Working Hand-in-Hand with Labor

EmblemHealth and labor have a long-standing, trusted partnership and continue to work hand-in-hand. And we put care first—just like you do—for our members as well as our community. We have responded to the specific demands of our region’s working men and women for more than 75 years with customizable plans and programs.

Why you should make your members our members

We know there are lots of choices out there for health care. Yet each day, millions of people across the New York tristate area look to EmblemHealth — including many of the area's largest labor unions. Union trustees and other decision makers like you know that we will:

Understand and Respect Members’ Health Care Needs

No one wants to be just a number on an ID card. It’s why we’re always working to be and do better, while providing the personal attention that each of our members deserves.

Offer Quality Care at an Affordable Price

Every dollar counts, especially today. It’s why we offer a selection of plans to meet every budget. Prices vary, but the level of attentive care offered by the health care providers in our networks and overall service our members receive never will — no matter which plan you select.

Be Accessible When You Need Us Most

We live in a 24/7 world and health care plans should meet this expectation. We get this and offer ways for our members to get what they need when they need it. Whether it’s 24/7 customer service or access to urgent care, we aim to provide our members with what they need, when they it.

From the people we hire, to the programs we design and the providers we select — we’re working to put our members first every day. Our commitment to caring for members like you is long-standing, proven and stronger than ever.

Our labor clients include, but are not limited to, members from the following health and welfare funds:

  • New York City and its Unions
  • United Federation of Teachers
  • Service Employees International Union
  • International Brotherhood of Teamsters
  • Unite Here Health — formerly the Hotel Employees and Restaurant Employees International Union Welfare Fund
  • Graphic Communications International Union
  • American Federation of Government Employees
  • International Brotherhood of Electrical Workers

 

Many EmblemHealth employees are Local 153 Office and Professional Employees International Union AFL-CIO members.

Our broad selection of plans gives fund trustees the flexibility to offer multiple options to their union membership. You can choose from:

Preferred Provider Organization (PPO) and InBalance PPO plans that combine family-friendly benefit designs (no referrals required) with freedom of provider choice, through the EmblemHealth National Network. Members also have the freedom to go out-of network for additional out-of-pocket costs. The InBalance option lowers group premiums by increasing member cost-sharing for certain services.

Exclusive Provider Organization (EPO) and InBalance EPO plans are an attractive and affordable option. In addition to access to the EmblemHealth National Network, this family-friendly plan also offers in-network-only benefits and no referrals are required. The InBalance option lowers group premiums by increasing member cost-sharing for certain services.

Consumer Direct PPO and Consumer Direct EPO plans offer low group premiums based on higher-than-customary member deductibles. These high-deductible health plans help groups offset member costs with tax-saving Health Savings Accounts (HSAs).

CompreHealth EPO plans cover in-network-only benefits, with no referrals required, and offers access to the EmblemHealth NY Metro Network, with leading physicians and other medical practitioners across New York City and Nassau, Suffolk and southern Westchester counties. This option also features multispecialty physician group practices that offer a broad range of medical services, typically under one roof, as well as access to the metro area's leading hospitals.

Dental Plans. We offer a choice of three programs featuring different benefit designs, network size and cost-sharing responsibilities, ranging from paid-in-full network coverage to in-network discounts on more costly services.

Pharmacy Services Program. This option is available by separate rider, provides a wide range of retail and mail order prescription drug benefits, as well as an extensive formulary of drugs covered by the prescription plan.

Your EmblemHealth sales representative will work closely with you to help put together a plan design that best serves your union members' needs.

A great health care plan doesn't have to break your budget

Times are tough. But this doesn't mean you can't get your members the health care they deserve at a price that won't break your budget. At EmblemHealth, we've built our product portfolio around the needs of our customers, so you can choose from a number of benefit designs, cost-sharing arrangements, leased networks, funding arrangements and administrative services only (ASO) plans.

In addition, our long-standing relationships with the area's top hospitals, provider networks and pharmacies allow us to negotiate aggressive discounts that we pass along to our customers like you.

Explore this site to better understand your options and find one you like.

We'll work closely with you to tailor a health coverage solution that fits within your budget and shows your members that you care (like we do) about their coverage needs.

Your Plan, Your Way — The EmblemHealth Shared Administrative Advantage Program

At EmblemHealth, we understand that as health care costs continue to rise, it's more challenging than ever for your members, hard-working New Yorkers, to get the most out of their health care dollar.

By combining EmblemHealth's extensive provider network with your health care plan, the Shared Administrative Advantage (SAA) program is a health care option designed to help you get your members the quality care they deserve — at an affordable price.

You're in the driver's seat

You can customize your own health plan to the needs of your members, who will benefit from:

  • Provider discounts
  • An extensive provider network — nationwide
  • Premier hospitals in New York State
  • A seamlessly administered plan
  • Quality care

Our ASO arrangements offer claims processing and customer service for a low per-member administrative fee, plus the quality care and competitive fee schedules available through the EmblemHealth National Network.

EmblemHealth case management services enable your union to take advantage of our medical management and member assistance capabilities through all aspects of cases — even the most complex.

Reduce costs and simplify benefits administration with EmblemHealth Network Access

For hassle-free benefits administration, quality physician and hospital networks and cost-saving fee schedules, consider the advantages of leasing with the EmblemHealth Network Access program.

Network Access

Network Access gives your group members access to our extensive PPO network, which includes many of the area's leading physicians, other medical practitioners and acute care hospitals.

Flexibility

Network Access gives you the flexibility to choose how to price claims, giving you complete control over your benefits administration. Lease our hospital network, medical network, or both.

Extensive Networks Provide Quality Care

Our medical network provides access to a wide range of medical practitioners and includes:

  • Primary care physicians and specialists, including pediatricians, OB/GYNs, cardiologists, oncologists and more
  • Mental health inpatient and outpatient services provided through an alliance with ValueOptions®
  • Ancillary providers, including skilled nursing facilities, medical equipment and vision care
  • Clinical laboratories, such as Quest Diagnostics

Our hospital network includes nearly every acute-care hospital, including Memorial Sloan-Kettering Cancer Center, Northern Westchester Hospital Center, St. Francis Heart Center and many others.

Deep Discounts Mean Significant Savings

Our longstanding relationships with participating providers have enabled us to negotiate sizable payment discounts, which provide exceptional savings like these:

  • Medical Network reimbursement schedule produces discounts of 75% to 80% of RBRVS (Resource Based Relative Value Scale).
  • Hospital Network reimbursement schedule produces savings of up to 40% to 60%.

Security You Can Trust

Network Access uses the HIPAA 837 format and a secure Web re-pricing portal to ensure that your claims transmittal is secure and confidential.

Claims Pricing Options

You may utilize one or both of the following claims pricing options:

Mainframe Pricing by EmblemHealth Online Pricing by Client
For clients who want to submit claims electronically, EmblemHealth prices systemically and returns them to the client for processing and payment. Authorized benefit administration staff can price claims at their own convenience via remote Internet access to the EmblemHealth Network Access provider claims re-pricing system.

Value-Added Health and Wellness Programs

EmblemHealth’s Healthy Discounts Program offers your group discounts on weight-loss and exercise programs, hearing aids, massage therapy and more at no additional cost — to help your group members get healthy and stay healthy. And healthy members can mean lower claims costs.

Simplified benefits administration. Quality medical and hospital networks. Competitive fee schedules. These are some of the advantages of leasing with EmblemHealth Network Access.

The program provides your union members access to the EmblemHealth PPO network, which includes many of the area’s leading physicians, other medical practitioners and acute care hospitals.

You’ll have the flexibility to choose how to price claims plus the option to lease our hospital network, medical network, or both.

Quality Networks Mean Quality Care

Our Medical Network, which provides access to a wide range of medical practitioners, includes:

  • Primary care physicians and specialists, including pediatricians, OB/GYNs, cardiologists, oncologists and more
  • Behavioral and mental health services provided through an alliance with ValueOptions®
  • Ancillary providers, including skilled nursing facilities, medical equipment and vision care
  • Clinical labs, such as Quest Diagnostics

Our Hospital Network is available at nearly every acute-care hospital, including Memorial Sloan-Kettering Cancer Center, Northern Westchester Hospital Center, St. Frances Heart Center and many others.

Your EmblemHealth representative can help you select the funding method that works best for you and your fund members. The most common conventional and alternative options for groups include:

Experience Rated

Historical claims experience is used as the basis for projecting future claims and determining premium. These arrangements include pooling of individual high-cost claims to protect funds against the effects of catastrophic claims.
Availability: Funds with 51 or more eligible members.

Prospective Rated

The anticipated claims experience is evaluated for a future policy period based on a fund’s actual experience and the performance of the EmblemHealth pool for similar businesses. The cost of the plan is determined and fixed in advance of the policy period, and the fund is not eligible for any retroactive rate refunds. Losses (deficits) are not carried forward.
Availability: Funds with 51 or more eligible members.

Retrospective Rated

This approach evaluates and measures a fund’s past claims data to estimate future costs of providing benefits, based on a fund’s actual experience. The fund is eligible for retroactive rate refunds when earned premium exceeds the plan's overall expenses.
Availability: Funds with 1,000 or more eligible members, these arrangements are subject to underwriting review and approval.

Deferred Premium

Eligible funds are allowed to remit a percentage of their gross earned premium on a monthly basis, called the "payment rate." The difference between the payment rate and the gross earned premium rate is "callable" by EmblemHealth at a later date, depending upon claims experience and other factors.
Availability: Subject to underwriting review and approval.

Community Rated

This methodology combines overall medical cost per plan to determine a standard premium rate for that plan.
Availability: All funds with fewer than 51 eligible members and all funds enrolled in EmblemHealth HMO plans.

Administrative Services Only (ASO)

Administrative Services Only (ASO) enhances cash flow by allowing the fund to reimburse EmblemHealth solely on the basis of paid claims plus administrative fees. This rating arrangement is not insured and the fund is responsible for all claim payments and administrative charges associated with the plan. Stop-loss insurance is recommended for all ASO accounts, but is required for funds with less than 1,000 eligible members. The fund retains the flexibility of securing its own stop-loss quote through a vendor of its choosing or having EmblemHealth request a quote through one of its preferred vendors.
Availability: Funds with 250 or more eligible members.

EmblemHealth offers conventional and alternative funding arrangements and will consider special funding arrangements as requested by prospective funds — including ASO self-insurers — contingent upon fund size.

For purposes of this document, any reference to members is representative of the contract holder.

At EmblemHealth we are committed to organized labor. Because of this, you can count on us to provide your members with quality, affordable health care that meets their fundamental needs. We’ll also give you the guidance that you need to select a plan that suits your needs.

Let us show you how EmblemHealth can work for your union members. We invite you to call our team below.

Roberto Hormazabal
Senior Director, Labor Sales and Account Management
55 Water Street
New York, NY 10041
646-447-6480

 

Christine O’Connor
Senior Director, City Relationship Leader, Labor and Government Account Management
55 Water Street
New York, NY 10041
646-447-6981