GHI PPO/EPO and PPO/EPO Share - EmblemHealth

Table of ContentsWelcome............................................................................................................................................. 1Internet Access to GHI...................................................................................................................... 2Your GHI ID Card.............................................................................................................................. 3Types of Plans..................................................................................................................................... 4GHI PPO and PPO Share........................................................................................................... 4GHI EPO and EPO Share........................................................................................................... 4Member Eligibility............................................................................................................................. 5Choosing Your Health Care Providers............................................................................................... 8Claims and Reimbursement.............................................................................................................. 11Your Benefits....................................................................................................................................... 16Precertification............................................................................................................................. 16Additional Programs and Riders.................................................................................................. 18Utilization Management.................................................................................................................... 20Coordinated Care............................................................................................................................... 22Filing a Grievance or Appeal.............................................................................................................. 25Member Rights and Responsibilities................................................................................................ 29Member Services................................................................................................................................ 32Coordination of Benefits (“COB”).................................................................................................... 33Important Definitions........................................................................................................................ 34Important Contact Information......................................................................................................... 39Other Programs that Add Value for MembersEmploye Assistance Program (EAP).................................................................................................. 43Healthful Choices.............................................................................................................................. 45Healthy Discounts............................................................................................................................. 46Health Manager.................................................................................................................................. 48GHI Notice of Privacy Practices........................................................................................................ 49Back to Tableof ContentsDownloadClaim FormsRegister at ​ghi.comDirectory of HealthCare Providersii