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.

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.

Take Me To The Provider Website

Healthfirst OVERVIEW

For more than 25 years, Healthfirst has been serving New Yorkers. Healthfirst helped pioneer the value-based healthcare model—where hospitals and physicians are paid based on patient outcomes—because Healthfirst was founded on the belief that insurers need to be true partners in the health system.

Network availability & ELIGIBILITY

Healthfirst

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE

To enroll in Pro plans employees must live/work/reside in the five boroughs, Nassau, Suffolk, Westchester and Rockland. Healthfirst* N/A N/A N/A
*Service area consists of five boroughs, Nassau, Suffolk, Westchester and Rockland

Pediatric Dental

Healthfirst

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE

Healthfirst DentaQuest N/A N/A N/A

Pediatric Vision

Healthfirst

NEW YORK

NEW JERSEY

CONNECTICUT

NATIONWIDE

Healthfirst Davis Vision Davis Vision Davis Vision Davis Vision

 

Telemedicine
  • When a member uses their Teladoc services there is no charge excluding HSA plans where a $40 Primary/$75 Specialist copay applies prior to the deductible. Teladoc is just a click away – teladoc.com/healthfirst
  • Capsule, Medly Pharmacy and ExactCare medication delivery services, for non-maintenance medications are also available.
Prescription Mail Order
Added Values
  • Gym reimbursement – 50 visits per 6-month period and earn $200. The covered spouse will earn $100 for 50 visits within a 6-month period.
  • Acupuncture is a covered benefit.

Provider Directory

  • To enroll in Pro plans employees must live/work/reside in the five boroughs, Nassau, Suffolk, Westchester and Rockland.

To find a provider:

    • Enter the type of care you looking for
    • Enter your location
    • Select Healthfirst Platinum, Gold, Silver and Bronze Pro EPO Plans or Healthfirst Gold Pro Plus EPO Plans
    • Search

Take Me To The Provider Website

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.

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).

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.

Take Me To The Provider Website