The information in the table below lists the Care, Place and Time to receive medical treatment. The table also includes the cost of in-network services if provided by an AdvantageCare Physician (ACPNY) or by a non-ACPNY physician, as well as emergency services.
Visit emblemhealth.com/city for a full list of preventive services.
PCP (including Mental Health Providers)
|Telehealth (beginning July 1, 2016)||$15||$15|
|Urgent Care Center||$50|
Some ACPNY Offices offer Extended, Urgent Care and Weekend Hours
Scheduling - Some doctors appointments may be scheduled online using ZocDoc
Telehealth is available 24 hours a day.
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).
Preventive Prescriptions and Diabetic Medications as listed on emblemhealth.com/city.
|Self-Injectibles and Chemotherapy||PICA Program|
|Other Prescriptions||Union Welfare Fund or High-Optional Rider|
|GHI-CBP/EBCBS Services Requiring Pre-Certification||
If you are an employee or non-Medicare eligible retiree participating in GHI-CBP/Empire BlueCross BlueShield
As previously communicated, many procedures require pre-certification. Your provider should call NYC Healthline at 1-800-521-9574 for pre-certifications including:
|Maximum Out-of-Pocket (MOOP)||
MOOP refers to the maximum amount of in-network cost-sharing expenses that you will pay in each plan year for covered services/essential health benefits 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.
For July 1, 2016 – December 31, 2016
For calendar years beginning January 1, 2017 – December 31, 2017** (Subject to indexing by the federal government)
|GHI CBP Member ID Cards||Your new GHI CBP member ID card will be mailed to you approximately 10 days prior to the July 1, 2016 effective date of your plan changes. Please begin using it when claiming benefits, and be sure to destroy your previous card once you receive your new one.|
If you have any questions about the changes to your GHI CBP medical benefits, please call EmblemHealth Customer Service at 1-800-624-2414, Monday to Friday, 8 am to 6 pm. If you have a hearing or speech impairment and use a TTY/TDD, please call 711. Or, visit emblemhealth.com/city.
If you have any questions about changes to your Empire BlueCross BlueShield hospital benefits, call 1-800-433-9592. Or visit empireblue.com/nyc.