COMMERCIAL NETWORKS AND BENEFIT PLANS
Provider Networks and Member Benefits
2026 Changes to Service Areas and Networks
2026 Essential Plan
2026 Individual and Family Plans
2026 Small Group Plans
2026 Member ID Cards
Coordinating Care for Members
Dispute Resolution
Provider Educational Resources
Bridge Program
Extended Networks’ Geographic Coverage Area
For a complete list of the commercial plans offered and their corresponding networks, along with details including member cost shares, service areas, and referral requirements, see Summary of Lines of Business, Networks & Plans.
To easily determine if you or a provider you manage is in-network for EmblemHealth members, use the Check Provider Network Status tool in the Member Management section of the provider portal.
We are not changing the composition of our provider networks in 2026. You may continue to see members who have plans that include the networks you participate in. It is possible, however, that some of your patients will select plans with networks you do not participate in. For each appointment, check member ID cards and use the Check Provider Network Status tool in the Member Management section of the provider portal to see if you are in-network for the patient.
The Essential Plan offers health insurance for eligible low-income New Yorkers who do not qualify for Medicaid or minimum essential coverage through an employer. Members in an Essential Plan have access to care through the Enhanced Care Prime Network.
There are five Essential Plan variants: Essential Plan 200-250, 1, 2, 3, and 4. Individuals will be enrolled in a variant based on income and other eligibility criteria.
All Essential Plan variations have no monthly premium or deductible and low or no cost shares. See the updated Summary of Lines of Business, Networks, and Plans for details on the Essential Plan.
Benefits for members
Please share this with your staff and any patients you think may be eligible for the Essential Plan:
In 2026, individual and family plans underwritten by Health Insurance Plan of Greater New York (HIP) will continue to be sold on and off the NY State of Health insurance marketplace. Members have access to care through the Millennium or Select Care network depending on where the plan subscriber resides.
In 2026, EmblemHealth small group plans are sold on and off the NY State of Health insurance marketplace. All plans are underwritten by Health Insurance Plan of Greater New York (HIP) and have access to the Select Care Network (New York only).
EmblemHealth Platinum, Gold, and Silver Premier plans have out-of-network coverage for most services.
To help members keep costs down, their cost-sharing responsibilities for the following services may be lower based on place of service:
For example, the highest cost sharing will apply when the services are provided in an outpatient hospital setting and the lowest cost sharing will apply when services are provided in freestanding facilities and/or provided by primary care providers (PCPs) in their offices.
The following chart summarizes which plans and networks will be offered:
2026 Dental Plans
In 2026 small groups will continue to have the option of enrolling in one of four dental plans.
Please look at the member ID card when determining which network(s) the member’s plan uses. Plans that need a referral have a PCP shown on the front of the card. Plans that don’t require referrals do not have a PCP name on the member ID card. Providers and members can confirm PCP names through our provider and member portals, respectively. Members can select a PCP whether their plan requires it or not. Members may also change their PCP at any time.
Please refer to the Sample ID Cards section of the EmblemHealth Provider Manual to see sample ID cards for all members.
For helpful resources to assist your practice in coordinating care for EmblemHealth members, see Clinical Corner and the Utilization and Care Management chapter of the EmblemHealth Provider Manual.
Also take advantage of quality improvement resources including the Comprehensive CAHPS Guide and Tips to Improve Member Satisfaction.
Please encourage your members to complete the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) if they are selected for the survey sample.
See the Dispute Resolution for Commercial and Child Health Plus Plans chapter of the EmblemHealth Provider Manual. Contracted time frames in provider agreements will supersede time frames in this guide. For facility time frames, see the EmblemHealth Provider Manual or applicable agreement.
EmblemHealth offers the Bridge Program to fully insured large groups and organizations seeking administrative services. The Bridge Program gives our members access to care through a combination of our existing networks and the networks of Cigna, First Health, and QualCare. See Extended Networks’ Geographic Coverage Area below. Learn more about the Bridge Program.
See the New York City Employee PPO Plan page for details on the new plan for New York City employees, non-Medicare retirees, and their dependents .
EmblemHealth partners with Cigna Healthcare PPO Network, First Health Network, and QualCare Network to provide coverage for some of our plans beyond EmblemHealth’s geographic coverage area. These extended networks are considered in-network for our members based on their geography as follows:
Bridge Program
EmblemHealth works with Cigna Healthcare PPO Network, First Health Network, and QualCare Network to provide coverage for care beyond our own contracted networks’ geographic coverage area. Depending on their group or plan, members may have different network access through which they receive care.
In the following counties, the EmblemHealth network is the primary network for the member:
Albany, Bronx, Broome, Columbia, Delaware, Dutchess, Fulton, Greene, Kings, Montgomery, Nassau, New York, Orange, Otsego, Putnam, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Schoharie, Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester.
These extended networks are considered in-network, based on their geography, for our members with the Bridge Program as follows:
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