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  • Health Promotion and Disease Management > Health Promotion

    EmblemHealth has health and wellness programs, tools and resources to help members stay fit and enhance their quality of life. EmblemHealth members have access to Healthy Discounts programs at no additional cost. Participating vendors offer discounts off their usual and customary fees for health club memberships, acupuncture, massage therapy and nutrition counseling, weight loss services, hearing and vision care, vitamins and supplements, and other comprehensive health care services and products. For more about these services, visit http://emblemhealth.com/Health-and-Wellness/Stay-Healthy/Healthy-Discounts.aspx

    Some member benefit plans include the ExerciseRewardsTM Program, a gym membership reimbursement program where members can get back up to $200 of their membership dues.

    EmblemHealth promotes the following quality improvement initiatives for EmblemHealth, GHI and HIP plan members through member and provider newsletters, and other educational materials:

    Women's Wellness

    • Breast health and mammography
    • Cervical cancer screening
    • Chlamydia screening
    • Osteoporosis and musculoskeletal health
    • Timely prenatal and postpartum care

    Adult Health

    • Cardiac care
    • Cholesterol management
    • Colorectal cancer screening
    • Depression screening
    • High blood pressure management
    • Influenza and pneumonia vaccinations
    • Stress management
    • Weight management
    • Appropriate use of antibiotics
    • Respiratory management (COPD and asthma)
    • Medication management and safety

    Childhood and Adolescent Care

    • Well-care visits
    • Vaccinations
    • Lead screening
    • Dental screening
    • Depression screening
    • Adolescent immunizations
    • Adolescent screening and counseling for:
      • Exercise
      • Nutrition
      • BMI and weight management
      • Sexual activity
      • Tobacco and substance abuse
      • Appropriate use of antibiotics

    Counseling

    • Smoking
    • Alcohol
    • Substance abuse

    Clinical practice guidelines are updated regularly on emblemhealth.com. Please check updates on a monthly basis.

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    Glossary terms found on this page:

    A health insurance product offered by a health plan company that is defined by the benefit contract and represents a set of covered services. Also called a health benefit plan.

    An organization comprised of individual physicians or physicians in group practices that contracts with the managed care organization on behalf of its member physicians to provide health care services. Also called an Independent Practice Association.

    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.

    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.

    A type of health benefit plan that allows enrollees to go outside the health plan's provider network for care, but requires enrollees to pay higher out-of-pocket fees when they do. Also called Point of Service.

    A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:

    • Doctor of medicine
    • Doctor of osteopathy
    • Dentist
    • Chiropractor
    • Doctor of podiatric medicine
    • Physical therapist
    • Nurse midwife
    • Certified and registered psychologist
    • Certified and qualified social worker
    • Optometrist
    • Nurse anesthetist
    • Speech-language pathologist
    • Audiologist
    • Clinical laboratory
    • Screening center
    • General hospital
    • Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes

    A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.

    The process to objectively and systematically monitor and evaluate the quality, timeliness and appropriateness of covered services, including both clinical and administrative functions, to pursue opportunities to improve health care and resolve identified problems in any of these services.

    The use of one or more drugs for purposes other than those for which they are prescribed or recommended.

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