Date Issued: 10/28/2014
Open enrollment on the New York State of Health Marketplace begins November 15, 2014 for individuals and continues through February 15, 2015. For small group coverage effective January 1, 2015, open enrollment for employees runs from November 1, 2014 to November 30, 2014. During this time, you may get calls from prospective and current patients, asking if your office participates in ObamaCare. Please answer “yes,” if your office participates in EmblemHealth’s Select Care network.
Does My Office Participate in the Select Care Network?
To find out, simply sign in to our secure site at www.emblemhealth.com with your HIP user ID and password and click on the “Practice/Provider Profile” link. Then, scroll down to the bottom of the “Practice/Provider Profile” screen for a list of the networks you participate in. Please note: To help improve your patients’ satisfaction and to help us meet regulatory requirements, please share this network information with your office staff responsible for booking appointments.
New 2015 Select Care Network Plans
For 2015, EmblemHealth introduces nine new Select Care network plans (see the plans marked with an asterisk in the table below). All current and new plans are HMOs and are available in the following 28 New York State counties: Albany, Bronx, Broome, Columbia, Delaware, Dutchess, Fulton, Greene, Kings (Brooklyn), Montgomery, Nassau, New York (Manhattan), Orange, Otsego, Putnam, Queens, Rensselaer, Richmond (Staten Island), Rockland, Saratoga, Schenectady, Schoharie, Suffolk, Sullivan, Ulster, Warren, Washington and Westchester.
Helpful hint #1: If you are a Select Care network provider, you participate in all the Select Care network plans listed in the table below. It doesn’t matter whether the plan was purchased from the New York State of Health Marketplace or directly from EmblemHealth.
Helpful hint #2: To identify Select Care network plans, look for the words “Network: Select Care” on the front of the member ID card.
| 2015 Select Care Network Suite of Benefit Plans | |
| New York State of Health Marketplace |
Direct Pay |
Individual:
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Individual:
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Small Business:
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Small Business:
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*Added to the Select Care network for the 2015 plan year.
Cost-Sharing Changes for 2015
Monthly premium and out-of-pocket expenses will differ from 2014. Please see the member’s ID card or sign in to our secure site at www.emblemhealth.com to access member cost-sharing information such as copays, coinsurance and deductibles.
Cost-Sharing Reminders for 2015
Here are two cost-sharing reminders to keep in mind:
- Most Select Care network plans have a deductible that applies to in-network services.
- As mandated by New York State, the following services receive payment at the PCP copay level:
- Cardiac and pulmonary rehabilitation
- Chemotherapy
- Dialysis
- Infusion therapy
- ABA treatment and assistive communication devices for autism spectrum disorder
- Diabetic supplies, insulin and self-management education
- Outpatient mental health and substance abuse services
Make Sure You Use Other Select Care Providers
The Select Care network includes a full complement of physicians, hospitals and community health centers, plus a wide range of facility and ancillary services. Urgent care and immediate care are also available. Please be sure to refer your Select Care patients to other Select Care providers. To locate participating providers, please use the “Find a Doctor” online directory at www.emblemhealth.com/find-a-doctor and create all your referrals using our secure site at www.emblemhealth.com.
Know Your Network Participation
Take a few minutes to become familiar with the networks you participate in. The easiest way to know whether you participate in a particular network and accept a patient's plan is to check the “Practice/Provider Profile” screen on our secure website at www.emblemhealth.com.
For a comprehensive list of all EmblemHealth plans and networks, please refer to the Provider Networks and Member Benefit Plans chapter of the Provider Manual.
