Medical
Emblemhealth Overview
EmblemHealth is one of the nation’s largest not-for-profit health insurers, serving more than three million people in New York City and the tristate area. For the past 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, healthcare is more complex than ever. That’s why EmblemHealth remains committed to finding new ways to deliver quality care at affordable prices.
EmblemHealth Medical Plans
Network availability & ELIGIBILITY
EMBLEMHEALTH |
NEW YORK |
NEW JERSEY |
CONNECTICUT |
NATIONWIDE |
| To enroll in Bridge plans employees can reside in any of the 50 US states. Bridge Program includes: Prime, GHI National, Connecticare,QualCare and First Health networks. |
Bridge – Prime |
Bridge – QualCare |
Bridge – ConnectiCare |
Bridge – GHI National & First Health |
| To enroll in Prime plans employees must live/work/reside in NY, NJ and CT. | Prime | Prime – QualCare |
Prime – ConnectiCare |
N/A |
Pediatric Dental
EMBLEMHEALTH |
NEW YORK |
NEW JERSEY |
CONNECTICUT |
NATIONWIDE |
| EmblemHealth | Healthplex | Healthplex | Healthplex | N/A |
Pediatric Vision
EMBLEMHEALTH |
NEW YORK |
NEW JERSEY |
CONNECTICUT |
NATIONWIDE |
| EmblemHealth | EyeMed | EyeMed | EyeMed | EyeMed |
Telemedicine
- When a member uses their Teladoc services there is no charge excluding HSA plans there is a $0 copay after the deductible is met. AdvantageCare Physicians Centers are also available to schedule virtual visits. Virtual plan members have access to ACPNY via the EmblemHealth app. Medly Pharmacy medication delivery service is available at no cost.
Prescription Mail Order
- When a member uses Express Scripts to order a 90-day supply of a drug they will pay 2.5 months of copays. Register on-line at https://www.express-scripts.com
Added Values
- Gym reimbursement – 50 visits per a 6-month period and earn up to $200. The covered spouse earns $100 per 50 visits within a 6-month period.
- Acupuncture is covered for 12 visits.
Provider Directory
- To enroll in Bridge plans employees can reside in any of the 50 US states. Bridge Program includes: Prime, GHI National, Connecticare, QualCare and First Health networks.To enroll in Prime plans employees must live/work/reside in NY, NJ and CT.
To find a provider:
-
- If you already have a doctor in mind, you can use the quick search feature. Some services or specialties are only available through EmblemHealth partners, so for the best possible results, please sign in or search by your plan name.
EMPIRE OVERVIEW
Empire is dedicated to delivering better care to our members, providing greater value to our customers and helping improve the health of our communities.
Empire Healthcare Medical Plans
Network availability & ELIGIBILITY
EMPIRE |
NEW YORK |
NEW JERSEY |
CONNECTICUT |
NATIONWIDE |
| To enroll in PPO/EPO plans employees can Live/work/reside anywhere in the US. | PPO/EPO* | BlueCard | BlueCard | BlueCard |
| To enroll in Blue Access plans employees can Live/work/reside anywhere in the US. | Blue Access* | BlueCard | BlueCard | BlueCard |
| To enroll in Connection plans employees Can live/work/reside anywhere in the US. | Connection** | BlueCard | BlueCard | BlueCard |
|
*Empire PPO/EPO & Blue Access service area consists of five boroughs, Nassau, Suffolk, Westchester, Rockland, Orange, Putnam, Dutchess, Ulster, Sullivan, Delaware, Clinton, Essex, Albany, Columbia, Fulton, Green, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington (other New York areas access BlueCard Network). **Empire Connection service area consists of five boroughs, Nassau, Suffolk, Westchester and Rockland (other New York areas access BlueCard Network). |
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Pediatric Dental
EMPIRE |
NEW YORK |
NEW JERSEY |
CONNECTICUT |
NATIONWIDE |
| EMPIRE | Dental Complete | Dental Complete | Dental Complete | Dental Complete |
Pediatric Vision
EMPIRE |
NEW YORK |
NEW JERSEY |
CONNECTICUT |
NATIONWIDE |
| EMPIRE | Blue View Vision | Blue View Vision | Blue View Vision | Blue View Vision |
Telemedicine
- Members can connect to virtual care you need using our SydneySM Health mobile app. Members can have a video visit with a doctor 24/7 for common health issues, and mental and emotional healthcare is available by appointment.
Prescription Mail Order
- When a member uses CarelonRx to order a 90-day supply of a drug they will pay 2.5 months of copays.
Added Values
- Engagement Package 200 member and their Spouse/Domestic Partner can earn up to $200 max each year
- Up to $400 of fitness membership dues. All family members 18 and older can receive this gym reimbursement
- Sydney Health, members have a single point of access to their benefits, tools, and resources
- Easy pharmacy refills and updates
- Tailored experience based on individual history
- Find Care with personalized match and virtual care
- Ability to get questions answered via chat
- Electronic ID Cards
Provider Directory
-
To find a provider:
- 1. Select ‘Basic search as a guest’
- 2. Choose ‘Medical Plan or Network…’
- 3. Select New York
- 4. Select Medical (Employer-Sponsored)
- 5. Select your plan or network – either EPO/PPO Network Empire EPO or PPO, Blue Access Network Empire
EPO or Connection Network Empire EPO - 6. Enter your search criteria
OXFORD OVERVIEW
Oxford serves millions of people from their earliest years through their working lives and into retirement. What unites them is their mission to help people live healthier lives and make the health system work better for everyone.
Oxford is working to play their part in creating a more sustainable healthcare system: one that works better for everyone.
Oxford Medical Plans
Network availability & ELIGIBILITY
Oxford |
NEW YORK |
NEW JERSEY |
CONNECTICUT |
NATIONWIDE |
| To enroll in Metro plans employees must live/work in NY and NJ. | Metro | Metro | N/A | N/A |
| To enroll in Liberty non-gated plans employees can live anywhere in the continental US. To enroll in Liberty gated (G) plans employees must live in NY, NJ and CT. These members have access to Core Network when they travel or have children attending college outside of the Oxford service area (NY/NJ/CT). |
Liberty* | Liberty | Liberty | Core Network |
|
*Service area consists of five boroughs, Nassau, Suffolk, Westchester, Rockland, Orange, Putnam, Dutchess, Ulster and Sullivan (other New York areas access Core Network). |
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Pediatric Dental
Oxford |
NEW YORK |
NEW JERSEY |
CONNECTICUT |
NATIONWIDE |
| Oxford | National Options PPO 20 | National Options PPO 20 | National Options PPO 20 | National Options PPO 20 |
Pediatric Vision
Oxford |
NEW YORK |
NEW JERSEY |
CONNECTICUT |
NATIONWIDE |
| Oxford | UnitedHealthcare Vision/Spectera | UnitedHealthcare Vision/Spectera | UnitedHealthcare Vision/Spectera | UnitedHealthcare Vision/Spectera |
Telemedicine
- Oxford – Members can access virtual doctor visits on myuhc.com or through the UnitedHealthcare mobile app. Virtual visits are covered at no charge excluding HSA plans have a $49 charge per virtual visit and no charge after deductible.
Prescription Mail Order
- When a member uses OptumRx to order a 90-day supply of a drug they will pay 2.5 months of copays. Register on-line at https://www.optumrx.com
Added Values
- Gym reimbursement – 50 visits per 6-month period and earn $200. The covered spouse and eligible dependents earn $100 for 50 visits per 6-month period.
- UnitedHealthcare Rewards
- Core (all plans except Motion plans) – members can earn up to $300/year for reaching program goals and completing one-time reward activities
- Premium (those enrolled in Motion plans) – members can earn up to $1,000/year for reaching program goals and completing one-time reward activities
- Real Appeal – A personalized transformation coach to help guide you and customize steps to fit your weight loss needs, personal preferences, medical history and goals. 24/7 support is available online.
Provider Directory
- Go to myuhc.com
- Select Find a Provider
- Choose Medical Directory
- Choose Employer and Individual Plans
- Scroll down and select Oxford Health Plans
- Choose your Oxford plan
- You can find your plan type on the front of your member ID card in the bottom right corner
- Finally, select the healthcare category you would like to search, or use the search bar if you know the doctor’s name, specialty, facility, clinic or medical group name.
Find a behavioral health provider in your Oxford network:
- Go to liveandworkwell.com
- Select Find a provider in the Explore column
- Choose Employer or individual Plans
- Use the search bar to find a provider by name, specialty, or location or search using the care categories shown.
Plans with out-of-area coverage:
Follow these steps if your plan has access to the national UnitedHealthcare Core network when traveling outside of the tri-state area. Please verify a doctor’s participation status by calling the number on your health plan ID card.
- Go to myuhc.com
- Select Find a Provider
- Choose Medical Directory
- Choose Employer and Individual Plans
- Scroll down and select Oxford Health Plans. Then select your plan with out-of-network coverage – Liberty with Core
- Finally, select the healthcare category you would like to search, or use the search bar if you know the doctor’s name, specialty, facility, clinic or medical group name.