EmblemHealth Privacy & Security Policies
EmblemHealth Privacy Notice
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
We maintain high standards for the protection of your privacy on our Web site. Please click here for more information on how we do this.
EmblemHealth Data Security Policy
We strive to afford our customers with easy online means of viewing claims data. When you use our Member Online Services or Provider Online Services to view your health care transactions, the data that you view is encrypted for your protection.
Read our Data Security Policy.
Managed Care Disclosure for GHI HMO and HIP HMO Members
The following is information about GHI and HIP HMO that we must give to all prospective and existing HMO members who request the information. Additional details about the following items are in your Member Handbook or Certificate of Insurance.
About GHI HMO and HIP HMO
The names, business addresses and titles of officers, directors, owners and controlling persons of GHI or HIP.
How to get a copy of:
- The most recent annual financial statements.
- GHI or HIP HMO's most recent direct payment contracts.
Information about GHI HMO and HIP HMO Information includes:
- Consumer complaint program.
- How we protect our members medical records and other member information.
- Quality assurance procedures.
- Utilization Review program including Utilization Review policies and procedures as well as clinical review criteria. This includes information about certain diseases and conditions that are covered.
About GHI HMO and HIP HMO Benefits
How to get a copy of:
- The preferred prescription drug list (formulary), if you have a GHI HMO or HIP HMO prescription drug benefit.
How to get a list of:
- All participating providers (including facilities), along with their specialty, address, and telephone number including whether they are board certified and what hospitals they are affiliated with.
- The minimum qualifications for providers to be in the GHI HMO or HIP HMO network.
- What services need prior authorization.
- How to get emergency services, 24 hours a day.
- How to select primary and specialty providers and get services. This includes information about how to get a referral to a non-network provider in certain cases.
- How a member may get a referral to a specialist provider, and how that referral can become a standing referral.
- How a member with a life-threatening condition or a degenerative and disabling condition or disease which requires specialized medical care can request a specialist Primary Care Physician or access to a specialty care center.
- How we pay providers.
- How GHI HMO and HIP HMO decide which experimental/investigational treatments, drugs and devices procedures are covered.
A description of all benefits including benefit maximums, coverage exclusions and the definition of medical necessity.
GHI HMO/HIP HMO and Members
- The member's responsibility for payment of premiums, coinsurance, copayments and deductibles, and definitions of these words.
- The member's responsibility for payment of services by non-network providers or for noncovered services.
- Our process for filing a grievance.
- How members can participate in the development of GHI HMO and HIP HMO policies.
- How non-English speaking members are served.
- How members can contact GHI HMO or HIP HMO.
If you have questions about the Managed Care Act Disclosure Provision, would like copies of information about GHI HMO or HIP HMO, or for any other questions:
For GHI HMO: Call Customer Service toll free at 1-877-244-4466.
For HIP HMO: Call Customer Service toll free at 1-800-447-8255.