2017 Benefit Changes to Select Care Plans and Essential Plan

Date Issued: 11/2/2016

Open Enrollment Period November 1, 2016, through January 31, 2017

EmblemHealth offers individual and small group Select Care plans both on the NY State of Health marketplace (NYSOH; i.e. on-exchange) and off the NYSOH marketplace (i.e. off-exchange) and the Essential Plan on-exchange. Select Care plans use the Select Care Network, and Essential Plan uses the Enhanced Care Prime Network.

To identify Select Care plans, look for the words “Network: Select Care” on the front of the member ID card. To identify the Essential Plan, look for the words “Network: Enhanced Care Prime” on the front of the member ID card. You may also sign in to our secure provider website to view the member’s eligibility and also see your network participation and review/edit your practice information.

For 2017 health coverage, the open enrollment period is November 1, 2016, through January 31, 2017, for individual Select Care plans both on- and off-exchange. Small group Select Care plans and the Essential Plan have a rolling open enrollment and can apply during any month of the year.

Some of the changes for EmblemHealth’s individual and small group plans in 2017 include:

  • Pediatric Dental Benefits: New for 2017, pediatric dental benefits are embedded in all individual and small group Select Care plans both on- and off-exchange. EmblemHealth’s standalone dental plan FirstSmiles is discontinued.
  • Two Nonstandard Plans: New for 2017, Select Care Silver Value and Select Care Bronze Value plans, both on- and off-exchange, provide a specific number of primary care physician (PCP) visits at no cost before the deductible and also offer dental and vision benefits for adults and children, no-cost lab services, and no-cost telemedicine. Standard plans follow the standardized plan designs established by New York State and nonstandard plans can change the cost-sharing required in any benefit category.
  • Telemedicine: All EmblemHealth individual and small group Select Care plans both on- and off-exchange and the Essential Plan offer telemedicine services at no cost.

Both individual and small group Select Care plans and the Essential Plan cover 10 categories of essential health benefits. Individuals pay no cost-sharing (no deductible, copay or coinsurance) on preventive care services, such as checkups, screenings and vaccinations. The 10 categories of essential health benefits are:

  1. Routine doctor visits
  2. Emergency room visits
  3. Hospital care
  4. Maternity and newborn care
  5. Mental health and substance-use treatment
  6. Prescription drugs
  1. Habilitative and rehabilitative services
  2. Laboratory tests
  3. Preventive and wellness services, and chronic disease management
  4. Pediatric services, including vision care

EmblemHealth offers its individual and small group Select Care members and Essential Plan members a few noteworthy value-added health and wellness benefits:

  • Gym Reimbursement: Members can get reimbursed for the cost of membership. Learn more.

Please be sure to refer your Select Care patients to other Select Care providers and your Essential Plan patients to other Enhanced Care Prime providers. To locate participating providers, please use the “Find a Doctor” directory and create all your referrals using our secure provider website.

Learn more about changes in the EmblemHealth Select Care plans and Essential Plan for 2017.