News from the NIC - EmblemHealth

Some of our members have contacted the NYSCA Insurance Committee regarding the processing of claims for billed services rendered to EmblemHealth's senior care members.  Emblem has recently posted the following information relative to copayments:

EmblemHealth has suspended the $15 copay for City of New York retirees receiving certain services offered through the GHI Senior Care Plan. You should NOT collect this copay when providing the following services:

  • Office visits (primary care providers, or PCPs).
  • Office visits (specialists).
  • Urgent care.
  • Allergy testing/injections.
  • Chiropractic services.
  • Podiatry (non-routine).
  • Cardiac rehab.
  • Pulmonary rehab.
  • Vision care (Medicare-covered).
  • Physical therapy, occupational therapy, and speech therapy.
  • Diagnostic lab/x-ray (including Hi Tech Imaging).
  • Radiation therapy.
  • Outpatient – mental health.
  • Outpatient – substance use disorder.

For more information, visit our City of NY Page.

In addition, GHI has updated their claims processing system to cover the additional 20% patient responsibility.  As such, the patient will have no out of pocket expense.  

Share this post: