Please use this chart to let your appointment schedulers know how you participate with EmblemHealth. Circle the networks below covered by your contract(s). Use the Check Provider Network Status look-up tool in the Member Management section of the provider portal to easily determine if a provider is in-network for a member. See sample member ID Cards in the EmblemHealth Provider Manual and our Bridge Program page.
Summary of Lines of Business, Networks, and Plans
- 2026
- 2025
Network |
Line(s) of Business |
Plan Names |
Out of Network (OON) Coverage, Referral Required |
Bridge* (EmblemHealth lower 13 counties, United Healthcare Choice Plus Network in all other counties) |
New York City Plan |
|
OON Coverage: Yes Referral Required: No |
Enhanced Care Prime
|
Commercial – Essential Plan
|
|
OON Coverage: No Referral Required: No |
State Sponsored Programs – Medicaid, Health and Recovery Plan (HARP) |
|
OON Coverage: No Referral Required: No |
|
| Select Care | Commercial – Individual and Family Plans (On- and Off-Exchange) |
|
OON Coverage: No Referral Required: No |
Select Care |
Commercial – Small Group |
|
OON Coverage: No Referral Required: No |
Commercial – |
|
OON Coverage: No Referral Required: Yes |
|
Millennium |
Commercial – Individual and Family Plans (On and Off Exchange) |
|
OON Coverage: No Referral Required: No |
Commercial – Large Group |
|
OON Coverage: No Referral Required: Yes |
|
| Prime | State-Sponsored Programs |
|
OON Coverage: No Referral Required: No |
Commercial – Large Group |
|
OON Coverage: No Referral Required: Yes |
|
Commercial – Large Group |
|
OON Coverage: Yes Referral Required: No |
|
VIP Prime |
Medicare |
|
OON Coverage: No Referral Required: Yes |
VIP Bold |
Medicare |
|
OON Coverage: No Referral Required: No |
VIP Reserve |
Medicare |
|
OON Coverage: No Referral Required: No |
Medicare Choice PPO |
Medicare |
|
OON Coverage: Yes Referral Required: No |
Network Access Network (Professional Services) Medicare Choice PPO (Facility Services) |
N/A |
EmblemHealth does not adjudicate ArchCare’s claims. EmblemHealth leases its networks to and prices claims for ArchCare based on the applicable network’s contracted rates. |
OON Coverage: No Referral Required: Yes |
*The 13 counties include Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Ulster, and Westchester.
Bridge Program
The Bridge Program offers access to care in NY State through the Prime Network and the National (GHI PPO) Network. For care outside of NY State, members have access to care through the Cigna Healthcare PPO Network or through the First Health Network and QualCare Network in New Jersey.
Check the member’s ID card to confirm the networks they have access to.
Bridge + Cigna |
Commercial – |
|
OON Coverage: Yes Referral Required: No |
Bridge + First Health and QualCare |
Commercial – Large Group |
|
OON Coverage: Yes Referral Required: No |
| Bridge* (EmblemHealth lower 13 counties, United Healthcare Choice Plus Network in all other counties) | New York City Plan |
|
OON Coverage: Yes Referral Required: No |
*The 13 counties include Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Ulster, and Westchester.
Select Care for Large Groups
New for Jan. 1, 2026, members have access to care in NY State through the Select Care Network and the National (GHI PPO) Network. For care outside of NY State, members have access to care through the Cigna Healthcare PPO Network or through the First Health Network and QualCare Network in New Jersey.
Check the member’s ID card to confirm the networks they have access to.
Select Care + Cigna |
Commercial – Large Group |
|
OON Coverage: Yes Referral Required: No |
Select Care + First Health and QualCare |
Commercial – |
|
OON Coverage: Yes Referral Required: No |
Large Group HMO Access
For members with access in Connecticut and New Jersey, care may be provided through Cigna Healthcare PPO Network or through the First Health Network in Connecticut and QualCare Network in New Jersey.
Check the member’s ID card to confirm the networks they have access to.
HMO EmblemHealth network** + Cigna |
Commercial – |
|
OON Coverage: Yes Referral Required: Yes |
HMO EmblemHealth network** + First Health and QualCare |
Commercial – |
|
OON Coverage: Yes Referral Required: No |
**Access to care in NY State is available through the EmblemHealth Prime, Select Care, or Millennium network based on the member’s plan.
Please use this chart to let your appointment schedulers know how you participate with EmblemHealth. Circle the networks below covered by your contract(s). Use the Check Provider Network Status look-up tool in the Member Management section of the provider portal to easily determine if a provider is in-network for a member. See sample member ID Cards in the EmblemHealth Provider Manual and our Bridge Program page.
Network |
Line(s) of Business |
Plan Names |
Out of Network (OON) Coverage, Referral Required |
National Network (GHI PPO National/CBP) |
New York City Plan |
|
OON Coverage: Yes Referral Required: No |
Enhanced Care Prime
|
Commercial – Essential Plan
|
|
OON Coverage: No Referral Required: No |
State Sponsored Programs – Medicaid, Health and Recovery Plans (HARP) |
|
OON Coverage: No Referral Required: No, PCP needed unless homeless |
|
Select Care
|
Commercial – Individual and Family Plans (On- and Off-Exchange)
|
|
OON Coverage: No Referral Required: No
|
Select Care |
Commercial –
|
|
OON Coverage: No Referral Required: No
|
Commercial – |
|
OON Coverage: No Referral Required: Yes |
|
Millennium |
Commercial – Individual and Family Plans (On and Off Exchange) |
|
OON Coverage: No Referral Required: No |
Commercial – Large Group |
|
OON Coverage: No Referral Required: Yes |
|
Prime
|
State-Sponsored Programs |
|
OON Coverage: No Referral Required: No |
Commercial – |
|
OON Coverage: No Referral Required: Yes |
|
Commercial – |
|
OON Coverage: Yes Referral Required: No |
|
Bridge* |
Commercial – |
|
OON Coverage: Yes Referral Required: No |
VIP Prime |
Medicare |
|
OON Coverage: No Referral Required: Yes, PCP needed |
VIP Bold |
Medicare |
|
OON Coverage: No Referral Required: No, PCP needed |
VIP Reserve |
Medicare |
|
OON Coverage: No Referral Required: No, PCP needed |
Medicare Choice PPO |
Medicare |
|
OON Coverage: Yes Referral Required: No |
| Network Access Network | N/A |
EmblemHealth does not adjudicate ArchCare’s claims. EmblemHealth leases its networks to, and prices claims for, ArchCare based on the applicable network’s contracted rates. |
OON Coverage: No Referral Required: Yes |
*The Bridge Program offers access to care through the Prime, ConnectiCare Choice, Qualcare, National, and First Health networks.
JP 70864 12/2025