EmblemHealth and Labor: True partners in care.

 

For us, providing health care to unions is really a labor of love. After all, your members have been our members for more than 80 years. And our long, proud history of serving the working men and women of New York is at the heart of everything we do. This bond continues today with a steadfast commitment to meet and exceed labor’s changing needs during challenging times and beyond. 

 

Like you, we’ve built the solid local relationships necessary to stay strong and agile. This translates into a wide range of provider networks and unique arrangements that offer the value and access you need. Give us a call today at 646-447-1266, to learn how we can customize plans to keep your members covered and your costs in check.  

为什么要让您的成员成为我们的会员

我们知道医疗保健有很多选择。但是,每天,纽约三州地区数百万人(包括该地区许多最大的工会)都希望使用安保健康保险。Union trustees and other decision-makers like you know that we will:

 

了解并尊重会员的医疗保健需求

没有人愿意只是会员卡上的号码。这就是为什么我们始终努力做到更好,同时让我们每个会员得到应有的个人关注。

 

以负担得起的价格提供优质护理

每一块钱都很重要,尤其是在今天。这就是为什么我们提供一系列计划以符合每个预算的原因。Prices vary, but the level of attentive care offered by the health care providers in our networks and the overall service our members receive never will — no matter which plan you select.

 

当您最需要我们时可以获得

我们生活在一个 24/7 全天候的世界中,医疗保健计划应符合这一期望。我们做到了这一点,并为我们的会员提供在他们需要时获得所需的东西。无论是 24/7 全天候客户服务还是获得紧急护理,我们都致力于为会员提供所需的服务。



从我们雇用的员工到我们设计的方案以及我们选择的医疗人员,我们正在努力将我们的会员每天放在首位。Our commitment to caring for members like you is long-standing, proven, and stronger than ever.

 

Many EmblemHealth employees are Local 153 Office & Professional Employees International Union AFL-CIO members.

 

The EmblemHealth ASO Bridge Network* – Your bridge to savings.

Robust local coverage, significant savings – that’s what you’ll get with our ASO Bridge Network. With Bridge, you’ll have access to our largest provider network, giving you one of the best discounts in the tristate area.

 

*With our ASO Bridge Network solution, you can:

  • Dramatically lower costs. 
  • Join a network with 193,000 providers across New York, New Jersey, and Connecticut 
  • Gain in-network access to every hospital system in the state of New York.

For more information, on our ASO Bridge Network, contact Jolt Mena at jmena@emblemhealth.com

我们广泛的计划选择使基金受托人可以灵活地为其工会会员提供多种选择。您可以选择:

 

*InBalance Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO) Plans

These family-friendly plans on the National Network feature no referrals and the ability to lower group premiums by increasing member cost-sharing for certain services. PPO members have the freedom to go outside the network for additional out-of-pocket costs; EPO plans offer in-network benefits only. Choose the one that works best for you and your members.

 

HMO Plans

To meet member health care needs and employer health care budgets, consider one of our many HMO plan options. EmblemHealth HMO plans are community-rated and offer a choice of benefit levels so you can always find the right plan at the right price. Groups can save money when compared to other similar plans. Plus, to promote wellness through early detection of diseases, preventive services are available at no cost to members.

 

ConsumerDirect PPO and ConsumerDirect EPO Plans

These plans offer low group premiums based on higher-than-customary member deductibles. 这些高自付额的健保计划可帮助团体通过节税的健康储蓄账户 (HSA) 抵消会员费用。

 

牙科计划

We offer a choice of three programs featuring different benefit designs, network size, and cost-sharing responsibilities, ranging from paid-in-full network coverage to in-network discounts on more costly services.

 

Pharmacy Services Program

这一选项由单独的附加保险提供,提供广泛的零售和邮购处方药物保险福利,以及一个处方药计划承保的品种繁多的药物名册。

 

您的安保健康保险销售代表将与您紧密合作,以帮助制定最能满足您的工会成员需求的计划设计。

  

Your EmblemHealth representative can help you select the funding arrangement that works best for you and your members. EmblemHealth offers conventional and alternative funding arrangements and will consider special funding arrangements. Options include:

 

仅管理服务 (ASO)

仅管理服务 (ASO) 通过允许基金仅根据已支付的理赔加上管理费用来偿还安保健康保险来增加现金流。This rating arrangement is not insured, and the fund is responsible for all claim payments and administrative charges associated with the plan. Our stop-loss insurance option is offered to all ASO accounts through our vendor.
可用性: 拥有 250 名或更多合资格会员的基金。

 

经验评级

Historical claims experience is used as the basis for projecting future claims and determining premiums. 这些安排包括汇聚个别高成本理赔,以防基金受巨灾理赔的影响。

  • 前瞻评级
    • 根据基金实际经验和安保健康保险对类似业务汇聚的表现,评估未来保单期限的预期理赔经验。该计划的费用是在保单期限之前确定并固定下来,基金没有资格获得任何追溯性退款。Losses (deficits) are not carried forward..
  • 追溯评级
    • 该方法评估和衡量基金的过往理赔数据,以根据基金的实际经验估算提供保险福利的未来成本。The fund is eligible for retroactive rate refunds when earned premium exceeds the plan’s overall expenses.
  • 递延保费
    • Eligible funds are allowed to remit a percentage of their gross earned premium on a monthly basis, called the “payment rate.”The difference between the payment rate and the gross earned premium rate is "callable" by EmblemHealth at a later date, depending upon claims experience and other factors. Availability: Subject to underwriting review and approval.

 

社区评级

这种方法结合了每个计划的总体医疗费用,以确定该计划的标准保费率。
Availability: All funds with 100 or less eligible members must be community rated by law with limited exceptions. HMO plans are community rated regardless of fund size.

 

 For purposes of this document, any reference to members is representative of the plan participant.

The health and well-being of your members is at the heart of everything your organization achieves. In fact, employers have reported greater productivity and growth after implementing workplace wellness programs.* That’s why EmblemHealth offers buy-up products through our partner, WellSpark Health. WellSpark takes a proactive approach to filling in the gaps in preventive care and supporting chronic disease. Lifestyle coaching, diabetes prevention, and promoting health literacy are just a few of the things WellSpark does to help spark better employee health outcomes. For more information, visit wellsparkhealth.com.

 

*Held, Justin, and Teri Dougherty. Workplace Wellness Trends, 2017 Survey Results. International Foundation of Employee Benefit Plans, www.ifebp.org.

When it comes to access, we’ve got you covered. With EmblemHealth’s Network Access Program, you and your members gain access to an extensive PPO network that includes top doctors, leading hospitals, hassle-free benefits administration, and competitive prices. And we always give you the power to choose the arrangement that works best for your organization. For example, access both our medical provider and hospital network, or just the one you need.

At EmblemHealth, we are committed to organized labor. 因此,您可以指望我们为您的会员提供满足其基本需求的优质、平价的医疗保健。We’ll also give you the guidance to select a plan that suits your needs.

 

让我们向您展示安保健康保险如何为您的工会会员服务。我们邀请您致电以下我们的团队。

 

Roberto Hormazabal
AVP, Labor Sales and Account Management
55 Water Street
New York, NY 1004
Office: (646) 447-6480  Cell: (646) 369-5646
RHormazabal@EmblemHealth.com

Jolt Mena
Labor Sales Representative
55 Water Street
New York, NY 10041
Office (646) 447-1266  Cell: 347-346-1570
jmena@emblemhealth.com

 

For more information and to request marketing materials, please email Jolt Mena at jmena@emblemhealth.com, or call him directly at 646-447-1266 or 347-346-1570.

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