Hub for resources to help you care for our Commercial members.

 

EmblemHealth offers individuals, fully insured large and small groups, and organizations seeking administrative services the Bridge Program. Bridge is an innovative concept that gives our members access to a combination of our existing networks through our affiliated companies and partners. See Extended Networks’ Geographic Coverage Area below. Learn more about the Bridge Program.

EmblemHealth and its affiliate ConnectiCare Insurance Company, Inc. partner with QualCare and First Health to provide coverage for certain of our benefit plans beyond our own contracted networks’ geographic coverage. These extended networks are considered in-network for our members, based on their geography, as follows:

Bridge Program (EmblemHealth and ConnectiCare)

 

    QualCare = New Jersey Only

    First Health Network (for EmblemHealth’s companies) = All States except:

  • Connecticut
  • Massachusetts’s 4 Counties (Berkshire, Hampden, Hampshire, and Franklin)
  • New Jersey
  • New York’s 28 Counties (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)

 

ConnectiCare Insurance Company, Inc.’s Flex Network

 

    First Health Network = All States except:

  • Connecticut
  • Massachusetts’s 4 Counties (Berkshire, Hampden, Hampshire, and Franklin)
  • New York’s 28 Counties (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)

Gold Plan for Individuals and Families

EmblemHealth now offers a Gold Premier plan to individuals and families. This plan is offered by Health Insurance Plan of Greater New York (HIP). Members have access to the Select Care Network. This plan does not require referrals.

 

Small Group Plans Moved to Bridge Program Access

In January 2022, we expanded members’ network access from only the Prime Network to the Bridge Program where they have access to five networks: Prime, National, ConnectiCare Choice, QualCare, and First Health. The following plans moved to the Bridge Program:

  • Platinum PPO-N
  • Gold PPO-N
  • Gold Virtual EPO-N

See the Bridge Program web page for instructions on recognizing members, managing their care, and submitting claims.

Starting in January 2022, the following large group plans no longer offered by EmblemHealth Insurance Company (formerly HIP Insurance Company of New York (HIPIC)) with the Prime Network. There will be no members with these plans:

  • HIP Prime PPO
  • HIP Select PPO

Member ID cards for 2022 have been redesigned. Plans that need a referral have a primary care doctor (PCP) shown on the front of the card. Plans without referrals no longer have a PCP name on the ID cards. 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, and this ID card design change does not affect the member’s PCP selection. There will be no changes made to a member’s assigned PCP.

 
 

Please refer to the Sample ID Cards section of the EmblemHealth Provider Manual to see representative ID cards for all our members.

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