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2022 EmblemHealth GHI and HIP

EmblemHealth, formerly GHI and HIP, has recapitalized and reloaded dynamic plan offerings for 2022. They have had stable 3 years of single-digit increases. Emblem has added a new 3rd network, Millennium Network, to its stellar lineup of Hip Prime and Select Care Network. The discounts vary between 8% and 15% discount

1. Prime Network: Largest Emblem Network. – newly expanded 123,000 Providers Tristate.

All plans are non-gated and include Pediatric and Adult Dental and Vision.

NYS – EmblemHealth has expanded the small group Prime Network to include both the First Health National Network and ConnectiCare Network in Connecticut. This is in addition to the current HIP Prime Network in New York. Members can choose from over 90,000 private and group practice health professionals, facilities, and 144 hospitals in 28 New York State counties — all five boroughs of New York City (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), plus Nassau, Suffolk, Orange, Rockland, and Westchester counties, and upstate areas that stretch north of Albany.

CT – The ConnectiCare HMO Network has 17,000 primary care providers and specialists, and 33 hospitals in all eight counties in the State of Connecticut.

NJ – The QualCare HMO Network includes 26,000 primary care providers and specialists, and 76 hospitals in all 21 counties across the State of New Jersey.

2. Select Care Network – Balance between cost/size – 51,000 Providers. 28 Counties NY Only.

It is a smaller subset of the larger Prime Network @ -8% savings. It includes over 51,000 health care professionals, facilities, and hospitals throughout 28 counties in New York State. PRIME vs. SELECT NETWORK: Click Here

All plans are non-gated and include Pediatric and Adult Dental and Vision.

3. New Millennium Network – Balance between cost/size – 31,000 Providers. Downstate NY Only.

Tailored to an 8 County downstate New York service area. Focused around ACPNY, 6 key independent practice associations (IPA’s) and several prominent hospital systems, such as NY Presbyterian, Catholic Health Services, and Mount Sinai. All Millennium plans are Gated (need referrals). This is a subset of the Emblem Prime Network @-15% savings. 

Emblem Bridge Program 

Bridge is an innovative concept that gives members access to a combination of our existing networks through our affiliated companies and partners.  If you participate in any of these networks, you are an in-network provider for Bridge Program members. The Frequently Asked Questions section below details how to determine if you may see a member with Bridge access and how you will be paid.

New Plan Features

  • 3 free copays for PCP on selected plans.
  • New: 2 Virtual EPO plans.  $0 copay for in-app covered PCP.  Integrated home monitoring devices like Apple Health and Google Fit.
  • PPO with 80th percentile of FAIR Health. Best value $1,028.
  • National PPO Network – First Health  Available on PPO and EPO plans.  774,000+ health care providers and 5,300+ Hospitals.  NCQA-accredited.
  • Urgent Care no deductible
  • Labs no deductible
  • $0 Generics before deductible
  • Adult & pediatric preventive dental no deductible,
  • $0 Telemedicine through Teledoc. Members can get non-urgent medical care. It’s convenient, immediate, and available 24 hours a day, 365 days a year. Telemedicine doctors can even prescribe certain medicines.
  • $0 Acupuncture on Prime and Select Networks.
  • Vision Included – free annual exam and lenses at 20% coinsurance.
  • Gym Reimbursements – up to $400 for members and $200 for spouses.
  • OK to enroll 1099 employees

Emblem has been a NYS mainstay for 80 years.  They insure 612,000 members. Notable clients are Union plans such as the NYC Teachers Union.

DOCTOR SEARCH:  Click Here

PRIME vs. SELECT NETWORK: Click Here

BENEFITS SUMMARY:  Platinum Premier,  Gold Choice,  Silver Plus(gated)  and Bronze Plus HSA (gated)  

EMBLEMHEALTH SMALL BUSINESS OVERVIEW. Click Here

ACPNY(ADVANTAGE CARE PHYSICIANS NY) Network

Group Sample Rates:  EmblemHealth 2022 Q1 Small Group Rate Sheet

 

 

 

 

 

 

 

 

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