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  • Access to Care and Delivery System > Newborn Access to Care

    EmblemHealth Medicaid Newborns

    Newborn children of mothers enrolled in EmblemHealth's Medicaid plans will be automatically enrolled in the Medicaid program of the mother's plan, and shall receive all benefits and services of that plan beginning on the newborn's date of birth, even if the newborn has not yet been enrolled.

    All members should call our Customer Service department to provide their newborn's name, sex, date of birth, birth weight and birth hospital so that we can complete the enrollment process. Once enrolled, the newborn is issued a member ID card.

    Note that enrollment could be delayed for a number of reasons. Therefore, if a newborn presents for care without an ID card, but the mother was an active Medicaid member on the date of the baby's birth, care must be rendered. Practitioners should call EmblemHealth's Customer Service Department to verify eligibility.

    EmblemHealth Child Health Plus

    Note: If a Child Health Plus member gives birth, the parent must complete an application for the newborn. There is no automatic enrollment in Child Health Plus. The parent can contact Customer Service for information on how to apply.

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    Glossary terms found on this page:

    Services available to a member as defined in his or her contract. Benefit design includes the types of benefits offered, limits (e.g., number of visits, percentage paid or dollar maximums applied) and subscriber responsibility (cost sharing components).

    A determination of whether or not a person meets the requirements to participate in the plan and receive coverage under the plan.

    An institution which provides inpatient services under the supervision of a physician, and meets the following requirements:

    • Provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery
    • Has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry
    • Has bylaws, rules and regulations pertaining to standards of medical care and service rendered by its medical staff
    • Maintains medical records for all patients
    • Has a requirement that every patient be under the care of a member of the medical staff
    • Provides 24-hour patient services
    • Has in effect agreements with a home health agency for referral and transfer of patients to home health agency care when such service is appropriate to meet the patient's requirements

    A card which allows the subscriber to identify himself or his covered dependents to a provider for health care services.

    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    A jointly funded federal and state program that provides hospital and medical coverage to the low-income population and certain aged and disabled individuals.

    An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.


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