Frequently Asked Questions | EmblemHealth

Switch to:

Frequently Asked Questions

Older woman outside, smiling with her daughter.

Portal Account Setup and Preferences

You’ll need your member ID number, which you can find on your ID card, invoice, or other plan materials you may have received from us. Once your information is successfully validated, you’ll set up a username and password to sign in. 

Get Started

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

Create an Account

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

You can also download our myEmblemHealth app and view your account with a simple tap. Visit our mobile app page to learn about the features available and download the app for your Android or iOS device.

App Store Google Play

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.

Sign In

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.

Two-step verification is an extra layer of security for your account. It cannot be turned off. You may be able to skip it if you choose to have the portal remember the browser you use.

Every time you sign in, you’ll have the option to get a verification code sent to you by email or text message. If you prefer to get your code by text, make sure you add your mobile phone number to your profile.

Once your code is verified, you can check the ’Remember Me‘ box. This will save the specific browser and device you’re using and skip that step the next time you sign in. If you use any other browser, request your username, or reset your password, you will have to verify again.

As the subscriber, you will see the names and coverage status for all dependents included on your plan. You can view your underage dependent’s information, update their profile, and set up preferences for them.

For dependents over 18, your view of their information may be limited unless they grant you permission to see more.

Additional restrictions may apply for sensitive information.

Your username is unique and cannot be changed once created. It can be your email address or any other combination of letters and numbers arranged in an email address format. Ex:

For the best possible experience, we recommend using the latest version of Google Chrome, Safari, or Microsoft Edge. Other browsers, including Internet Explorer, are not currently supported.

Turn on alerts to be notified when changes are happening or when there are updates for your account. You can receive alerts when new documents are available, when new claims are finalized, and more.

To update your alert preferences:

  • Sign in to your account.
  • Click your name in the top right corner and select ‘My Profile.’
  • Click the ‘Communication Preferences’ tab.
  • From there, scroll to Alerts and click the ‘Edit’ button to make changes.

Yes! Turn on the paperless option for your account to get your Explanation of Benefits (EOB) or Health Plan Payment Summary online. You will be notified when a new EOB document is available, and you can view and download it in PDF format from the ’Claims’ section of the portal.

Visit our Understanding your Health Plan Payment Summary page to learn more about your Explanation of Benefits (EOB).

Visit our Understanding Your Health Plan Payment Summary page to learn more about your Health Plan Payment Summary or Explanation of Benefits (EOB).

Depending on what plan you have, you may be able to update your address in the portal. Sign in, click your name in the top right corner and select ‘My Profile.’ If available, you will have an edit option for your address if that is supported by your plan.

You cannot change your name in the portal. If you purchased an individual plan, please call the number on your ID card for help with changing your name.

If you get your health insurance through your employer or a group, please contact your benefits manager or administrator for help with these updates.

Unfortunately, this feature is not currently supported. Please check back soon. We’re always working to improve and enhance all our digital experiences.

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

No. Each account is unique. Every member must have their own unique username in a form of a valid email [i.e.] and password to use our portal, even if they are on the same plan. If you try to register with the same username as someone else, your account will not be completed, and you will be prompted to choose a different username.

Changes to your PCP will be reflected on your ID card within the member portal 24 hours after the change has been made.


Navigating and Using the Portal

To quickly search all primary care providers (PCPs) near your home, select the ‘Primary Care’ tile on the portal homepage.

For more search options, click ‘Find Care’ in the navigation bar at the top of the member portal homepage to begin. On the ‘Service Type’ page, select ‘Primary Care Provider.’ If you have a doctor in mind, enter their name in the next step. Then, select a specialty and a location for your search.


On the search results page, pick ‘Choose as PCP’ on your selected provider and follow the instructions to save your new PCP or replace your current one.


If you are looking for a doctor other than a PCP, be sure to select the ‘Doctor’ tile on the ‘Service Type’ page.

Once you’re signed in, the portal automatically has your plan and network information. You can select any criteria for your search, and your results should include only providers available in your network.

Click ‘Find Care’ in the navigation bar at the top of the homepage to begin a search. You can see each provider’s network status on the search results page.

Sign in and select ‘ID Cards’ in the navigation bar at the top. You can request an ID card for yourself or any member on your plan. You can download and print a copy of your ID card or request an ID card by mail. Allow up to 10 days for your new ID card to arrive in the mail.

You can pay with a credit or debit card, or with a bank account. Sign in and select ‘Billing and Payment’ in the navigation bar at the top. From there, you can see your current bill and options to make a payment or set up autopay.

Visit our website for other ways to pay your bill.

Sign in and select ‘Billing and Payment’ in the navigation bar at the top. Below the summary section, you will see the tabs for invoice and payment history for the last 24 months.

Your pharmacy benefits are managed by Express Scripts. From the ‘Pharmacy’ page in the portal, you will find shortcuts to view your benefits, look up drug prices, and view other features available on the Express Scripts website. To get started, sign in to the portal and select ‘Pharmacy’ in the navigation bar at the top of the homepage.

Beginning April 1, 2023, all EmblemHealth Enhanced Care (Medicaid) and Enhanced Care Plus (HARP) members will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. To get information about NYRx, look up covered drugs or find a pharmacy visit the NYRx website.

From the Pharmacy page in the portal, select ‘Go to Express Scripts’ to view your pharmacy benefits. On the Express Scripts website, you can choose home delivery for your prescriptions.

Beginning April 1, 2023, all EmblemHealth Enhanced Care (Medicaid) and Enhanced Care Plus (HARP) members will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. To get information about NYRx, look up covered drugs or find a pharmacy visit the NYRx website.

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 here, too.

It takes a few days from when the claim is finalized to when a copy of your paperless Health Plan Payment Summary is available in our portal. Check back after five business days from when the claim is finalized if you don’t see it right away.

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

This feature is not currently supported, but you can download the claim forms in PDF format and mail them to us. Visit for the correct address. You can find the relevant claim forms at the bottom of the claims page in the portal.

If your plan includes a wellness program, you will be able to view this feature in the portal by clicking the ‘Health and Wellness’ menu in the navigation bar at the top of the homepage.

Your computer’s security settings, like pop-up blockers, can sometimes block new pages from loading. Please ensure you have your pop-up blockers disabled and try again.

If your search results bring back fewer than 10 providers, the tool will automatically expand the search to 50 miles.

On the new portal, you can use the ‘Find Care’ tab to search for a doctor or find a care facility.

Yes, you can view a Healthcare Financial Summary for all your dependents on the portal, even those over the age of 18.


General FAQ

Enrollment in one of our health plans is easy and simple. Depending on the plan or eligibility, you can enroll online, by mail, in person, on the New York State of Health Marketplace, or by contacting us directly.

Select the type of plan you’re looking for below to get started.

Medicare Advantage
Available to people who have Medicare Parts A and B.

Individual & Family
Qualifying individuals, families, and young people age 21 or under living in one of 28 New York counties, including the five NYC boroughs, Long Island, Westchester, and regions stretching north of Albany. Children and young adults can stay on a parent’s plan until age 26, or through age 29 for an added cost.

Medicaid, HARP or Child Health Plus (CHPlus)
Eligibility requirements for these programs are established by New York State and include household income, residency, family size, and age, as well as your citizenship or immigration status and whether you already have other insurance.

Medicare Supplement
These types of plans “supplement” Medicare by covering the bills that are only partially covered by Medicare Parts A and B.

Group plans
Start here if you're considering EmblemHealth insurance for your business or family.

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.

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.    

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.  

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:






Visit our IRS Form 1095-B: Everything You Need to Know page to learn more, including information on how to get your form electronically.

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

Sign In


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

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

For PPO/EPO Members or Dental Members:

For HMO Members:

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.

EmblemHealth is reviewing out-of-network medical claims that were processed during the period from July 16, 2015, to Sept. 30, 2023, as the result of an agreement with the U.S. Department of Labor.

Participants, such as yourself, may have been responsible for payments to out-of-network providers that should have been covered by your EmblemHealth insurance plan if your plan is offered by a private employer. Specifically, as part of EmblemHealth’s agreement with the U.S. Department of Labor, you are entitled to reimbursement from EmblemHealth for any amount that your provider charged you as a result of EmblemHealth withholding payment to your provider because EmblemHealth previously overpaid your provider for a claim not related to you or your beneficiaries. If EmblemHealth withheld payment to your provider for this reason, it would be reflected on any Explanations of Benefits (EOBs) with the code “860 ADJUST/VOID CLAIM-ABNORMAL- EFFECTS 1099 AMT & NOT REMITS.”

If you incurred out-of-pocket costs related to out-of-network medical services during the above-referenced period resulting from the practice described above, please contact EmblemHealth at 800-624-2414 (TTY: 711) or download a form you can mail to us. You will need to include documentation. Examples of out-of-pocket costs may include:

  • Paying a bill from a medical provider (including paying interest, fees, or penalties for late payment).
  • Paying a collection agency hired by a provider (including interest, fees, or penalties).
  • Having your wages garnished or a lien imposed because of an unpaid medical bill.
  • Defending a legal proceeding regarding an unpaid medical bill; and/or
  • Declaring bankruptcy because of a medical bill.

Keep in mind that the out-of-pocket costs referred to above must be costs that you incurred because your provider billed you as a result of EmblemHealth withholding payment to your provider due to a previous overpayment it paid to your provider. They may not be costs for any other reason, including cost-sharing like copays, coinsurance, and deductibles required under your plan.

Additionally, if you are still being billed by a medical provider or hospital or pursued by a collection agency because of a previous overpayment by EmblemHealth to your provider, please contact EmblemHealth at 800-624-2414 (TTY: 711). We will make our best efforts to try to resolve the outstanding bill or collections.

You have until 365 days from Dec. 15, 2023 to contact us about this issue, but we would prefer to hear from you as soon as possible. If you do not contact us within that time, any right to review by EmblemHealth that you may have under this letter will be considered waived.

Please keep in mind that the settlement with the U.S. Department of Labor does not change participants’ responsibilities for other copays and coinsurance requirements required under their EmblemHealth plan, including that participants may be responsible for a significant share of out-of-network claims or services that are not covered by their plan. If your medical bills result from other cost-sharing provisions of your plan rather than previous alleged overpayments to your provider, you would not be eligible for reimbursement by EmblemHealth as set forth in this letter.


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


We’re here to help

If you’re having trouble paying online or need other assistance, please call our Customer Service team at 1-855-283-2146, seven days a week (excluding major holidays), from 8 am to 8 pm.

Want to enroll in a health plan?  Go to the NY State of Health Marketplace.

Man sitting on couch with father looking at a tablet PC.