Emblem Health Insurance Review & Complaints (2024)
Emblem Health Insurance review reveals quotes for a 30-year-old Manhattan resident range from $409/mo for the Select Care Bronze Value to $742/mo for the Select Care Platinum Plan. Emblem Health Insurance is divided into three categories: Select Care Standard, Select Value, and Essential Emblem Health.
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Zach Fagiano
Licensed Insurance Broker
Zach Fagiano has been in the insurance industry for over 10 years, specializing in property and casualty and risk management consulting. He started out specializing in small businesses and moved up to large commercial real estate risks. During that time, he acquired property & casualty, life & health, and surplus lines brokers licenses. He’s now the Senior Vice President overseeing globa...
Licensed Insurance Broker
UPDATED: Sep 26, 2023
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Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.
UPDATED: Sep 26, 2023
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance companies please enter your ZIP code on this page to use the free quote tool. The more quotes you compare, the more chances to save.
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Emblem Health is a not-for-profit New York health insurance company offering a variety of coverage options, including individual and family plans and the best overall Medicare company plans. Their focus is on New York City and surrounding areas, but they offer coverage throughout the tri-state area as well.
What is Emblem Health?
Emblem Health was formed in 2006 through the merger of two New York health insurance companies with roots going back to 1937 when Group Health Incorporated (GHI) was founded. The second company, Health Insurance Plan of Greater New York (HIG), was founded in 1947. Both plans have a history of focusing on health coverage for low and moderate-income people in the New York area. The merger made Emblem one of the largest not-for-profit health care insurers in the country.
Emblem Health has its head office in Lower Manhattan but also has offices in other areas including Albany, Syracuse, and Farmington, CT. They serve 3.1 million members across the service area and have neighborhood care locations in several boroughs of New York City.
Emblem Health sells products including individual and family plans, group plans, and Medicare plans.
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What Emblem Health Plans are Offered?
To access benefit summaries of care plans, we entered the zip code for the Emblem headquarters in New York City. This returned basic summaries of a benefit plan. Individual and family plans are offered in three categories; Select Care Standard, Select Value, and Essential. All of Emblem’s plans are HMO plans, so coverage is offered with their specific national networks. The Select Care network includes health care providers in 28 counties in New York.
Select Care Standard
Select Care Standard plans are available at multiple levels.
Select Care Basic is a catastrophic plan that is a high-deductible HMO offering three free primary care visits per year before the deductible is applied. Our results did not offer the deductible amount.
Select Care Bronze offers 50% coinsurance after the deductible is met, and has an individual deductible of $4,000. Primary care visits are covered at 100%.
Select Care Silver is described as offering mid-level out-of-pocket costs. Pharmacy coverage is included before the deductible is met, and the individual deductible is $2,000.
Select Care Gold has a $600 individual deductible. Primary care visits are covered at 100%, and pharmacy coverage is available without a deductible.
Select Care Platinum is a $0 deductible plan that offers the lowest level of out-of-pocket costs with many of the same perks as lower-level plans. The maximum out-of-pocket expense with Medicare with this plan is a low $2,000.
Select Care Value
The Select Care Value plans are offered at the Bronze and Silver levels. These plans have higher deductibles, but the deductible at each level is also the out-of-pocket care costs limit. Value plans include adult dental benefits and vision services with networks of vision providers in New York and New Jersey, as well as nationwide. Medicare Advantage may cover dental implants if this is something you need.
The Bronze Value plan has a $7,150 deductible, and many services and care costs are covered in full before the deductible applies. This includes two sick visits, lab services, and prescription drug coverage.
The Silver Value plan has a $5,800 deductible and even more covered services and care costs, including unlimited urgent care and specialist visits, three free sick visits, and generic covered drugs before the deductible applies.
Essential Plan
The last plan is the Essential plan, which is offered only to those who qualify based on income requirements. The website states that there are four versions of the plan, but does not list further details of the plans or out-of-pocket care costs.
Medicare Plans
Emblem has several types of Medicare plans, including both Medicare Advantage and supplemental insurance. At the time of our review, the website was not functioning properly. In addition to the site errors, attempts to gain more information on the plans failed.
The site listed only the names of the plans, EmblemHealth HMO and EmblemHealth 1199SEIU Premier HMO. It is likely there are several plan options with varying coverage benefits and cost beneath each of these headings. Aside from the Select Care Network, other plans offered to Small Groups include the Prime Network and the Millenium Network, but we were unable able to access it to get answers to questions about coverage for patients and specialty care due to the links not responding. The Prime network includes providers in 28 counties in New York with Tristate access to all counties in Connecticut and New Jersey. The Millennium Network is for individual and family plans on or off the New York State in the 8 downstate counties: Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Suffolk, and Westchester.
Overall, the provider portal was unable to provide more than moderate amounts of information when we visited.
Are Emblem Health Rates Cheap?
Emblem Health has a relatively easy online quoting system, and we requested rates for a 30-year-old male living in the area of the Lower Manhattan company headquarters.
The lowest-priced plan returned was the Select Care Bronze Value at $409 a month. Rates rise from there to $742/month for the Select Care Platinum plan, which is the zero deductible option.
New York tops the list of most expensive states for health insurance premiums, so it is no surprise that these rates are quite high when compared to other states. Compared to insurers in New York, Emblem still comes out a little high on monthly premiums but does have lower deductibles than some other options. Given that it is an HMO, which usually means lower premiums, insurance shoppers will have to decide if limited networks and reasonable deductibles balance out in terms of the monthly cost.
Emblem Health Claims Process
Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)
Emblem Health Insurance offers multiple avenues for policyholders to file claims, ensuring convenience and accessibility. Whether you prefer the ease of online submissions, the efficiency of over-the-phone claims, or the convenience of mobile apps, Emblem Health has you covered.
Average Claim Processing Time
While Emblem Health Insurance provides various options for filing claims, it’s essential to understand the average claim processing time. Policyholders want to know how quickly their claims will be reviewed and settled.
We’ll explore Emblem Health’s claim processing times to give you a clear picture of what to expect.
Customer Feedback on Claim Resolutions and Payouts
Customer feedback is a valuable resource for assessing an insurance provider’s claim resolutions and payouts. In this section, we’ll delve into the experiences of Emblem Health Insurance policyholders to gauge their satisfaction levels with claim resolutions and the timeliness of payouts.
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Emblem Health Digital and Technological Features
Mobile App Features and Functionality
Emblem Health Insurance offers a mobile app that can be a powerful tool for policyholders. We’ll explore the features and functionality of the app, highlighting how it enhances the overall insurance experience.
Whether it’s for managing policies, accessing resources, or filing claims on the go, we’ll cover it here.
Online Account Management Capabilities
In today’s digital age, online account management is crucial for insurance policyholders. Emblem Health Insurance provides online account management tools to make it easier for policyholders to access their policy information, make payments, and more.
We’ll take a closer look at these capabilities and how they benefit policyholders.
Digital Tools and Resources
Emblem Health Insurance offers a range of digital tools and resources to assist policyholders in making informed decisions about their coverage. From educational resources to calculators and other online assets, we’ll explore how Emblem Health leverages technology to provide value to its customers.
How are Emblem’s Ratings and Consumer Reviews?
Emblem Health currently has an A+ rating with the Better Business Bureau (BBB). There have been a total of 61 complaints filed against the health services company in the past three years, 25 of which were closed in the past 12 months. These numbers are low for such a large company.
The BBB does report a government action against Emblem in 2014, in which the company was fined $300,000 and agreed to disclose out-of-network fees. The complaint against the company cited failure to adequately disclose out-of-pocket costs to members for out-of-network care. The BBB’s record indicates that the action was specifically against GHI, which was already a part of Emblem at the time of the action.
There are 83 reviews of Emblem on Yelp, most of which are negative. You can read more reviews in our review directory. There are moderate amounts of positive reviews scattered throughout. Most negative reviews seem to focus on difficulty finding doctors in the provider directory that accept the insurance and difficulty reaching people for help at the company.
What is the Bottom Line?
Emblem Health is a huge company, and their rates are a bit on the high side, even for New York. They may be worth looking at for those who are willing to pay more monthly for a lower deductible, and who do not mind a more limited number of network providers. Finding out more about the average health insurance cost per month in the U.S. is always helpful when evaluating prices.
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Are you looking for free insurance quotes?
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Frequently Asked Questions
What is Emblem Health Insurance?
Emblem Health Insurance is a health insurance provider that offers a range of health insurance plans for individuals, families, and businesses. They provide coverage for medical services, prescriptions, and other healthcare needs.
How can I find reviews for Emblem Health Insurance?
You can find reviews for Emblem Health Insurance by conducting an online search or visiting consumer review websites. These platforms often feature reviews and ratings from policyholders who have had experiences with Emblem Health Insurance.
Are there any positive aspects of Emblem Health Insurance?
Yes, there are positive aspects of Emblem Health Insurance as well. Many policyholders appreciate their wide range of health insurance plans, including options for individuals, families, and businesses. Some also praise the coverage for essential medical services and prescription drugs.
How does Emblem Health handle claims?
Emblem Health runs HMO plans, and claims processing is typically handled internally. However, the content does not provide specific details about the claims process.
What are the ratings and reviews for Emblem Health Insurance?
Emblem Health has an A+ rating with the Better Business Bureau (BBB). However, consumer reviews found on platforms like Yelp may vary, with some positive reviews praising their coverage options and negative reviews expressing concerns about provider networks and customer service.
What is the Select Care Standard category?
The Select Care Standard category includes plans with varying levels of coverage and cost. It offers options such as Select Care Basic, Select Care Bronze, Select Care Silver, Select Care Gold, and Select Care Platinum.
Are you looking for free insurance quotes?
Your one-stop online insurance guide. Get free quotes now!
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Zach Fagiano
Licensed Insurance Broker
Zach Fagiano has been in the insurance industry for over 10 years, specializing in property and casualty and risk management consulting. He started out specializing in small businesses and moved up to large commercial real estate risks. During that time, he acquired property & casualty, life & health, and surplus lines brokers licenses. He’s now the Senior Vice President overseeing globa...
Licensed Insurance Broker
Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.