EmblemHealth and ConnectiCare Reciprocity for Network Access
EmblemHealth’s Medicare Advantage members using VIP Prime and VIP Bold networks (except members of dual eligible special needs plans (D-SNPs) and VIP Reserve members) can use ConnectiCare’s Medicare Choice Network in Connecticut. Some services are available only through delegated networks and providers. These include routine vision care and eyewear (EyeMed); behavioral health (Beacon Health Options); chiropractic, occupational, and physical therapy (Palladian); and dental (Healthplex).
Similarly, Medicare members using ConnectiCare’s Medicare Choice Network (except members of D-SNPs and Passage plan members) have access to the VIP Bold Network in New York. Some services are only available through ConnectiCare’s delegated networks and providers, such as behavioral health and chiropractic offered through Optum, vision care and eyewear (EyeMed Insight network), and dental (Healthplex).
See the 2022 Summary of Companies, Lines of Business, Networks & Benefit Plans for details on all of our Medicare plans, including PCP and Specialist copay amounts, deductibles, maximum out-of-pocket expenses, service area where the plan will be offered, and whether there is reciprocity between EmblemHealth and ConnectiCare networks.
City of New York Offers Medicare Advantage Option in 2022
The City of New York (CNY) recently awarded its group retiree business to Retiree Health Alliance, a collaboration between EmblemHealth and Empire BlueCross BlueShield (BCBS). In 2022, Medicare-eligible City of New York retirees will transition to Retiree Health Alliance’s NYC Medicare Advantage Plus plan. Please continue to monitor our website and newsletters for updates.
This Medicare Advantage PPO plan allows retirees to receive services from both in-network and out-of-network providers with no difference in cost-share. Out-of-network providers must be eligible to receive Medicare payments. NYC Medicare Advantage Plus coves all Medicare Part A and Part B services, as well as additional benefits Medicare does not provide such as an annual routine physical exam, hearing, health and fitness tracker LiveHealth Online, and SilverSneakers®. CNY retirees enrolled in EmblemHealth Medicare Advantage plans can choose to opt out of enrollment in the new plan.
Here are important resources to help you understand this new product:
We will continue to add resources as new information becomes available.
Value-Based Insurance Design and New Benefits
The EmblemHealth family of companies is pleased to announce our participation in the CMS-approved Value-Based Insurance Design (VBID) Model. This program is designed to promote wellness and advance care planning to help ensure our Medicare members receive medical care that is consistent with their values, goals, and preferences. Plans participating in VBID include the following D-SNPs:
- EmblemHealth’s NY D-SNP (VIP Dual and VIP Dual Reserve) plans
- ConnectiCare’s Choice Dual plan
Starting Jan. 1, 2022, as part of VBID, members of these dual plans can use their over-the-counter (OTC) allowance to buy healthy foods, fresh produce and other groceries in participating pharmacies, retail locations, and online. This valuable benefit will help our vulnerable members with both Medicaid and Medicare to address food insecurity and will improve health outcomes.
Many of our plans continue to offer OTC benefits and more plans will offer OTC benefits for the first time in 2022. For more information, please see the new Member Resource Hub.
We remind all our providers to discuss the importance of having executed advance directives at every visit and ensure that completed directives are included in the member’s medical record. The purpose of these directives is to ensure our Medicare members receive medical care that is consistent with their values, goals, and preferences, and that they designate a health care agent for the time the member is unable to make decisions on their own.