Summary of Lines of Business, Networks, and Plans

2026
2025

Please use this chart to let your appointment schedulers know how you participate with EmblemHealth. Circle the networks below covered by your contract(s). Use the Check Provider Network Status look-up tool in the Member Management section of the provider portal to easily determine if a provider is in-network for a member. See sample member ID Cards in the EmblemHealth Provider Manual and our Bridge Program page.

Network	Line(s) of Business	Plan Names	Out of Network (OON) Coverage, Referral Required
Bridge* (EmblemHealth lower 13 counties, United Healthcare Choice Plus Network in all other counties)	New York City Plan	NYCE PPO To learn more about the NYCE PPO plan, visit our webpage	OON Coverage: Yes Referral Required: No
Enhanced Care Prime	Commercial – Essential Plan	Essential Plan 200-250 Essential Plan 1 Essential Plan 2 Essential Plan 3 Essential Plan 4	OON Coverage: No Referral Required: No
Enhanced Care Prime	State Sponsored Programs – Medicaid, Health and Recovery Plan (HARP)	EmblemHealth Enhanced Care EmblemHealth Enhanced Care Plus EmblemHealth VIP Dual Enhanced (HMO D-SNP) Medicaid-only services	OON Coverage: No Referral Required: No
Select Care	Commercial – Individual and Family Plans (On- and Off-Exchange)	EmblemHealth Select Care Platinum/Platinum D EmblemHealth Select Care Gold/Gold D EmblemHealth Select Care Silver/Silver D EmblemHealth Select Care Silver CSR 1 EmblemHealth Select Care Silver CSR 2 EmblemHealth Select Care Silver CSR 3 EmblemHealth Select Care Catastrophic/Catastrophic D	OON Coverage: No Referral Required: No
Select Care	Commercial – Small Group	EmblemHealth Platinum Premier EmblemHealth Gold Premier EmblemHealth Silver Premier EmblemHealth Silver Plus H.S.A. EmblemHealth Bronze Premier EmblemHealth Bronze Plus H.S.A. EmblemHealth Healthy Gold NY	OON Coverage: No Referral Required: No
Select Care	Commercial – Large Group	HIP Prime HMO EmblemHealth HMO Plus	OON Coverage: No Referral Required: Yes
Millennium	Commercial – Individual and Family Plans (On and Off Exchange)	EmblemHealth Millennium Platinum/Platinum D EmblemHealth Millennium Gold/Gold D EmblemHealth Millennium Silver/Silver D EmblemHealth Millennium Silver CSR 1 EmblemHealth Millennium Silver CSR 2 EmblemHealth Millennium Silver CSR 3	OON Coverage: No Referral Required: No
Millennium	Commercial – Large Group	HIP Prime HMO EmblemHealth HMO Plus	OON Coverage: No Referral Required: Yes
Prime	State-Sponsored Programs	Child Health Plus	OON Coverage: No Referral Required: No
	Commercial – Large Group	HIP Prime HMO EmblemHealth HMO Plus EmblemHealth HMO Preferred Plus HIP Access I HIP Access II	OON Coverage: No Referral Required: Yes, based on plan
	Commercial – Large Group	HIP Prime POS	OON Coverage: Yes Referral Required: No
National	Commercial – Large Group	EmblemHealth EPO EmblemHealth PPO EmblemHealth Consumer Direct EPO EmblemHealth InBalance EPO EmblemHealth InBalance PPO	OON Coverage: Yes Referral Required: No
VIP Prime	Medicare	EmblemHealth VIP Premier (HMO) Group EmblemHealth VIP Rx CarveOut (HMO) Group	OON Coverage: No Referral Required: Yes
VIP Bold	Medicare	EmblemHealth VIP Dual (HMO D-SNP) EmblemHealth VIP Dual Enhanced (HMO D-SNP) EmblemHealth VIP Gold (HMO) EmblemHealth VIP Gold Plus (HMO) EmblemHealth VIP Value (HMO-POS)	OON Coverage: No Referral Required: No
VIP Reserve	Medicare	EmblemHealth VIP Dual Reserve (HMO D-SNP)	OON Coverage: No Referral Required: No
Medicare Choice PPO	Medicare	EmblemHealth Group Access Rx (PPO)	OON Coverage: Yes Referral Required: No
Network Access Network (Professional Services) Medicare Choice PPO (Facility Services)	N/A	ArchCare Senior Life HMO PACE EmblemHealth does not adjudicate ArchCare’s claims. EmblemHealth leases its networks to and prices claims for ArchCare based on the applicable network’s contracted rates.	OON Coverage: No Referral Required: Yes

*The 13 counties include Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Ulster, and Westchester.
**Access I and Access II do not require referrals.

Bridge Program

The Bridge Program offers access to care in NY State through the Prime Network and the National (GHI PPO) Network. For care outside of NY State, members have access to care through the Cigna Healthcare PPO Network or through the First Health Network and QualCare Network in New Jersey.

Check the member’s ID card to confirm the networks they have access to.

Bridge + Cigna

Commercial –
Large Group/ New York City Plan

DC37-Med-Team
EmblemHealth EPO
EmblemHealth PPO
EmblemHealth Consumer Direct EPO
EmblemHealth Consumer Direct PPO
EmblemHealth InBalance EPO
EmblemHealth InBalance PPO
Administrative Services Only (ASO)

OON Coverage: Yes

Referral Required: No

Bridge + First Health and QualCare

Commercial –
Large Group

EmblemHealth EPO
EmblemHealth PPO
EmblemHealth Consumer Direct EPO
EmblemHealth Consumer Direct PPO
EmblemHealth InBalance EPO
EmblemHealth InBalance PPO
Administrative Services Only (ASO)

OON Coverage: Yes

Referral Required: No

Bridge* (EmblemHealth lower 13 counties, United Healthcare Choice Plus Network in all other counties)

New York City Plan

NYCE PPO
To learn more about the NYCE PPO plan, visit our webpage

OON Coverage: Yes

Referral Required: No

*The 13 counties include Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Ulster, and Westchester.

Select Care for Large Groups

New for Jan. 1, 2026, members have access to care in NY State through the Select Care Network and the National (GHI PPO) Network. For care outside of NY State, members have access to care through the Cigna Healthcare PPO Network or through the First Health Network and QualCare Network in New Jersey.

Check the member’s ID card to confirm the networks they have access to.

Select Care + Cigna

Commercial –
Large Group

EmblemHealth EPO
EmblemHealth PPO
EmblemHealth Consumer Direct EPO
EmblemHealth Consumer Direct PPO
EmblemHealth InBalance EPO
EmblemHealth InBalance PPO

OON Coverage: Yes

Referral Required: No

Select Care + First Health and QualCare

Commercial –
Large Group

EmblemHealth EPO
EmblemHealth PPO
EmblemHealth Consumer Direct EPO
EmblemHealth Consumer Direct PPO
EmblemHealth InBalance EPO
EmblemHealth InBalance PPO

OON Coverage: Yes

Referral Required: No

Large Group HMO Access

For members with access in Connecticut and New Jersey, care may be provided through Cigna Healthcare PPO Network or through the First Health Network in Connecticut and QualCare Network in New Jersey.

Check the member’s ID card to confirm the networks they have access to.

HMO EmblemHealth network** + Cigna

Commercial –
Large Group/New York City Plan

HIP HMO Preferred
HIP Prime HMO
EmblemHealth HMO Plus
EmblemHealth HMO Preferred Plus
HIP Access I
HIP Access II

OON Coverage: Yes

Referral Required: Yes

HMO EmblemHealth network** + First Health and QualCare

Commercial –
Large Group

HIP Prime HMO
EmblemHealth HMO Plus
EmblemHealth HMO Preferred Plus
HIP Access I
HIP Access II

OON Coverage: Yes

Referral Required: No

**Access to care in NY State is available through the EmblemHealth Prime, Select Care, or Millennium network based on the member’s plan.

Network	Line(s) of Business	Plan Names	Out of Network (OON) Coverage, Referral Required
National Network (GHI PPO National/CBP)	New York City Plan	GHI CBP DC37-Med-Team	OON Coverage: Yes Referral Required: No
Enhanced Care Prime	Commercial – Essential Plan	Essential Plan 200-250 Essential Plan 1 Essential Plan 2 Essential Plan 3 Essential Plan 4	OON Coverage: No Referral Required: No
Enhanced Care Prime	State Sponsored Programs – Medicaid, Health and Recovery Plans (HARP)	EmblemHealth Enhanced Care EmblemHealth Enhanced Care Plus	OON Coverage: No Referral Required: No, PCP needed unless homeless
Select Care	Commercial – Individual and Family Plans (On- and Off-Exchange)	EmblemHealth Select Care Platinum/Platinum D EmblemHealth Select Care Gold/Gold D EmblemHealth Select Care Silver/Silver D EmblemHealth Select Care Silver CSR 1 EmblemHealth Select Care Silver CSR 2 EmblemHealth Select Care Silver CSR 3 EmblemHealth Select Care Catastrophic/Catastrophic D	OON Coverage: No Referral Required: No
Select Care	Commercial – Small Group	EmblemHealth Platinum Premier EmblemHealth Gold Premier EmblemHealth Silver Premier EmblemHealth Silver Plus H.S.A. EmblemHealth Bronze Premier EmblemHealth Bronze Plus H.S.A. EmblemHealth Healthy Gold NY	OON Coverage: No Referral Required: No
Select Care	Commercial – Large Group	HIP Prime HMO EmblemHealth HMO Plus	OON Coverage: No Referral Required: Yes
Millennium	Commercial – Individual and Family Plans (On and Off Exchange)	EmblemHealth Millennium Platinum/Platinum D EmblemHealth Millennium Gold/Gold D EmblemHealth Millennium Silver/Silver D EmblemHealth Millennium Silver CSR 1 EmblemHealth Millennium Silver CSR 2 EmblemHealth Millennium Silver CSR 3 EmblemHealth Millennium Catastrophic/Catastrophic D	OON Coverage: No Referral Required: No
Millennium	Commercial – Large Group	HIP Prime HMO EmblemHealth HMO Plus	OON Coverage: No Referral Required: Yes
Prime	State-Sponsored Programs	Child Health Plus	OON Coverage: No Referral Required: No
	Commercial – Large Group	HIP Prime HMO EmblemHealth HMO Plus EmblemHealth HMO Preferred Plus HIP Access I HIP Access II	OON Coverage: No Referral Required: Yes, based on plan
	Commercial – Large Group	HIP Prime POS	OON Coverage: Yes Referral Required: No
Bridge*	Commercial – Large Group	EmblemHealth EPO EmblemHealth PPO EmblemHealth Consumer Direct EPO EmblemHealth Consumer Direct PPO EmblemHealth InBalance EPO EmblemHealth InBalance PPO Administrative Services Only (ASO)	OON Coverage: Yes Referral Required: No
VIP Prime	Medicare	EmblemHealth VIP Premier (HMO) Group EmblemHealth VIP Rx CarveOut (HMO) Group	OON Coverage: No Referral Required: Yes, PCP needed
VIP Bold	Medicare	EmblemHealth VIP Dual (HMO D-SNP) EmblemHealth VIP Dual Enhanced (HMO D-SNP) EmblemHealth VIP Gold (HMO) EmblemHealth VIP Gold Plus (HMO) EmblemHealth VIP Rx Saver (HMO)	OON Coverage: No Referral Required: No, PCP needed
VIP Reserve	Medicare	EmblemHealth VIP Dual Reserve (HMO D-SNP)	OON Coverage: No Referral Required: No, PCP needed
Medicare Choice PPO	Medicare	EmblemHealth Group Access Rx (PPO)	OON Coverage: Yes Referral Required: No
Network Access Network	N/A	ArchCare Senior Life HMO PACE EmblemHealth does not adjudicate ArchCare’s claims. EmblemHealth leases its networks to, and prices claims for, ArchCare based on the applicable network’s contracted rates.	OON Coverage: No Referral Required: Yes

*The Bridge Program offers access to care through the Prime, ConnectiCare Choice, Qualcare, National, and First Health networks.
**Access I and Access II do not require referrals.

JP 70864 04/2026

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Summary of Lines of Business, Networks, and Plans