Emblem Health Insurance Review & Complaints (2023)

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.

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.

How does Emblem Handle Claims?

Emblem runs HMO plans and is directly connected to the health care services provider. That usually means fairly quick and simple internal claims processing without having to contact customer service. Like most health insurance providers, Emblem does not offer much information on the claims process.

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.