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PerfectHealth Merges with GHI

PerfectHealth members are now GHI members
On December 31, 2009, Group Health Incorporated (GHI), an EmblemHealth company, assumed all rights, liabilities and obligations of The PerfectHealth Insurance Company (PerfectHealth). Members with PerfectHealth insurance are now covered by GHI. A Certificate of Assumption was mailed to all affected members, groups, brokers and general agents on January 22, 2010.

This change does not affect your rights or the terms and conditions of your agreement with PerfectHealth. GHI is now responsible for all benefits and compensation formerly administered by PerfectHealth.

Please submit your paper claims, correspondence, other requests or documentation to the address below:

GHI PHIC Operation Center
55 Water Street
Fifth Floor
New York, NY 10041-8190

PerfectHealth HDHP discontinued
Effective, May 1, 2010, EmblemHealth will replace PerfectHealth’s High Deductible Health Plans with either a ConsumerDirect PPO or a ConsumerDirect EPO plan. Both of these plans have the advantages of a High Deductible Health Plan, featuring lower premiums based on a higher deductible and a separate Health Savings account for members.

Practitioners are reminded that you can expedite claims payment and avoid payment errors by submitting claims for medical services for ConsumerDirect PPO or EPO members to EmblemHealth before billing the member. Member liability is determined after a claim has been processed. The Explanation of Benefits you receive with your payment will clearly indicate the member’s responsibility. If any deductible or coinsurance remains, you may bill the member directly.

If you have any questions you may contact us at mdq&adownstate@emblemhealth.com if your practice is in New York City or Nassau, Rockland, Suffolk or Westchester counties. For all other New York State counties, including Orange County send your inquiry to mdq&aupstate@emblemhealth.com.