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Frequently Asked Questions

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Get Answers To Your Questions

myEmblemHealth Member Portal

How do I sign in or register for the new member portal?

I currently get coverage through my parent’s or partner’s health insurance plan. Can I still get an account?

If you are a dependent on someone else’s plan, and you are 18 or older, you can register for a member portal account. You just need to have your member ID number and create a username and password before you can sign in to view your account. 

Can I view the portal on my phone or tablet?

Yes! You can use the latest versions of Chrome or Safari on your phone or tablet to visit the member portal at my.emblemhealth.com.

You can also download the myEmblemHealth mobile app and view your account with a simple tap. It includes the same great features as the desktop member portal and lets you view your virtual member ID card anytime, anywhere. The app is available for iOS and Android.

What do I do if I forget my username or password?

On the member portal sign in page, you will see links for ‘Forgot Username’ and ‘Forgot Password.’ Choose the option that applies to you and follow the instructions.

My coverage is no longer active. Can I still view my account?

You can view your account for up to 18 months after your coverage ends. Some features may be unavailable due to your account being inactive.

How do I sign up for paperless communications?

Can I assign an advocate or representative to help manage my account?

Yes, you can request to add an authorized representative or designee to help manage your account. Start by completing and submitting the Designee Authorization Form. Once your form has been accepted or approved, an invitation will be sent to your designee so they can register to view and manage your account on your behalf.

What languages are supported in the portal?

The myEmblemHealth member portal is available in English, Spanish (español), and Simplified Chinese (中文). Once you’re signed in, you can select a different language in the top left corner of the portal. This change is immediate and will be saved to your account until you switch.

Can different members under the same plan use the same information to register for the portal?

No.  Every member must have their own unique username in the format of an email address [for example: john@abc.com] and password, even if they are on the same plan. If you try to register with the same username as someone else, you will be prompted to choose a different one. Your registration will not be complete until you choose a unique username.  

How do I add or change my primary care provider (PCP), and how long will it take for my new PCP to be reflected on my member ID Card?

Once you’re signed in, go to ‘Find Care’ and select the Primary Care Provider tile to begin your search. If you have a doctor in mind, you can enter their first and last name on the specialties page to narrow down your results. Once you find your doctor, select ‘Choose as PCP’ and follow the instructions to save your PCP.

PCP changes may take up to 24 hours to be reflected on your virtual member ID card in the portal. You can download or print your ID card while waiting for your physical card to arrive in the mail, which could take up to 14 business days.  

How can I check if a doctor or facility is in my network?

The best way to search for in-network doctors is by signing in to your myEmblemHealth member portal. The portal has your plan and network information saved so all your search results are automatically in-network.

How can I get a member ID card?

Sign in and select ‘ID Cards’ in the menu bar at the top. You can request an ID card for yourself or any member on your plan. You can also download and print a copy of your card, or request to have it mailed to you. Please allow up to 10 days for your new member ID card to arrive in the mail.

Where can I find my invoices and how can I make payments?

Sign in and select ‘Billing and Payment’ in the menu bar at the top. From there, you can see your current bill and options to make a payment or set up autopay; you can pay with a credit or debit card, or with a bank account. Below the summary section, you will find your invoices and payment history for the last 24 months.

Where can I find my pharmacy benefits, drug costs, and home delivery options?

From the Pharmacy page in the portal, you will see options to visit our partner site to view your pharmacy benefits and estimate your drug costs. Once you’re on their site, you can choose home delivery for your prescriptions.

Where can I find my referrals and preauthorization requests?

Click the ‘Approval Status’ menu in the navigation bar at the top to see the status of your referrals and preauthorization requests for the last 24 months. If your plan has dental coverage, you can see your predeterminations there, too.

My claim is finalized but I don’t see an Explanation of Benefits (EOB) or Health Plan Payment Summary. Why?

It may take a few days after a claim is finalized to see a copy of your EOB in our portal. Check back if you don’t see it after five business days.

Where can I find my EyeMed vision benefits documents?

If your plan includes vision benefits through EyeMed, you can visit the EyeMed portal to view your documents and more.

How can I join the wellness program?

If your plan includes a wellness program, you will be able to join and visit the program from the myEmblemHealth portal. Select ‘Health and Wellness’ in the menu bar at the top to see all the options available to you. 

General

How do I renew my Medicaid, Health and Recovery Plan (HARP), Child Health Plus, or Essential Plan Coverage?

Depending on how you enrolled, the NYC Human Resources Administration (HRA), your Local Department of Social Services (LDSS), or the NY State of Health (NYSOH) Marketplace will send you a letter or an email with your renewal information.

To renew through the NY State of Health Marketplace:

  • Call us at 888-432-8026 (TTY: 711), 8:30 a.m. to 6 p.m. Monday to Friday, and Saturday from 9 a.m. to 1 p.m. (excluding major holidays). A representative will help you complete the renewal application over the phone. You can also call to schedule an in-person appointment.
  • You can also visit one of our Neighborhood Care locations where our staff can assist you with your renewal.

To renew your Medicaid or HARP plan through the NYC HRA or your LDSS:

  • Complete and mail your renewal package to HRA or the LDSS as soon as possible, but no later than the due date on the letter.

If you did not receive your renewal package or need further assistance, call us at 888-432-8026 (TTY: 711), 8:30 a.m. to 6 p.m. Monday to Friday, and Saturday from 9 a.m. to 1 p.m. (excluding major holidays). You may also visit our Medicaid Renewal page for more information.

How do I find help on mental health issues?

Visit our Mental Health section of our website to find resources on various mental/behavioral health conditions. You can also call the number on your member ID card to speak with a representative.    

How do I check if my medical procedure requires preauthorization?

Want to see if your procedure requires a preauthorization? We have a resource for that. It’s a quick form that tells you whether a preauthorization is needed for specific services. 

You will need your member ID and the following details from your provider before you can use the tool:

  • Procedure Code—also known as CPT or HCPCS Code
  • Diagnosis Code
  • Place of Service—where the services will be performed. 

Click the button below to launch the tool and enter the requested information to see if you need to get a preauthorization ahead of your procedure. 

Remember, you never have to get a preauthorization for emergency services. 

If you have any questions, please contact us here or at the number on your ID card.  

How do I stay up to date on the latest news from EmblemHealth?

Visit our website often as we’re constantly adding relevant information to help you make the most out of your EmblemHealth plan. Check out our blog for health and wellness tips, member resources, and more.

You can also follow us on social media to stay up to date on the latest from us:
Facebook | Instagram | LinkedIn | Twitter | YouTube

What is IRS Form 1095-B, and how can I learn more about it?

Visit our IRS Form 1095-B Frequently Asked Questions page to learn more, including information on how to get your form electronically.

My question isn’t addressed here. How can I contact someone?

If you are a member, you can send us a secure message from the member portal or call the number on your ID card.

If you’re considering EmblemHealth or need general information, visit our contact page, call us at 866-274-0060, or complete the request form.

I am an HMO or EPO/PPO or Dental member. Can I submit my claims by email?

You can begin filing a claim via email with your claim form and supporting information at:

Please follow the below claim submission guidance to ensure your e-mail claim submission has all the necessary information for processing.

  1. Choose one of the following e-mail subject lines for your claim submission. Do not use “SECURE” in your e-mail subject line, or list sensitive information, including your member ID in the subject.
    • PPO Medical Claim Submission
    • PPO Hospital Claim Submission
    • PPO Dental Claim Submission
  2. Please fill out the provided claim form on our Member Resources page. You must submit the original form in one of our acceptable formats. We cannot accept a screenshot or photo of the form. All fields on the claim form must be completed.
  3. You can confirm your plan type and member ID on your ID card. All information must be filled out, including member ID, patient name, DOB, CPT-4 codes, ICD-10 Diagnoses codes, and provider information such as NPI and Tax ID.
  4. The following documents are acceptable file formats (JPG/JPEG is NOT acceptable):
    • PDF
    • TIFF
    • MTIF
    • DOC
  5. Submit all claim pages (forms and supporting documentation) in one attachment. Claim information will only be processed together if all attachments are in one document. Separate documents will receive separate claim numbers.

You can send messages about claims using our secure member portal. You can see instructions above on how to register and sign into the member portal.

You can schedule an appointment online with your AdvantageCare Physicians Primary Care Provider and select Specialists! Visit the AdvantageCare Physicians website (ACPNY.com) where you can choose a convenient appointment time at a location near you. 

GET IN TOUCH

We’re here to help!

Call us at 800-447-8255 (TTY: 711) from 8 a.m. to 6 p.m., Monday through Friday.

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Also of Interest: 
Member Resources   |   Medicare Advantage Plan FAQs   |   IRS Form 1095-B