Can I receive hospital services from NYP after March 28, 2026?
We are continuing to advocate for you to get access to what is known as the two-month "cooling off" period so that services would be covered as an in-network benefit. NYP has taken the position that the cooling off period does not apply and it will be out-of-network for NYCE PPO beginning March 29, 2026. Members may be able to continue to get care on and after March 29, 2026, but at out-of-network rates. We will update you if our efforts to have the cooling off period apply are successful.
What if I am in the middle of treatment with my doctor?
Members who are eligible may be able to continue receiving care for an ongoing course of treatment with their current doctors for up to a 90-day continued care period, beginning March 29, 2026 (until June 26, 2026). The continuity of care period is required by federal law.
Members who are receiving care for pregnancy as of March 28, 2026, are eligible for a continued care period that extends through the postpartum period.
To receive other care from NYP or to find care from other nationally recognized hospital systems, call us first. Before getting any care from an NYP provider or going to an NYP hospital (except in the case of an emergency), please call EmblemHealth at 212-501-4444 (TTY: 711) from 8 a.m. to 8 p.m., Monday through Friday to obtain preauthorization. We can help you navigate your care or find another provider or hospital that participates in your New York City Employees (NYCE) PPO plan.
We are providing this information to you to ensure you are aware that if you continue to see your current doctors without preauthorization beginning March 29, 2026, (first day NYP is out of network), you may be responsible for any out-of-pocket costs related to out-of-network care.
Besides pregnancy, what else qualifies for continuity of care?
Continuity of care is for individuals:
- Undergoing a course of treatment for a serious and complex condition such as kidney dialysis, cancer treatment, etc.
- Undergoing a course of institutional or inpatient care.
- Scheduled to undergo nonelective surgery from the provider, including receipt of postoperative care.
- Determined to be terminally ill and receiving treatment for such illness.
I have been with my doctor for a very long time. Can I continue to see them and for how long?
Yes, but if it’s for routine care or treatment for a new condition, care will not be covered at the in-network level. As a NYCE PPO member, your plan includes out-of-network benefits so you may continue to see your doctor – but it will cost you more. With your out-of-network benefits, you will be responsible for paying more than you would if you go to an in-network provider.
I have been receiving mental health treatment from a NewYork-Presbyterian provider. How will this impact my care?
Under your NYCE PPO benefit plan, mental health services are not impacted by this contract negotiation.
What are my out-of-network benefits if I want to continue seeing my provider and it’s not for an ongoing course of treatment?
NYCE PPO members have out-of-network benefits. Please contact Customer Service at 212-501-4444 (TTY: 711) from 8 a.m. to 8 p.m., Monday through Friday. They can help you check your out-of-network benefits.
How can I find a new doctor or hospital?
NYCE PPO members have excellent in-network options in convenient locations. To find a list of hospitals and doctors near you, visit nyceppo.com and use the "Find a provider" tool.
