Child Health Plus

  • Help your child stay healthy with low or no monthly costs. With CHPlus there is never a copay. 

    How many children don't get the health care they need because their parents can't afford it? At EmblemHealth, we don't want any children to go without health insurance. That's why we offer the New York State-sponsored CHPlus program. It provides uninsured children under 19 years of age with a full range of health care services for free or for a low monthly cost, depending on family income. In addition to immunizations and well-child care visits, CHPlus covers pharmaceutical drugs, vision, dental and mental health services.

    PCP Required Referral for Specialists Visits PCP/Specialist Copay Network Out of network coverage Deductibles Out-of-pocket maximum
    Yes Yes No Prime Yes* None None
    *Requires prior authorization from plan
  • Our goal at EmblemHealth is to provide you with access to high-quality dental care, which is why we have contracted with DentaQuest to manage the dental needs of our CHPlus members. DentaQuest gives you access to their large network of quality dentists, which includes a dental clinic operated by an academic dental center. CHPlus members will receive the following services:

    • Routine exams
    • X-rays
    • Cleanings, fillings and tooth pulling
    • Emergency treatment
    • Replacement of missing teeth (full and partial dentures). Covered when conditions meet Medicaid guidelines.
    • Root canals. Patients must be evaluated on a case-by-case basis to determine if conditions meet Medicaid coverage guidelines. Coverage will generally be provided when the number of teeth needing or likely to need root canals is "not excessive" and the patient has good oral hygiene, and has a healthy mouth and gums, and:
      • Has few, if any cavities; and
      • Has a full complement of natural teeth; and
      • Has had all other necessary restorations completed; and/or
      • Is undergoing orthodontic treatment

    Root canals will not be covered when the prognosis of the tooth is questionable or extraction and replacement is a reasonable alternative course of treatment.

    • Crowns will not routinely be approved if restorative materials can restore the teeth. Fixed bridges are considered beyond the scope of the program and are not covered.

    When you need covered dental specialty services, your DentaQuest network dentist will refer you.

    If you have questions about your dental coverage or would like to change your network dentist, visit dentaquest.com or call DentaQuest at 1-844-776-8748, Monday through Friday from 8 am to 5 pm.

  • The following services are covered under the CHPlus program. To qualify, you must meet income guidelines, live in New York State, not have access to similar health insurance and not be eligible for Medicaid. Children may be eligible for health coverage through CHPlus regardless of immigration status.

    Download the CHPlus Member Handbook and learn how EmblemHealth will work for you.

    • Well-child care
    • Physical exams
    • Immunizations
    • Diagnosis and treatment of illness and injury
    • X-ray and lab tests
    • Outpatient surgery
    • Emergency care
    • Prescription and non-prescription drugs (if ordered)
    • Inpatient hospital medical or surgical care
    • Short-term therapeutic outpatient services (chemotherapy, hemodialysis)
    • Inpatient and outpatient treatment for mental health, alcoholism and substance abuse
    • Dental care
    • Vision care
    • Speech and hearing
    • Durable medical equipment
    • Emergency ambulance transportation to a hospital
    • Hospice
    • Mental health and substance abuse services

    See if your child qualifies for New York State-sponsored CHPlus

    * Your routine vision benefits are administered by EyeMed. If you’d like help finding an eye care provider, visit eyemedvisioncare.com/emblem or call EyeMed at 1-877-324-2791, 7:30 am to 11 pm, Monday through Saturday or 11 am to 8 pm on Sunday.

  • Learn what is not covered by CHPlus.

    For your information, the following services are not covered by the plan:

    • Experimental medical or surgical procedures
    • Experimental drugs
    • Drugs bought without a prescription (except as defined)
    • Prescription drugs to treat erectile dysfunction
    • Prescription drugs to cause the death, suicide, or mercy killing of a person
    • Private duty nursing
    • Home health care, except as defined
    • Care in connection with the detection and correction by manual or mechanical means of structural imbalance, distortion or subluxation in the human body for the purpose of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of the vertebral column
    • Services provided in a skilled nursing facility
    • Cosmetic, plastic, or reconstructive surgery, except as defined
    • In-vitro fertilization, artificial insemination or other means of conception and infertility services
    • Services covered by another payment source
    • Durable medical equipment and medical supplies, except as defined
    • Transportation, except as defined
    • Personal or comfort items such as Cervical Pillows, Rollabout/Geri-Chairs, Homedics Back Energizer 5-Motor Back Massager with Heat, Personal Response Systems, Wheelchair Ramps
    • Orthodontia services
    • Services that are not medically necessary

    See if your child qualifies for New York State-sponsored CHPlus

  • How much does CHPlus cost?

    There are no copayments for any CHPlus benefits, but you may have a monthly payment depending on your family's gross (before taxes) monthly income and your family size compared to the most current Federal Poverty Level (FPL) guidelines. Families with low incomes may be fully subsidized by the State and will not need to pay anything. Those families with higher incomes will need to pay a monthly premium of $9, $15, $30, $45, or $60 per child per month, depending on family income and family size. Those families whose incomes are above 400% are not State subsidized and will need to pay the plan premium rate. To find out the current EmblemHealth non-subsidized CHPlus monthly premium rate, please call Customer Service at 1-800-447-8255, Monday through Friday, 8 am to 6 pm.

    To find out what your monthly premium might be, check the most current FPL chart.