Summary of Lines of Business, Networks, and Plans

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

• EmblemHealth Group Access Rx (PPO)

OON Coverage: Yes

Referral Required: No

• 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