GHI CBP

The GHI Comprehensive Benefits Plan (CBP) gives you the freedom to choose in-network or out-of-network doctors. You can see any network doctor without a referral. In most cases, when you see a network doctor, your cost will just be a copay. When you choose to use out-of-network doctors, payment for covered services will be made under the NYC Non-Participating Provider Schedule of Allowable Charges. You will be responsible for any difference between the provider’s fee and the amount of the reimbursement, in addition to deductibles and coinsurance; therefore, you may have a substantial out-of-pocket expense. This plan is offered to employees and non-Medicare eligible retirees and covers medical and surgical services. Hospitalization benefits are provided to you by Empire BlueCross BlueShield.

Customer Service: 800-624-2414, seven days a week (excluding major holidays), 8 am to 8 pm. 

 

Plan Details

GHI CBP offers great coverage everyone can afford. You get:

  • Coverage for in-network services
  • No required primary care physician (PCP)
  • Coverage of out-of-network services
  • Low copays for in-network services
  • No payroll deduction for base coverage
  • No referrals for in-network doctors
  • $0 copay at an AdvantageCare Physicians provider or Montefiore faculty-based center

Current in-network costs

  • ACPNY PCP: $0 copay
  • ACPNY Specialist: $0 copay
  • All Other PCPs: $15 copay
  • All other specialty providers: $30 copay
  • Urgent Care: $50 copay
  • Diagnostic/Lab: $20 copay
  • MRI/CAT/Hi-Tech Radiology: $50 copay
  • Physical Therapy: $20 copay
  • Emergency Room: $150 copay

Out-of-network costs

There will be no changes to your current out-of-pocket costs. You will still pay any applicable out-of-network cost-sharing plus the difference between the provider’s fee and GHI’s reimbursement (which may be substantial.)

Benefits are subject to approval by the New York State Department of Financial Services.

MOOP refers to the maximum amount of in-network cost-sharing expenses that you will pay in each calendar year for covered services received from Participating Providers under the GHI/Empire BlueCross BlueShield plans combined. MOOP includes deductibles, coinsurance and copay charge amounts that you must pay for covered in-network services and any applicable riders in a calendar year. Cost-sharing amounts attributable to services received from Non-Participating Providers generally do not count toward MOOP. Amounts incurred for non-covered services and other non-covered expenses, such as amounts in excess of plan allowances as well as any financial penalties do not count toward MOOP. Premiums and/or premium contributions also do not count toward MOOP. The MOOP amount may change from calendar year to calendar year**.

For calendar years beginning January 1, 2019 – December 31, 2019** (Subject to indexing by the federal government)

Individual MOOP

  • GHI Medical MOOP: $4,550
  • EBCBS Hospital MOOP: $2,600

Family MOOP

  • GHI Medical MOOP: $9,100
  • EBCBS Hospital MOOP: $5,200

  • Summary of Benefits and Coverage (Base Plan)

  • Summary of Benefits and Coverage (Enhanced Plan)

  • Summary of Benefits and Coverage (With Rider)

  • GHI CBP Certificate of Insurance

  • Brochure for City of New York Employees and Retirees


Drugs Covered

For City of New York employees who have prescription drug coverage:

  • 2019 City of New York Employee Formulary Summary

    A list of the most commonly prescribed drugs.

  • 2020 Medicare Part D Drug Formulary: Covered Medication List

    For City of New York employees who have EmblemHealth Medicare PDP coverage.

  • 2019 Medicare Part D Drug Formulary: Covered Medication List

    For City of New York employees who have EmblemHealth Medicare PDP coverage.

  • 2019 Medicare Part D Formulary Changes

  • 2019 Step Therapy Criteria

    The drugs on this list require step therapy pre-approval. This means that your doctor must have you first try a different drug to treat your medical condition before we will cover a drug that needs step therapy pre-approval.

  • 2019 Prior Authorization Criteria

Provider Coverage

With our robust network of quality doctors, you can get care from many of the region’s leading doctors, clinicians and facilities, including hospitals and urgent care centers.

A partner in wellness

The Right Care, in the Right Neighborhood

AdvantageCare Physicians are the newest addition to the EmblemHealth family and are now one of the largest primary and specialty care practices in New York City. With 37 locations throughout New York City and Long Island, you can find a convenient location near home or work.