Changes in 2016 EmblemHealth Select Care Network Plans

Date Issued: 9/22/2015

The New York health insurance marketplace, also known as NY State of Health marketplace (NYSOH), is an online medium where individuals and small businesses can compare and shop for health plans. EmblemHealth offers individual and small group Select Care plans both on NYSOH (i.e. on-exchange) and off NYSOH (i.e. off-exchange).

For 2016 health coverage, the open enrollment period is November 1, 2015 through January 31, 2016 for individual plans both on and off NYSOH. Small groups have a rolling open enrollment and can apply during any month of the year. Below is a summary of changes in the EmblemHealth Select Care Network plans for 2016:

2016 Select Care Network Benefit Plans
On NYSOH Off NYSOH
Individual
Select Care Bronze:
  • Deductible increased to $3,500 for individuals and $7,000 for families.
  • Out-of-pocket maximum (MOOP) increased to $6,850 for individuals and $13,700 for families.
Select Care Bronze:
  • Deductible increased to $3,500 for individuals and $7,000 for families.
  • Out-of-pocket maximum (MOOP) increased to $6,850 for individuals and $13,700 for families.
Select Care Silver
CSR-1:

  • Deductible increased to $1,500 for individuals and $3,000 for families.
  • MOOP increased to $5,450 for individuals and $10,900 for families.
Select Care Basic
(catastrophic plan):

  • Deductible and MOOP both increased and are the same dollar amounts, at $6,850 for individuals and $13,700 for families.
Select Care Basic 
(catastrophic plan):
  • Deductible and MOOP both increased and are the same dollar amounts, at $6,850 for individuals and $13,700 for families.
Select Care Platinum POS:
  • Plan has been discontinued for 2016.
Small Business
Select Care Bronze S
(Standard plan):

  • Deductible increased to $3,500 for individuals and $7,000 for families.
  • Out-of-pocket maximum (MOOP) increased to $6,850 for individuals and $13,700 for families.
EH HMO 40/60 S
(Nonstandard Gold):
  • Deductible increased to $200 for individuals and $400 for families.
  • MOOP increased to $5,500 for individuals and $11,000 for families.
EH HMO 40/60 S
(Nonstandard Gold):
  • Deductible increased to $200 for individuals and $400 for families.
  • MOOP increased to $5,500 for individuals and $11,000 for families.
EmblemHealth HMO 35/55 S
(Nonstandard Silver):

  • Deductible increased to $3,000 for individuals and $6,000 for families.
EmblemHealth HMO 35/55 S (Nonstandard Silver):
  • Deductible increased to $3,000 for individuals and $6,000 for families.
EmblemHealth EPO 35/55 (HIPIC Silver):
  • Deductible increased to $3,000 for individuals and $6,000 for families.

Essential Plan:

  • Offered on the EmblemHealth Enhanced Care Prime Network, formerly the Medicaid Prime Network
  • Unlike other on-NYSOH products, service area is only an eight-county region
  • Qualifying Select Care and Medicaid members will be migrated to this plan

Both individual and small group Select Care plans and the Essential Plan cover 10 categories of essential health benefits. Individuals pay no cost-sharing (no deductible, copay or coinsurance) on preventive care services, such as checkups, screenings and vaccinations. The 10 categories of essential health benefits are:

  • Routine doctor visits
  • Emergency room visits    
  • Hospital care 
  • Maternity and newborn care 
  • Mental health and substance-use treatment
  • Prescription drugs
  • Habilitative and rehabilitative services
  • Laboratory tests
  • Preventive and wellness services, and chronic disease management
  • Pediatric services, including vision care

EmblemHealth offers its individual and small group Select Care members and Essential Plan members a few noteworthy value-added benefits such as our health and wellness programs and discounts:

  • Telehealth - offers members a faster and more convenient way to consult a doctor via phone, computer or tablet (excluded for the Essential Plan).
  • Gym Reimbursement - members can get reimbursed for the cost of membership. Learn more.  
  • Local Fruit & Veggies Program - aims to increase member access to local fruits and vegetables and offers a discount on those purchases, while giving them an incentive to visit their PCP. Learn more.

Please be sure to refer your Select Care patients to other Select Care providers and your Essential Plan patients to other Enhanced Care Prime providers. To locate participating providers, please use the “Find a Doctor” directory at emblemhealth.com/find-a-doctor, and create all your referrals using our secure provider website at emblemhealth.com/providers.

To identify Select Care network plans, look for the words “Network: Select Care” on the front of the member ID card, and to identify the Essential Plan, look for the words “Network: Enhanced Care Prime” on the front of the member ID card, or sign in to our secure provider website to view the member’s eligibility. You can also see your network participation and review/edit your practice information.