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  • 2019 Provider Networks and Member Benefit Plans > Summary Table: Companies, Networks & Benefit Plans

    The following table summarizes how our Provider Networks and Member Benefit Plans relate to our underwriting companies. You can print this page as a reference tool for the staff who schedule appointments for you. Check the boxes to show them which networks your contract covers. The blank spaces allow you to customize for each practice location.

    Dr.____________at ____________________________can accept patients who have these networks:

    Company Provider Network Member Benefit Plan
    GHI Commercial:
    CBP Network
    (Member ID cards may
    show: CBP, EPO, EPO1, EPO2,
    PPO, PPO1 or PPO4)
    New York City Plans
    • GHI CBP plan
    • DC37 Med-Team
    National Network
    Tristate Network
    EmblemHealth EPO/PPO
    Network Access Network
    Network Access Plan
    Medicare Choice PPO Network
    EmblemHealth Group Access Rx (PPO)
    EmblemHealth Group Access Rx National (PPO)
    ArchCare Advantage HMO SNP
    HIP/HIPIC Commercial:
    Select Care Network
    Individual On/Off Exchange:
    • EmblemHealth Platinum/EmblemHealth Platinum D
    • EmblemHealth Gold/EmblemHealth Gold D
    • EmblemHealth Silver/EmblemHealth Silver D
    • EmblemHealth Bronze/EmblemHealth Bronze D
    • EmblemHealth Basic/EmblemHealth Basic D
    • EmblemHealth Gold Value/EmblemHealth Gold Value D
    • EmblemHealth Silver Value/EmblemHealth Silver Value D
    Small Group:
    • EmblemHealth Platinum Choice
    • EmblemHealth Gold Choice
    • EmblemHealth Gold Value S
    • EmblemHealth Silver Choice
    • EmblemHealth Silver Value S
    • EmblemHealth Bronze Value S
    Prime Network
    Prime Network – NYC, LI & Westchester
    • Child Health Plus
    Large Group – Prime Network with Tristate Access:
    • Prime HMO
    • HIP HMO Preferred (City of NY)
    • EmblemHealth HMO Plus
    • EmblemHealth HMO Preferred Plus
    • Prime POS
    • Access I
    • Access II
    • EmblemHealth EPO Value
    • GHI HMO
    • Vytra HMO
    Large Group – Prime Network:
    • Prime PPO
    • HIP Select PPO
    Small Group - Prime Network with Tristate Access:
    • EmblemHealth Platinum Premier
    • EmblemHealth Gold Premier
    • EmblemHealth Gold Premier1
    • EmblemHealth Gold Plus
    • EmblemHealth Gold Plus1
    • EmblemHealth Healthy NY Gold
    • EmblemHealth Silver Premier
    • EmblemHealth Silver Premier1
    • EmblemHealth Silver Plus
    • EmblemHealth Silver Plus1
    • EmblemHealth Bronze Plus H.S.A.
    Enhanced Care Prime Network
    EmblemHealth Enhanced Care (Medicaid)
    EmblemHealth Enhanced Care Plus (HARP)
    Essential Plan (BHP)
    VIP Prime Network
    EmblemHealth VIP Dual (HMO SNP)
    EmblemHealth VIP Gold (HMO)
    EmblemHealth VIP Gold Plus (HMO)
    EmblemHealth VIP Premier (HMO)
    EmblemHealth VIP Rx Carve-Out (HMO)
    EmblemHealth VIP Dual Group (HMO SNP)
    EmblemHealth VIP Rx Saver (HMO)
    EmblemHealth VIP Part B Saver (HMO)
    EmblemHealth VIP Go (HMO-POS)
    EmblemHealth VIP Essential (HMO)
    EmblemHealth VIP Value (HMO)
    EmblemHealth Affinity Medicare Passport Essentials (HMO)
    EmblemHealth Affinity Medicare Passport Essentials NYC (HMO)
    EmblemHealth Affinity Medicare Ultimate (HMO SNP)
    EmblemHealth Affinity Medicare Solutions (HMO SNP)
    ConnectiCare, Inc. Commercial:
    Choice Network (includes full Prime Network)

    Passage Network (includes Prime Network except PCPs)
    Choice HMO
    Choice POS
    Passage HMO
    Passage POS
    ConnectiCare Insurance Company, Inc. Commercial:
    Choice Network (includes full Prime Network)

    Flex Network (includes full Prime Network)

    Passage Network (includes Prime Network except PCPs)

    Choice EPO
    Choice POS
    Passage EPO
    Passage POS
    Passage Network
    Medicare Advantage
    HMO-SNP Plans
    ConnectiCare of Massachusetts Commercial:
    Choice Network (includes full Prime Network)
    Choice HMO
    Choice POS

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    Glossary terms found on this page:

    A health insurance product offered by a health plan company that is defined by the benefit contract and represents a set of covered services. Also called a health benefit plan.

    A legal agreement between an individual member or an employer group and a health plan that describes the benefits and limitations of the coverage.

    A health care benefit arrangement that is similar to a preferred provider organization in administration, structure and operation but does not cover out-of-network care. Also called an Exclusive Provider Organization.

    An organization that provides comprehensive health care coverage to its members through a network of doctors, hospitals and other health care providers. Also called a Health Maintenance Organization.

    A card which allows the subscriber to identify himself or his covered dependents to a provider for health care services.

    The group of individuals who provide person-centered care coordination and care management to participants in a FIDA plan. Each participant will have an interdisciplinary team (IDT). Each IDT will be comprised, first and foremost, of the participant and/or his or her designee, and the participant’s designated care manager, primary care physician, behavioral health professional, home care aide, and other providers either as requested by the participant or his or her designee or as recommended by the care manager or primary care physician and approved by the participant and/or his or her designee. The IDT facilitates timely and thorough coordination between a FIDA plan and the IDT, primary care physician and other providers. The IDT makes coverage determinations. Accordingly, the IDT’s decisions serve as service authorizations, may not be modified by a FIDA plan outside of the IDT, and are appealable by the participant, their providers and their representatives. IDT service planning, coverage determinations, care coordination and care management are delineated in the participant’s person-centered service plan and are based on the assessed needs and articulated preferences of the participant.

    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    A jointly funded federal and state program that provides hospital and medical coverage to the low-income population and certain aged and disabled individuals.

    A nationwide insurance program for the disabled and people age 65 and over, created by the 1965 amendments to the Social Security Act and operated under the provisions of the Act. It consists of two separate but coordinated programs, Part A and Part B.

    An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program. Also known as MA.

    An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

    The group of physicians, hospital, and other medical care providers that a specific plan has contracted with to deliver medical services to its members.

    A family physician, family practitioner, general practitioner, internist or pediatrician who is responsible for delivering or coordinating care. Also called a primary care physician.

    A type of health benefit plan that allows enrollees to go outside the health plan's provider network for care, but requires enrollees to pay higher out-of-pocket fees when they do. Also called Point of Service.

    A health plan that offers benefits in-network and out-of-network. In-network services are available to enrollees at lower out-of-pocket cost than the services of non-network providers. In addition, PPO enrollees may self-refer to any network provider at any time. Also called a Preferred Provider Organization.

    A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:

    • Doctor of medicine
    • Doctor of osteopathy
    • Dentist
    • Chiropractor
    • Doctor of podiatric medicine
    • Physical therapist
    • Nurse midwife
    • Certified and registered psychologist
    • Certified and qualified social worker
    • Optometrist
    • Nurse anesthetist
    • Speech-language pathologist
    • Audiologist
    • Clinical laboratory
    • Screening center
    • General hospital
    • Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes

    A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.

    A set of providers contracted with a health plan to provide services to the enrollees.


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