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Summary of Lines of Business, Networks, and Plans

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

Bridge* (EmblemHealth lower 13 counties, United Healthcare Choice Plus Network in all other counties)

New York City Plan
  • NYCE PPO
  • To learn more about the NYCE PPO plan, visit our webpage

OON Coverage: Yes

Referral Required: No

Enhanced Care Prime

 

Commercial – Essential Plan

 
  • Essential Plan 200-250
  • Essential Plan 1
  • Essential Plan 2
  • Essential Plan 3
  • Essential Plan 4     

OON Coverage: No

Referral Required: No

State Sponsored Programs – Medicaid, Health and Recovery Plan (HARP)
  • EmblemHealth Enhanced Care
  • EmblemHealth Enhanced Care Plus
  • EmblemHealth VIP Dual Enhanced (HMO D-SNP) Medicaid-only services

OON Coverage: No

Referral Required: No
Select Care Commercial – Individual and Family Plans (On- and Off-Exchange)
  • EmblemHealth Select Care Platinum/Platinum D
  • EmblemHealth Select Care Gold/Gold D
  • EmblemHealth Select Care Silver/Silver D
  • EmblemHealth Select Care Silver CSR 1
  • EmblemHealth Select Care Silver CSR 2
  • EmblemHealth Select Care Silver CSR 3
  • EmblemHealth Select Care Catastrophic/Catastrophic D

OON Coverage: No

Referral Required: No

Select Care

 Commercial –
Small Group
  • EmblemHealth Platinum Premier
  • EmblemHealth Gold Premier
  • EmblemHealth Silver Premier
  • EmblemHealth Silver Plus H.S.A.
  • EmblemHealth Bronze Premier
  • EmblemHealth Bronze Plus H.S.A.
  • EmblemHealth Healthy Gold NY

OON Coverage: No

Referral Required: No

Commercial –
Large Group
  • HIP Prime HMO
  • EmblemHealth HMO Plus

OON Coverage: No

Referral Required: Yes

Millennium

Commercial – Individual and Family Plans (On and Off Exchange)
  • EmblemHealth Millennium Platinum/Platinum D
  • EmblemHealth Millennium Gold/Gold D
  • EmblemHealth Millennium Silver/Silver D
  • EmblemHealth Millennium Silver CSR 1
  • EmblemHealth Millennium Silver CSR 2
  • EmblemHealth Millennium Silver CSR 3

OON Coverage: No

Referral Required: No

Commercial – Large Group
  • HIP Prime HMO
  • EmblemHealth HMO Plus

OON Coverage: No

Referral Required: Yes
Prime

State-Sponsored Programs
  • Child Health Plus

OON Coverage: No

Referral Required: No

Commercial – Large Group
  • HIP Prime HMO
  • EmblemHealth HMO Plus
  • EmblemHealth HMO Preferred Plus
  • HIP Access I
  • HIP Access II

OON Coverage: No

Referral Required: Yes

Commercial – Large Group
  • HIP Prime POS

OON Coverage: Yes

Referral Required: No

VIP Prime

Medicare
  • EmblemHealth VIP Premier (HMO) Group
  • EmblemHealth VIP Rx CarveOut (HMO) Group

OON Coverage: No

Referral Required: Yes

VIP Bold

Medicare
  • EmblemHealth VIP Dual (HMO D-SNP)
  • EmblemHealth VIP Dual Enhanced (HMO D-SNP)
  • EmblemHealth VIP Gold (HMO)
  • EmblemHealth VIP Gold Plus (HMO)
  • EmblemHealth VIP Value (HMO-POS)

OON Coverage: No

Referral Required: No

VIP Reserve

Medicare
  • EmblemHealth VIP Dual Reserve (HMO D-SNP)

OON Coverage: No

Referral Required: No

Medicare Choice PPO

Medicare
  • EmblemHealth Group Access Rx (PPO)

OON Coverage: Yes

Referral Required: No

Network Access Network (Professional Services)

Medicare Choice PPO (Facility Services)

N/A
  • ArchCare Senior Life HMO PACE

    • 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 –
Large Group/ New York City Plan
  • DC37-Med-Team
  • EmblemHealth EPO
  • EmblemHealth PPO
  • EmblemHealth Consumer Direct EPO
  • EmblemHealth Consumer Direct PPO
  • EmblemHealth InBalance EPO
  • EmblemHealth InBalance PPO
  • Administrative Services Only (ASO)

OON Coverage: Yes

Referral Required: No

Bridge + First Health and QualCare

 Commercial –
Large Group
  • EmblemHealth EPO
  • EmblemHealth PPO
  • EmblemHealth Consumer Direct EPO
  • EmblemHealth Consumer Direct PPO
  • EmblemHealth InBalance EPO
  • EmblemHealth InBalance PPO
  • Administrative Services Only (ASO)

OON Coverage: Yes

Referral Required: No
Bridge* (EmblemHealth lower 13 counties, United Healthcare Choice Plus Network in all other counties) 

New York City Plan
  • NYCE PPO
  • To learn more about the NYCE PPO plan, visit our webpage

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
  • EmblemHealth EPO
  • EmblemHealth PPO
  • EmblemHealth Consumer Direct EPO
  • EmblemHealth Consumer Direct PPO
  • EmblemHealth InBalance EPO
  • EmblemHealth InBalance PPO

OON Coverage: Yes

Referral Required: No

Select Care + First Health and QualCare

Commercial –
Large Group
  • EmblemHealth EPO
  • EmblemHealth PPO
  • EmblemHealth Consumer Direct EPO
  • EmblemHealth Consumer Direct PPO
  • EmblemHealth InBalance EPO
  • EmblemHealth InBalance PPO

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 –
Large Group/New York City Plan
  • HIP HMO Preferred
  • HIP Prime HMO
  • EmblemHealth HMO Plus
  • EmblemHealth HMO Preferred Plus
  • HIP Access I
  • HIP Access II

OON Coverage: Yes

Referral Required: Yes

HMO EmblemHealth network** + First Health and QualCare

Commercial –
Large Group
  • HIP Prime HMO
  • EmblemHealth HMO Plus
  • EmblemHealth HMO Preferred Plus
  • HIP Access I
  • HIP Access II

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
  • GHI CBP
  • DC37-Med-Team

OON Coverage: Yes

Referral Required: No

Enhanced Care Prime

 

 

 

 

Commercial – Essential Plan

 
  • Essential Plan 200-250
  • Essential Plan 1
  • Essential Plan 2
  • Essential Plan 3
  • Essential Plan 4     

OON Coverage: No

Referral Required: No

State Sponsored Programs – Medicaid, Health and Recovery Plans (HARP)
  • EmblemHealth Enhanced Care
  • EmblemHealth Enhanced Care Plus

OON Coverage: No

Referral Required: No, PCP needed unless homeless

Select Care

 

Commercial – Individual and Family Plans (On- and Off-Exchange)

 
  • EmblemHealth Select Care Platinum/Platinum D
  • EmblemHealth Select Care Gold/Gold D
  • EmblemHealth Select Care Silver/Silver D
  • EmblemHealth Select Care Silver CSR 1
  • EmblemHealth Select Care Silver CSR 2
  • EmblemHealth Select Care Silver CSR 3
  • EmblemHealth Select Care Catastrophic/Catastrophic D

OON Coverage: No

Referral Required: No

 

Select Care

Commercial –
Small Group

 
  • EmblemHealth Platinum Premier
  • EmblemHealth Gold Premier
  • EmblemHealth Silver Premier
  • EmblemHealth Silver Plus H.S.A.
  • EmblemHealth Bronze Premier
  • EmblemHealth Bronze Plus H.S.A.
  • EmblemHealth Healthy Gold NY

OON Coverage: No

Referral Required: No

 

Commercial –
Large Group
  • HIP Prime HMO
  • EmblemHealth HMO Plus

OON Coverage: No

Referral Required: Yes

Millennium

Commercial – Individual and Family Plans (On and Off Exchange)
  • EmblemHealth Millennium Platinum/Platinum D
  • EmblemHealth Millennium Gold/Gold D
  • EmblemHealth Millennium Silver/Silver D
  • EmblemHealth Millennium Silver CSR 1
  • EmblemHealth Millennium Silver CSR 2
  • EmblemHealth Millennium Silver CSR 3
  • EmblemHealth Millennium Catastrophic/Catastrophic D

OON Coverage: No

Referral Required: No

Commercial – Large Group
  • HIP Prime HMO
  • EmblemHealth HMO Plus

OON Coverage: No

Referral Required: Yes

Prime

 

State-Sponsored Programs
  • Child Health Plus

OON Coverage: No

Referral Required: No

Commercial –
Large Group
  • HIP Prime HMO
  • EmblemHealth HMO Plus
  • EmblemHealth HMO Preferred Plus
  • HIP Access I
  • HIP Access II

OON Coverage: No

Referral Required: Yes

Commercial –
Large Group
  • HIP Prime POS

OON Coverage: Yes

Referral Required: No

Bridge*

Commercial –
Large Group
  • EmblemHealth EPO
  • EmblemHealth PPO
  • EmblemHealth Consumer Direct EPO
  • EmblemHealth Consumer Direct PPO
  • EmblemHealth InBalance EPO
  • EmblemHealth InBalance PPO
  • Administrative Services Only (ASO)

OON Coverage: Yes

Referral Required: No

VIP Prime

Medicare
  • EmblemHealth VIP Premier (HMO) Group
  • EmblemHealth VIP Rx CarveOut (HMO) Group

OON Coverage: No

Referral Required: Yes, PCP needed

VIP Bold

Medicare
  • EmblemHealth VIP Dual (HMO D-SNP)
  • EmblemHealth VIP Dual Enhanced (HMO D-SNP)
  • EmblemHealth VIP Gold (HMO)
  • EmblemHealth VIP Gold Plus (HMO)
  • EmblemHealth VIP Rx Saver (HMO)

OON Coverage: No

Referral Required: No, PCP needed

VIP Reserve

Medicare
  • EmblemHealth VIP Dual Reserve (HMO D-SNP)

OON Coverage: No

Referral Required: No, PCP needed

Medicare Choice PPO

 Medicare
  • EmblemHealth Group Access Rx (PPO)

 

OON Coverage: Yes

Referral Required: No
Network Access Network N/A
  • ArchCare Senior Life HMO PACE

    • 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