EmblemHealth is committed to serving our partners at the City of New York, as well as delivering access to quality, affordable care to city employees, retirees, and their dependents. To facilitate this, we want to make you aware of the following information, including important notices and changes going into effect soon:
Do Not Collect Copays for Senior Care Members
EmblemHealth has suspended the $15 copay for City of New York retirees receiving certain services offered through the GHI Senior Care Plan. You should NOT collect this copay when providing the following services:
- Office visits (primary care providers, or PCPs).
- Office visits (specialists).
- Urgent care.
- Allergy testing/injections.
- Chiropractic services.
- Podiatry (non-routine).
- Cardiac rehab.
- Pulmonary rehab.
- Vision care (Medicare-covered).
- Physical therapy, occupational therapy, and speech therapy.
- Diagnostic lab/x-ray (including Hi Tech Imaging).
- Radiation therapy.
- Outpatient – mental health.
- Outpatient – substance use disorder.
For more information, visit our City of NY Page.
Changes to CBP Plan Copays
CNY members with GHI Comprehensive Benefits Plan (CBP) benefits will see the following changes:
- Effective April 1, 2023, CityMD Urgent Care centers will have a $100 copay. This is in addition to the ProHEALTH change for CNY members announced in the October 2022 Provider Newsletter.
- Effective April 1, 2023, Zwanger & Pesiri Radiology Group’s high-tech radiology imaging procedures (including, but not limited to: 3DI, CT scan, MRA, MRI, Nuclear Medicine, and PET scan) will have a $50 copay. This is an update to CNY PPO High-Tech Radiology tiering ($50.00 for a preferred facility and $100.00) first announced in the October 2022 Provider Newsletter. Refer to our regularly updated Summary of Companies, Networks, Benefits, and Plans document for complete details on this and other benefits.
- Effective Oct. 1, 2022, all Montefiore providers have a $15 primary care provider (PCP) copay or a $30 specialist copay, like all other non-preferred providers.
Changes to Preferred PCPs in the HMO Preferred Plan
As of April 1, 2023, we will make changes to the preferred PCPs in the Prime Network for the HMO Preferred Plan. Here is what is changing:
- $0 copay for services with a SOMOS PCP. If a member has a SOMOS PCP, there will be a $0 copay for most services, including in-network specialist visits.
- $10 copay for services with a Montefiore PCP. Montefiore PCPs will be non-preferred providers after April 1, 2023. If a member has a Montefiore PCP, there will be a $10 copay for most services.
Be sure to consult our Summary of Companies, Networks, Benefits, and Plans document on the Provider Toolkit. It contains information on copays and more for all EmblemHealth and ConnectiCare networks and plans.
JP 61585 03/2023