Doctors
Will our current GHI-CBP EmblemHealth doctors be part of the NYCE PPO plan?
Yes. All providers who are currently contracted with EmblemHealth (GHI) in the Downstate 13 counties (DS13), which is made up of New York City, Long Island and Dutchess, Orange, Putnam, Rockland, Ulster and Westchester counties, are also covered under the NYC Employees PPO plan.
Remember: At this moment, doctors are not aware of the NYCE PPO because it has only just been approved by the MLC. Therefore, doctors cannot answer any questions about NYCE PPO right now.
If you still wish to ask your doctor about the new plan:
For the Downstate 13, ask if they are in:
- EmblemHealth
- EmblemHealth Bridge Network
Outside the Downstate 13 (i.e., New Jersey and nationwide), ask if they are in:
United Healthcare Choice Plus
For mental or behavioral health care providers, ask if they are in:
- UnitedHealthcare Behavioral Health Network
If the answer is yes, they will be part of the NYCE PPO.
What about doctors in New Jersey, Connecticut and outside the Downstate 13 counties in New York State?
The current GHI CBP plan has a limited network outside the Downstate 13 counties — only about 29,000 providers. Under the NYCE PPO plan, members living outside the Downstate 13 now have access to 1.6 million providers nationwide through the UnitedHealthcare Choice Plus network.
For example:
In the NYCE PPO plan, the number of doctors in New Jersey will nearly double to around 28,000, up from about 15,000. The number of doctors in Connecticut will jump to around 14,000 and the number of doctors in Pennsylvania grows to more than 49,000.
Members in Florida will be able to access to 49,000 doctors in the NYCE PPO plan, compared to 4,000 in the current plan.
In other states like Georgia, Arizona, California, Virginia and North Carolina, there are currently only several hundred in-network doctors in each state under the GHI CBP plan. Under NYCE PPO, each of those states will have tens of thousands of in-network doctors. For example, Arizona will have about 21,000 in-network doctors, North Carolina will have about 32,000, and California will have about 80,000.
Could I see doctors outside New York or while traveling without a referral under the NYCE PPO plan?
Yes. The NYCE PPO is a true national PPO, which means you can see in-network doctors anywhere in the country without a referral. You do not have to live in a particular location to see a provider. This flexibility also applies if you are traveling or on vacation, so you can access care without needing to switch your primary doctor or get special approval. This larger nationwide network of providers also benefits dependents who are living out of state, such as children in college.
Do I need to designate a primary care provider under the NYCE PPO plan?
No, a primary care provider is not required with this plan.
What is a preferred provider?
Preferred providers are doctors, health care professionals and facilities that are available only in the EmblemHealth coverage area of New York City, Long Island and the Hudson Valley (Dutchess, Orange, Putnam, Rockland, Ulster and Westchester counties). These include AdvantageCare Physicians New York and New York City Health + Hospitals locations. By using preferred providers, NYCE PPO members will likely pay lower to $0 costs for health care services.
Would I need to get referrals from my doctor to see specialists?
No, the NYCE PPO would not require referrals.