EmblemHealth Launches the Select Care Network

Date Issued: 10/1/2013

EmblemHealth will offer Select Care individual health plans on NY State of Health: The Official Health Plan Marketplace. Individuals and families enrolling in these plans will have access to EmblemHealth’s tailored Select Care network, which includes approximately 12,000 doctors and other health care providers, as well as leading hospitals. The Select Care network is a subset of our existing HMO network. Participating hospitals, physicians and ancillary providers were notified this summer.

 

About the NY State of Health Marketplace

As part of the Affordable Care Act, the health plan marketplace gives uninsured and underinsured individuals an online place to compare insurance plans and find the plan that best suits their needs and budgets. Federal financial assistance in the form of tax credits and subsidies will be available through the marketplace to make coverage more affordable for qualifying individuals and families. Tax penalties will be levied on most individuals who do not obtain coverage in 2014.

 

The enrollment period for the marketplace starts October 1, 2013. Coverage begins January 1, 2014, for those who apply by December 15, 2013. After December 15, 2013, coverage effective dates depend on the date of application.

 

For any of your patients who may be eligible, it’s important to let them know they can visit www.nystateofhealth.ny.gov for more information. Your patients can also get helpful information about the marketplace from EmblemHealth’s Health Care Reform Web site.

 

EmblemHealth’s Select Care Plans on the Marketplace

As with all insurers on the marketplace, EmblemHealth will offer one plan at each “metal” level (bronze, silver, gold and platinum), as well as a catastrophic plan option for people under age 30 and others who qualify.

 

Our metal plans are called EmblemHealth Select Care Bronze, Select Care Silver, Select Care Gold and Select Care Platinum. Our catastrophic plan is called Select Care Basic. All five Select Care plans are HMO plans, and all are available in the five boroughs of New York City and Nassau, Orange, Rockland, Suffolk and Westchester counties. Learn more.

 

The metal levels denote the plan’s “actuarial value” — the percentage the insurer pays for total health care costs versus what the member pays.

  • Plans with low actuarial value, such as Select Care Bronze, have lower premiums but higher levels of cost-sharing (deductible, coinsurance and copays).
  • Plans with high actuarial value, such as Select Care Platinum, do the opposite — they have higher premiums but lower levels of cost-sharing.

 Note: Certain Select Care plans for individuals and small groups will be available directly from EmblemHealth. These off-the-NY State of Health marketplace plans will also use the Select Care network. Stay tuned for more information.

Select Care Network Training

Select Care network training will be available to participating providers beginning in December 2013. Training will include information on how to manage care for Select Care members, as well as specific prior approval rules and cost-sharing structures.