MAKE THE MOST OF YOUR EMBLEMHEALTH PLAN a
Thank you for renewing your health insurance coverage with EmblemHealth! We value your membership. We want to give you and your family the highest level of service and care. We hope to build a lasting relationship with you through better quality health care. To help you make the most of your plan, we ve created this brief guide to remind you about what you get from your plan. More detailed information can be found in your original member handbook.
Care at Your Fingertips It s never been easier to manage your health care! Visit emblemhealth.com/members, either log in or create an online account: For easy access to your benefits To find a doctor To see your health coverage end date Complete your free online To check on claims status health assessment Keep your personal health records And much more Your EmblemHealth Member ID Card You need to show your EmblemHealth member ID card when you visit your doctor or pharmacy. It s a good idea to keep your EmblemHealth ID card with you at all times. YOUR ID CARD SHOWS: Your network: This is a group of health care professionals or facilities that contract with EmblemHealth. They provide covered products and services to members. Your primary care doctor MEMBER: JOSEPH Q. SAMPLE ID NUMBER: 12345678 Enhanced Care Network: Enhanced Care Prime PCP: Dr. John Smith Tel: 000-000-0000 Copay: PCP $0 SPEC $0 ER $0 Rx $0 Dental: $0 BIN#: 015748 PCN: 0020111001 Your plan name. Doctor s phone number. Copays: The fixed amount you pay for services. Underwritten by HIP Health Plan of New York You should also keep your Medicaid benefit card. You will need it to get services that EmblemHealth doesn t cover, such as transportation. If you need a new member ID card sent to you, call Customer Service at 855-283-2146, (TTY: 711) 8 am to 6 pm, Monday to Friday or visit emblemhealth.com/members and log in. 1
Primary Care Doctor (PCP) Your primary care doctor is the health care professional or doctor who coordinates your care. He or she manages your health care and arranges for you to see a specialist when you need one. When you first joined the plan, you selected or were assigned a doctor. Not sure who your doctor is? You can find it on your member ID card. (See the previous section.) Regular checkups are important at all ages. So make sure to schedule a wellness visit with your primary care doctor every year for you and all covered family members. Talk to your doctor about tests and vaccines that you and your family may need to stay healthy. If you want to change your doctor, it s easy. Just log in to emblemhealth.com. If you don t have an account, click on Register Now to create one. Once you register, choose Change PCP. Follow the Find a Doctor instructions. If you need help creating an account or finding a doctor, call Customer Service at 855-283-2146, (TTY: 711). Our hours are 8 am to 6 pm, Monday to Friday. Remember: You must get care from a doctor or health care professional in our network. 2
Preventive Care Preventive care is the care you receive to prevent illnesses or diseases. They can help find conditions before they become serious. Here are a few examples of preventive care services covered under your plan: Flu shots Blood pressure readings Cholesterol level tests Sugar (glucose) level tests Mammogram Prostate screening and much more. Talk to your doctor about what tests are right for you. Free Transportation to and from Doctor Appointments Medicaid provides free transportation to your doctor s office and back home again. To get non-emergency transportation, you or your health care provider must call: Nassau and Suffolk County members: LogistiCare at 844-678-1103 Westchester County members: Medical Answering Services (MAS) at 866-883-7865 New York City Members: Medical Answering Services (MAS) at 844-666-6270 If you have an emergency and need an ambulance, call 911. 3
Emergency and Urgent Care If you have an emergency, go to the Emergency Room (ER) immediately or call 911 if you are in a life-threatening situation. The ER is open 24/7, but you may have to wait. Life-threatening emergencies will be treated first. If you have an injury or illness that is not an emergency but needs to be taken care of right away, going to an urgent care facility may be a better option. You will likely have a shorter wait time and receive treatment faster than at an ER. To find an urgent care facility, go to emblemhealth.com/findadoctor. 24-Hour Nurse Line You can speak to a registered nurse about every day, non-emergency health issues. The registered nurse can help you determine the best place to get care and how to handle medical concerns. Call the 24-Hour Nurse Line at 877-444-7988, 24 hours a day, seven days a week. AdvantageCare Physicians As an EmblemHealth member you have access to AdvantageCare Physicians (ACPNY). It s one of the largest medical groups in the New York metropolitan area, serving half a million patients at 36 convenient locations with routine and specialty care. For more information and a list of locations, visit acpny.com. 4
NEW! Special Free Phone Program We want to help you stay connected! Eligible EmblemHealth members may qualify for a FREE smartphone with unlimited text and more. This service is offered by SafeLink Wireless under the Federal Lifeline Assistance Program. To find out more, call Customer Service at 855-283-2146 or visit Safelinkwireless.com. Neighborhood Care EmblemHealth Neighborhood Care gives you the in-person support you need to get the most out of your health plan! Visit a location near you for in-person help understanding how to access care. You can also get in-person help with benefits, other customer service support, and even take a fitness or wellness class there. All services at EmblemHealth Neighborhood Care are offered at no cost to you. To learn more, please call or stop by one of our sites, or visit emblemhealth.com/community. We look forward to seeing you. *Fitness and wellness classes are offered at most locations. Call the site you plan to visit to confirm classes are available there. 5
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Health and Wellness Programs We offer our members programs and services to keep them healthy at no additional cost. Here are a few: Health Home Program A Health Home is not a physical place; it is a group of health care and service providers working together to make sure you get the care and services you need to stay healthy. If you have multiple health conditions such as asthma, COPD, diabetes, heart disease or other health care needs, you may be eligible for this program. You don t have to change your doctors or health benefits to join. The program is completely voluntary, which means joining is your choice. And you can leave the program at any time. A Health Home Care Manager will work with you and your doctors to help you get the care you need. To see if you qualify for this program, call 855-283-2146. Health Assessment After you take your Health Assessment, you ll get a personalized health report. It may even give you tips to help maintain and improve your health, like ways to deal with medical conditions like high blood pressure and diabetes. You can even print the report to share with your doctor. Here s how to take a free online Health Assessment: Go to emblemhealth.com/healthy Click on Get a picture of your health Then you ll need to log in or create an online account with us. Personal Health Record Your health records are very important. With EmblemHealth, you can store your health record online. Log in or create an account at emblemhealth.com/members. There, you will have the option to store health information such as lab results, medications and doctor visits in this secure online portal. You can also print it to take to your next doctor visit. Stop Smoking If you smoke, quitting is one of the best ways to improve your health. Our stop smoking program is available to you and your covered dependents at no extra cost. So join this program to quit smoking and tobacco use for good. Visit emblemhealth.com/quitsmoking or call 866-NY-QUITS (866-697-8487) for more details. 7
Healthy Discount Programs Your EmblemHealth membership saves you money with discount programs: Health Club Discounts Call 877-327-2746 to get discounts on gym or health club membership at participating facilities. Acupuncture Save up to 25% on acupuncture to help boost your immune system and stimulate your body s natural protective and pain-fighting systems. Locate a participating acupuncturist online at choosehealththy.com/emblem or call 877-327-2746. Weight Loss Get discounts on weight loss programs to help you lose the weight and keep it off: Nutrisystem You can sign up online at nutrisystem.com or sign up over the phone at 877-690-6534. Jenny Craig To get your discount, you ll need to register at jennycraig.com/emblem. 8
We are here to help you. If you have any questions, call Customer Service 855-283-2146 8 am to 6 pm, Monday to Friday. A representative will be happy to help. We speak your language. ATTENTION: If you speak other languages, language assistance services are available to you free of charge. Call 855-283-2146 (TTY: 711). ATENCIÓN: Si usted habla español, tiene a su disposición, gratis, servicios de ayuda para idiomas. Llame al 855-283-2146 (TTY: 711). 9
55 Water Street, New York, NY 10041-8190 Group Health Incorporated (GHI), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies. EMB_MB_BRO_39960_MaketheMostofYourPlan_Mcaid 3//18