	$$	$$$
Hospitals and other facilities	Montefiore Moses Hospital Jack D. Weiler Hospital (Einstein) The Children’s Hospital at Montefiore Montefiore Mt. Vernon Hospital Montefiore Wakefield Hospital Montefiore New Rochelle Hospital Westchester Square White Plains Hospital Montefiore Nyack Hospital Montefiore St. Luke’s Cornwall Hospital Montefiore Ambulatory Surgical Facilities Montefiore Department of Radiology Montefiore Imaging Center Advanced Endoscopy Center Burke Rehabilitation Hospital New York GI Center Montefiore Einstein Advanced Care	Defined by Anthem. These providers have agreed to negotiated rates.	Any providers outside of Montefiore Tier 1 and Anthem Networks.
Skilled nursing facility, hospice	Schaffer Extended Care Center	Defined by Anthem. These providers have agreed to negotiated rates.	Any providers outside of Montefiore Tier 1 and Anthem Networks.
Laboratories*	Montefiore Moses Hospital Jack D. Weiler Hospital (Einstein) The Children’s Hospital at Montefiore Montefiore Mt. Vernon Hospital Montefiore Wakefield Hospital Montefiore New Rochelle Hospital Westchester Square White Plains Hospital Montefiore Nyack Hospital Montefiore St. Luke’s Cornwall Hospital	Defined by Anthem, including Quest Labs, Labcorp and other facilities participating in the Anthem Network.	Any providers outside of Montefiore Tier 1 and Anthem Networks.
Physicians, therapists, and counseling for mental health and substance use	Montefiore Integrated Provider Association (MIPA) Montefiore Behavioral Care Integrated Provider Association (MBCIPA) Highland Medical, P.C. Montefiore Einstein Psychiatry Associates (MEPA)	Anthem Network Anthem Behavioral Health Network	Any providers outside of Montefiore Tier 1 and Anthem Networks.
How to find providers	Log into your Anthem account and click “Find Care and Costs.” Filter on Tier 1 providers to view Montefiore Network providers to find the lowest cost.	Log into your Anthem account and click “Find Care and Costs.”	Any providers outside of MontefioreTier 1 and Anthem Networks.

*If your provider sends you to Quest or Labcorp, services will be covered at the Montefiore Tier 1 Network level.

Use Anthem’s Find Care provider-search tool at anthem.com/find-care/. If you don’t log in, you can do a basic search using your ID number or prefix from your ID card.

Care Guidance

The Care Guidance Program for Montefiore employees provides you with a Personal Health Nurse (PHN) who will work one-on-one with you for as long and as often as you need. This is a voluntary program that can provide support and resources to help you, or a member of your family, manage your or their health. Montefiore provides this program at no cost to Montefiore employees and their family members who are covered by Montefiore’s Anthem BlueCross BlueShield medical plans. All services are completely confidential and at any point in time, you have the opportunity to OPT OUT of the program. For more information, call 855.MMC.WELL (855.662.9355) or email mmccareguidance@montefiore.org.

Learn More About Care Guidance

Prescription Drug Benefits

Prescription drug benefits are included in your medical coverage.

NEW FOR 2026: Anthem Will Administer Our Prescription Drug Coverage

Beginning January 1, 2026, our prescription drug benefits will be managed by Anthem, replacing Express Scripts. The Anthem team will help you through every step of your pharmacy experience, from understanding your coverage to finding the most affordable options and filling your prescriptions in the most convenient way.

Prior to January 1, Anthem will contact you if there’s a change to how your current medication is covered and with information on how to fill prescriptions through mail-order or their Specialty Pharmacy.

The prescription drug benefit through Anthem includes:

A combined medical and prescription drug ID card
Starting January 1, 2026, sign into anthem.com or use the Sydney Health app to manage your pharmacy benefits to find a pharmacy, including all in-house pharmacies and the Montefiore Specialty Pharmacy, check your drug list and compare medication costs, set up home delivery and refill prescriptions, review your claims and check your copay, deductible and coinsurance amounts.

View the Pharmacy Transition FAQ Document for more information.

Contact Anthem

866-236-6748
anthem.com

Need help finding care?

Select your plan flyer below to learn how you can find care quickly and easily at Anthem.com or on the Sydney Health app.

New Hire, New to Benefits or Looking for Current Year Benefit Information?

Find Benefits Summaries, Medical Comparisons and More

Visit the New Hire or New To Benefits page to access information about your benefits offerings for 2025.

Learn More