Helping you determine your eligibility for one of our programs is our goal. The questions and answers below address topics that can help you learn what you need to know about qualifying for and enrolling in one of our programs.
Search
Popular Tasks
Neighborhood Care
Eligibility and Enrollment
You've looked at your options, and now you're ready to enroll. We want to make the process as easy as possible for you. For details about your eligibility for one of these programs, please see the frequently asked questions below.
Make an appointment with a Facilitated Enroller.
To make an appointment with an EmblemHealth Facilitated Enroller (FE), call toll-free at 800-542-2412 (Monday through Friday, 8 am to 8 pm.)
What do I need to Enroll?
We ask about income and other information about you to tell you what coverage you qualify for and if you can get help paying for it. You may need the following information:
- Social Security numbers (or document numbers for legal immigrants who need health insurance)
- Birth dates
- Employer and income information for everyone in your family
- Policy numbers for any current health insurance
- Information about any job related health insurance available to your family
The Health and Recovery Plan (HARP) coordinates your health care services with mental health and substance use disorder services. Before you can join a HARP, New York State must determine you are eligible to participate. Once New York State lets us know you are eligible, we will also send you information about how to enroll in the plan.
Eligibility requirements for these programs are established by New York State and include household income (not necessarily how much money you have in the bank), residency, family size and age, as well as your citizenship or immigration status and whether you already have other insurance. The programs are available in all five boroughs of New York City, as well as in Nassau, Suffolk and Westchester counties.
To find out if you are eligible call Customer Service at 1-855-283-2146. You can also visit the NY State of Health Marketplace online at www.nystateofhealth.ny.gov or call 1-855-355-5777.
New York State will let you know if you are eligible to join a Health and Recovery Plan (HARP). To learn more, see our HARP brochure.
Not necessarily. Because eligibility for the Medicaid and Child Health Plus (CHPlus) programs is based on more than just family size and income, it is possible that members in the same family will be eligible for different programs.
For example, in a family with three children, it is possible that the parents and the youngest child will be eligible for Medicaid and the other children will be eligible for CHPlus. This will be because of differences in the age, immigration/citizenship status or other eligibility requirements of different family members.
Enrollment is easy; it just depends on whether you already have regular Medicaid coverage.
- If you already have regular Medicaid coverage and want to enroll in an EmblemHealth or in another managed care plan, call New York Medicaid Choice at 1-800-505-5678.
- If you are already enrolled in a Medicaid Managed Care plan but would like to change health plans, call New York Medicaid CHOICE at 1-800-505-5678 and ask to be switched to the Medicaid Managed Care plan of your choice.
- If you have no health care coverage and would like to apply for Medicaid or Child Health Plus coverage for you and your family, you must apply through the New York State of Health Marketplace online at www.nystateofhealth.ny.gov or call 1-855-355-5777.
We suggest that you meet with an EmblemHealth Marketplace Facilitated Enroller (FE) if you are uninsured or would like assistance in renewing your eligibility for a program. FEs are conveniently located in a variety of community sites and can assist you with the online application and answer any questions you may have. To make an appointment with an FE, call toll-free at 1-800-542-2412 (Monday through Friday, 8 am to 8 pm). Find a location near you.
What do I need to Enroll?
We ask about income and other information about you to tell you what coverage you qualify for and if you can get help paying for it. You may need the following information:
- Social Security numbers (or document numbers for legal immigrants who need health insurance)
- Birth dates
- Employer and income information for everyone in your family
- Policy numbers for any current health insurance
- Information about any job-related health insurance available to your family
If you already have Medicaid and are selecting or changing health plans through New York Medicaid Choice and:
- You request the change before the 20th day of the month, the change will be effective on the first day of the next month.
- You request the change after the 20th day of the month, the change will be effective on the first day of the second following month.
If you are uninsured and you completed an application on the NY State of Health Marketplace, and you or your child(ren) are found eligible for Medicaid or Child Health Plus and:
- Your completed application is processed before the 15th day of the month, your coverage may begin on the first day of the next month.
- Your completed application is processed after the 15th day of the month, your coverage may begin on the first day of the second following month.
Also note that if a Child Health Plus premium payment is required, the payment must be received before your child(ren) can obtain coverage.
The duration of postpartum health coverage for Medicaid and Child Health Plus (CHPlus) is a full year following pregnancy, regardless of your immigration status or how your pregnancy ended.
Yes. Shortly after you are successfully enrolled, we will:
- Send you an EmblemHealth member ID card.
- Call to welcome you to EmblemHealth and give you important information, help you select a primary care doctor, and answer any questions you may have.
- Send you a New Member Welcome Kit with information on how to access the Member Handbook that tells you about your health care coverage and how to use it.
- We will also send you member newsletters with updates on benefit and service changes, as well as tips about staying healthy.