2018 Benefit Changes to Qualified Health Plans and Essential Plan

Date Issued: 10/25/2017

Open Enrollment Period November 1, 2017, through January 31, 2018

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

To identify Prime plans, look for the words “Network: Prime” on the front of the member ID card. There will be our Individual/Family Standard plans (Basic, Bronze, Silver, Gold, Platinum) and all of our Small Group plans. To identify Select Care plans, look for the words “Network: Select Care” on the front of the member ID card. These will be our Individual/Family Nonstandard plans (Bronze Value and Silver Value) 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 2018 health coverage, the open enrollment period is November 1, 2017, through January 31, 2018, for individual Qualified Health plans both on- and off-exchange. Small Group 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 2018 include:

  • There will be two new Small Group plans available November 1, 2017. The Gold Open Access plan gives members the ability to visit a specialist without a referral from their primary care physician. This plan also offers multiple benefits before plan deductible is met and this plan covers adult/pediatric dental and vision before plan deductible is met. The Bronze HSA plan is a high deductible plan that allows employees to put away money in a “health savings account” to use in the case of a medical emergency or for other general care needs.
  • EmblemHealth Individual and Small Group Nonstandard plans will no include acupuncture benefit. Bronze Value, Silver Value, and Gold Open Access plans cover acupuncture treatment even before plan deductible is met

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