EmblemHealth and Labor: True partners in care.

 

For us, providing health care to unions is really a labor of love. After all, your members have been our members for more than 80 years. And our long, proud history of serving the working men and women of New York is at the heart of everything we do. This bond continues today with a steadfast commitment to meet and exceed labor’s changing needs during challenging times and beyond. 

 

Like you, we’ve built the solid local relationships necessary to stay strong and agile. This translates into a wide range of provider networks and unique arrangements that offer the value and access you need. Give us a call today at 646-447-1266, to learn how we can customize plans to keep your members covered and your costs in check.  

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 the 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.

 

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

 

The EmblemHealth ASO Bridge Network* – Your bridge to savings.

Robust local coverage, significant savings – that’s what you’ll get with our ASO Bridge Network. With Bridge, you’ll have access to our largest provider network, giving you one of the best discounts in the tristate area.

 

*With our ASO Bridge Network solution, you can:

  • Dramatically lower costs. 
  • Join a network with 193,000 providers across New York, New Jersey, and Connecticut 
  • Gain in-network access to every hospital system in the state of New York.

For more information, on our ASO Bridge Network, contact Jolt Mena at jmena@emblemhealth.com

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

 

*InBalance Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO) Plans

These family-friendly plans on the National Network feature no referrals and the ability to lower group premiums by increasing member cost-sharing for certain services. PPO members have the freedom to go outside the network for additional out-of-pocket costs; EPO plans offer in-network benefits only. Choose the one that works best for you and your members.

 

HMO Plans

To meet member health care needs and employer health care budgets, consider one of our many HMO plan options. EmblemHealth HMO plans are community-rated and offer a choice of benefit levels so you can always find the right plan at the right price. Groups can save money when compared to other similar plans. Plus, to promote wellness through early detection of diseases, preventive services are available at no cost to members.

 

ConsumerDirect PPO and ConsumerDirect EPO Plans

These 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).

 

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.

  

Your EmblemHealth representative can help you select the funding arrangement that works best for you and your members. EmblemHealth offers conventional and alternative funding arrangements and will consider special funding arrangements. Options include:

 

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. Our stop-loss insurance option is offered to all ASO accounts through our vendor.
Availability: Funds with 250 or more eligible members.

 

Experience Rated

Historical claims experience is used as the basis for projecting future claims and determining premiums. These arrangements include pooling of individual high-cost claims to protect funds against the effects of catastrophic claims.

  • 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..
  • 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.
  • 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 100 or less eligible members must be community rated by law with limited exceptions. HMO plans are community rated regardless of fund size.

 

 For purposes of this document, any reference to members is representative of the plan participant.

The health and well-being of your members is at the heart of everything your organization achieves. In fact, employers have reported greater productivity and growth after implementing workplace wellness programs.* That’s why EmblemHealth offers buy-up products through our partner, WellSpark Health. WellSpark takes a proactive approach to filling in the gaps in preventive care and supporting chronic disease. Lifestyle coaching, diabetes prevention, and promoting health literacy are just a few of the things WellSpark does to help spark better employee health outcomes. For more information, visit wellsparkhealth.com.

 

*Held, Justin, and Teri Dougherty. Workplace Wellness Trends, 2017 Survey Results. International Foundation of Employee Benefit Plans, www.ifebp.org.

When it comes to access, we’ve got you covered. With EmblemHealth’s Network Access Program, you and your members gain access to an extensive PPO network that includes top doctors, leading hospitals, hassle-free benefits administration, and competitive prices. And we always give you the power to choose the arrangement that works best for your organization. For example, access both our medical provider and hospital network, or just the one you need.

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 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
AVP, Labor Sales and Account Management
55 Water Street
New York, NY 1004
Office: (646) 447-6480  Cell: (646) 369-5646
RHormazabal@EmblemHealth.com

Jolt Mena
Labor Sales Representative
55 Water Street
New York, NY 10041
Office (646) 447-1266  Cell: 347-346-1570
jmena@emblemhealth.com

 

For more information and to request marketing materials, please email Jolt Mena at jmena@emblemhealth.com, or call him directly at 646-447-1266 or 347-346-1570.