GHI CBP Old

The GHI Comprehensive Benefits Plan (CBP) gives you the freedom to choose in-network or out-of-network doctors. You can see any network doctor without a referral.*

In most cases, when you see a network doctor, your cost will just be a copay. This plan is offered to employees and non-Medicare eligible retirees and covers medical and surgical services. Hospitalization benefits are provided to you by Empire BlueCross BlueShield, when you select GHI CBP.

Key Plan Features

Out-of-Pocket Costs Low copays for in-network services. No payroll deduction for the basic plan.
PCP Required No
Referrals Required Not for in-network services
Provider Coverage Your choice of in-network and out-of-network doctors in private practice or at physician group practices
Hassle-Free
Online Services
Yes
Wellness & Disease Management Programs Yes

*Note: Covered services from out-of-network doctors have deductibles and coinsurance. Payment for services provided by out-of-network providers is made directly to you under the NYC Non-Participating Provider Schedule of Allowable Charges. You will be responsible for any difference between the provider’s fee and the amount of the reimbursement; therefore, you may have a substantial out-of-pocket expense.

Estimate your out-of-pocket costs for care from out-of-network providers

Below are some examples of what you would typically pay out of pocket if you were to receive care or services from an out-of-network provider.

TYPICAL OUT-OF-POCKET COSTS FROM RECEIVING CARE FROM OUT-OF-NETWORK PROVIDERS
Established Patient Office Visit (typically 15 minutes) — CPT Code 99213
Estimated Charge for a Doctor in Manhattan $215
Reimbursement Under the Schedule -$36
Member Out-of-Pocket Responsibility $179
Routine Maternity Care and Delivery — CPT Code 59400
Estimated Charge for a Doctor in Manhattan $9,500
Reimbursement Under the Schedule -$1,379
Member Out-of-Pocket Responsibility $8,121
Total Hip Replacement Surgery — CPT Code 27130
Estimated Charge for a Doctor in Manhattan $20,000
Reimbursement Under the Schedule -$3,011
Member Out-of-Pocket Responsibility $16,989

Estimated Charge is set at FAIR Health’s 80th percentile and is based on Manhattan zip codes with a 100 prefix.

Please note that deductibles may apply and that you could be eligible for additional reimbursement if your catastrophic coverage kicks in or you have purchased the Enhanced Non-Participating Provider Schedule, an Optional Rider benefit that provides lower out-of-pocket costs for some surgical and in-hospital services from out-of-network doctors.



GHI Senior Care Benefits

If you are a Medicare-eligible retiree, you can also enroll in our Medicare Supplement program for enhanced coverage. Learn more >

Summary of Benefits and Coverage (SBC)
See your SBC or check out your benefits at a glance. Learn More

EmblemHealth Behavioral Management Program

Members can call
1-800-NYC-CITY
(1-800-692-2489)
to seek advice about mental health and substance abuse treatment. This phone line is administered by ValueOptions.