![]() All other specialty providers: $30 copay.$0 copay if you use an AdvantageCare Physicians (ACPNY) provider.Coverage for in-network and out-of-network services.This chart shows the estimated cost of seeing a doctor outside of our network. Using a health care professional in our network is a cost-effective way to use this plan. The calculator provides estimates for out-of-pocket costs, or what you may pay for certain items and services. If you choose to get services outside of our network, you can use our self-service treatment cost calculator available in the myEmblemHealth member portal. If you do not get a required prior approval, you may not get reimbursed. Hospitalization benefits are provided to you by Empire BlueCross BlueShield. You will be responsible for any difference between the provider’s fee and the amount of the reimbursement, in addition to deductibles and coinsurance therefore, you may have a substantial out-of-pocket expense. This plan is offered to employees and non-Medicare eligible retirees and covers medical and surgical services. Most of the reimbursement rates have not increased since that time, and will likely be less (and in many instances substantially less) than the fee charged by the out-of-network provider. The reimbursement rates in the Schedule are not related to usual and customary rates or to what the provider may charge but are set at a fixed amount based on GHI’s 1983 reimbursement rates. When you choose to use out-of-network doctors, payment for covered services will be made under the NYC Non-Participating Provider Schedule of Allowable Charges. Using an Out-of-Network Health Care Professional In most cases, when you see a network doctor, your cost will just be a copay. You can see any network doctor without a referral. For more information, visit the Anthem Blue Cross website or contact Anthem Blue Cross Member Services at (877) PERS-PPO or (877) 737-7776.The GHI Comprehensive Benefits Plan (CBP) gives you the freedom to choose in-network or out-of-network doctors. Refer to and read all plan documents for more complete descriptions. All insurance contracts and plans have limitations and exclusions that apply. This summary is meant only as a brief description of some of the programs for which members may be eligible. Mental health / Behavior health / Substance abuse physician visit Inpatient covered in full when enrolled in Future Moms program $10 copay for visits with personal doctor Eliminate coinsurance for inpatient delivery, after enrollment in the Healthy Moms program.īenefits comparison: In-network benefits for a common medical issue.Eliminate hospital tiering, so you can access any hospital in your network at one coinsurance rate.Award credits to reduce your annual deductible.Change copays for primary care, specialists, and urgent care.Incorporate your family and community to build a healthier you.Learn healthy habits that help prevent and detect diseases.Make empowering decisions about your own health and care.Get treatment without seeing a specialist, in most cases, or elect to see a specialist without a referral.Some benefits of the new PERS Select Plan: ![]() And the more preventative care you elect, the lower your deductible and some forms of coinsurance. The plan offers the benefit of working with a personal doctor to guide and coordinate your health care. The new PERS Select Basic plan will adopt VBID beginning in 2019. Depending on the organization and their plan, that means enhanced care, better wellness education programs, fewer unwarranted medical procedures, and accessible cost incentives. Value-Based Insurance Design (VBID) aims to improve the quality - while lowering the cost - of health care by empowering choice. PERS Select: Value-Based Insurance Design
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