By the end of 2020, all members will receive their own personal member identification (ID) card as EmblemHealth phases out cards that cover both the subscriber and dependents. Our New York City GHI PPO members are issued two ID cards, one from EmblemHealth and one from Empire BlueCross BlueShield (BCBS). Physical cards are mailed to members and are available virtually from the Eligibility Look-up results in the provider portal.
A member ID card does not guarantee eligibility or payment. Providers should verify member eligibility on emblemhealth.com/providers in addition to asking to see an ID card at each visit.
Cards show important health plan information, including the network the member may access, who is responsible for managing the member’s care, where to submit claims, covered riders, and copayments. Diagrams in the “Sample ID Cards” section of this chapter show how to quickly locate key coverage details and contact information.
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Chapter 4: Member Identification Cards
EmblemHealth uses unique non-Social Security, number-based identification numbers. For most members, this will be an 11-digit alphanumeric member ID. The IDs start with the letter “K” followed by a unique 8-digit number (a “K-ID”). The final two digits distinguish the subscriber from each dependent (01, 02, 03, etc.). Effective January 1, 2021, EmblemHealth will issue Medicare subscribers’ dependents new unique member IDs that are not derived from the Medicare subscriber’s ID. Medicaid members receive a unique Medicaid Client Identification Number. This practice protects our members’ confidentiality and deters identity theft and fraud.
Note: GHI PPO members (other than City of New York) are migrating upon plan renewal to our new claims platform through the end of 2020. You will know a member has been migrated when you see the K-ID.
Effective July 1, 2020, GHI PPO City of New York members will use K-IDs. EmblemHealth ID cards will display the full 11 digits. Empire BCBS will adopt the same K-ID but will only use and display the first 9 digits on their member ID cards. City of New York members who are also eligible for Medicare benefits will have member ID cards issued to all family members individually in compliance with CMS regulations.Effective July 1, 2020, GHI PPO City of New York members will use K-IDs. EmblemHealth ID cards will display the full 11 digits. Empire BCBS will adopt the same K-ID but will only use and display the first 9 digits on their member ID cards. City of New York members who are also eligible for Medicare benefits will have member ID cards issued to all family members individually in compliance with CMS regulations.
Remember: Please submit preauthorization requests and claims using the member ID in effect on the date of service.
This section shows generic examples of the ID cards you may see. The diagrams point out where to find key coverage details and contact information. Actual cards will be customized based on the member’s policy and, in the case of our Bridge Network, employer group.
Member ID cards may have logos for managing entities or extended networks that affect utilization management, member access to specific networks, and more. A key to these networks and entities appears below the Member ID diagrams.
Standard Templates
This first two examples are the ID card templates used for most EmblemHealth plans. These are the most common design you will see.
The third example is the ID card template used for Child Health Plus members. In 2020, Child Health Plus ID cards are being reissued with “CHILD” as the plan name in the upper right-hand corner on the front of the card. This is a cosmetic change only. The members’ benefits are not changing. Child Health Plus members access the Enhanced Care Prime Network.
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City of New York ID Card Templates
The next three images are examples of the ID cards used by City of New York members. City members with a GHI PPO plan are sent two ID cards – one from EmblemHealth and the other from Empire. In July 2020, both companies began using the same member ID number; however, Empire will only use and show the first 9 digits. Please be aware of this when switching between EmblemHealth and Empire systems.
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Managing Entities
HealthCare Partners: The member is assigned to an HCP primary care physician. The managing entity is responsible for utilization management for assigned members.
Montefiore Medical Center: The member is assigned to a Montefiore primary care physician. The managing entity is responsible for utilization management for assigned members.
SOMOS: The member is assigned to a SOMOS primary care physician. The managing entity is responsible for most utilization management for assigned members. SOMOS members, however, participate in EmblemHealth’s special utilization management programs.
Extended Networks
Bridge Network: Members who have the Bridge Network on their member ID cards belong to self-funded employer groups for which EmblemHealth and ConnectiCare are providing administrative services and access to our commercial networks. For information on the Bridge Network, click here. To see the quick reference guide which includes an image of a Bridge Network Member ID card, click here.
ConnectiCare: Some members who access care through the Prime Network may also access care through ConnectiCare in Connecticut. Similarly, some ConnectiCare members may access care through EmblemHealth’s Prime Network. See the Provider Networks and Member Benefit Plan chapter for applicable plans.
First Health Network: MultiPlan is being replaced by First Health Network for both EmblemHealth and ConnectiCare. This will be a rolling transition as member plans renew starting Jan. 1, 2020. Member ID cards will be redistributed with the First Health logo.
PHCS/MultiPlan: Members in the National Network have access to PHCS/MultiPlan outside of New York.
QualCare: Certain members in the Prime Network have access to QualCare’s network in New Jersey. Likewise, HMO members have access to the QualCare HMO network; other plans have access to QualCare PPO network. See the Provider Networks and Member Benefit Plan chapter for applicable plans.
