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Transitioning care and next steps

I’m currently in treatment or scheduled for surgery when this plan begins. How will it work moving to the new plan?

There are two things to keep in mind:

  1. Prior authorization: We’ll make sure your prior authorization information is transferred smoothly so your care continues without interruption. For services starting Jan. 1, 2026, doctors can begin submitting prior authorization requests for this plan on Dec. 1, 2025.
  2. Are your doctor and facility in-network? Given the expanded network, in the rare instance when a current in-network provider is not contracted with the NYCE PPO plan, you may qualify for transition of care coverage if you are under active treatment for certain medical conditions — for example, if you are in the second or third trimester of pregnancy. Transition of care coverage allows you to continue seeing that doctor for up to 90 days from Jan. 1, 2026, while you transition to an in-network doctor or facility. (If you are pregnant, you may continue care through delivery and any postpartum services directly related to the delivery.) You will be able to submit a request starting Dec. 1, 2025, and if approved, your provider will be treated as in-network during the transition period. It is important to remember to submit this request before your first 2026 doctor visit. We will review your clinical needs to help ensure your care continues smoothly. To check if your doctor is in-network, visit the provider medical search at nyceppo.com. Mental/behavioral health services work the same way.

You can also call EmblemHealth Customer Service at 212-501-4444 (TTY: 711) starting Dec. 1, 2025, to speak with a nurse about any transition of care needs.

I have an appointment with a doctor after Jan. 1, 2026. Do I need to do anything?

You will be able to keep appointments with your currently contracted/in-network EmblemHealth providers in New York City, Long Island and the Hudson Valley (Dutchess, Orange, Putnam, Rockland, Ulster and Westchester counties). In-network providers have a contract to deliver services to members of this health plan. For providers outside this area, you can always visit nyceppo.com to confirm your provider is in-network.

When will I get my new medical and hospital ID cards?

You will no longer have separate medical and hospital ID cards. Instead, you’ll have a single member ID card for all your medical needs with the same member ID number that you currently have. Your new member ID card, which will show you are a NYCE PPO member, should arrive before your coverage starts Jan. 1, 2026. Please remember to use only your NYCE PPO member ID card after the plan’s coverage starts in January 2026.

Will my dependent still have their own member ID card?

Yes, dependents will receive their own member ID cards.

When should I stop using my current medical and hospital ID card(s)?

You should continue to use your GHI CBP and Anthem BlueCross and BlueShield plan member ID cards through Dec. 31, 2025. After that, you’ll use the NYCE PPO member ID card.

Is there a new member portal?

Yes, you'll have a single, brand-new member portal to help you get the most from your benefits. While it will be different from your current EmblemHealth and Anthem member portals, you will have all your information in one place.

Expect your NYCE PPO welcome package — including guidelines for using the portal and other important plan information — to arrive before Jan. 1, 2026. Once you receive that package, you’ll be able to:

  • Register for the new portal.
  • Select your preference for paperless or paper communications.

If you have adult dependents, they will be able to register themselves and authorize you to view their information on their portal.

Will I be able to sign in to my old EmblemHealth and Anthem portals to see historical documents like explanations of benefits (EOBs)?

Yes, if you are registered for the EmblemHealth member portal by Dec. 31, 2025, you will be able to view the previous two years of your EOBs and other historical plan materials through the EmblemHealth portal, which will be available until July 1, 2027. Your Anthem materials will be available in the Anthem portal through Dec. 31, 2027.

Will there be a mobile app?

Yes, there will be a mobile app for NYCE PPO with easy, on-the-go plan information (like providers, claims, etc.) plus features like live text and chat.