Managed Long-Term Care Plans Update

Date Issued: 1/4/2016

Effective December 31, 2015, EmblemHealth has terminated the following Managed Long-Term Care (MLTC) benefit plans:

  • EmblemHealth MLTC-Partial
  • EmblemHealth MLTC Plus (HMO SNP)
  • EmblemHealth Dual Eligible (HMO SNP) MAP MLTC
  • EmblemHealth MLTC Plus (HMO SNP) MAP
  • EmblemHealth Dual Assurance FIDA Plan

Exiting MLTC aligns with EmblemHealth’s overall direction to leverage our unique delivery system in order to deliver exceptional member experiences. EmblemHealth will be selling its MLTC assets to GuildNet. Given the significant network overlap, years of partnership between our organizations and GuildNet’s role as a market leader, we believe that this will be a winning transition for our membership and providers.

MLTC-Partial members are being passively enrolled to GuildNet’s MLTC-Partial with a coverage effective date of January 1, 2016. MAP members are also being passively enrolled to GuildNet MLTC-Partial for their Medicaid and Long-Term Service and support (LTSS) benefits; however, these members will remain in the EmblemHealth Dual Eligible (HMO-SNP) for their Medicare benefits, with an effective date of January 1, 2016. EmblemHealth FIDA participants are being transitioned into other plans via passive enrollment by the state’s enrollment broker, New York Medicaid Choice (Maximus).

EmblemHealth will continue to support these plans in the following ways:

  • Contractually, providers have one year from date of service to submit claims. EmblemHealth will work with providers to expedite the submission of these claims.
  • EmblemHealth will not provide any service authorizations for dates of service past December 31, 2015, unless it is related to an inpatient stay that started prior to January 1, 2016.
  • The Associated Dual Assurance Network will continue to support the GuildNet Gold Plus FIDA Plan.

To verify Medicare eligibility, providers may call EmblemHealth at 1-877-344-7364. To confirm Medicaid and LTSS eligibility, providers can call GuildNet at 1-800-932-4703.