GHI PPO/EPO and PPO/EPO Share - EmblemHealth

Member EligibilityDependent Children Incapable of Self-Sustaining EmploymentIf you have a dependent who is incapable of self-sustaining employment due to mental illness,developmental disability, mental retardation or physical handicap, GHI will continue toprovide coverage for the dependent beyond the usual dependent age limit of your program. Pleasenote that GHI reserves the right to request proof that the child continues to qualify as a dependentincapable of self-sustaining employment. You must submit a completed questionnaire to GHI atleast 31 days prior to the date that dependent coverage would otherwise terminate in order forGHI to determine whether the dependent is eligible. You may contact Member Services online atwww.ghi.com, or call 1-212-501-4GHI or 1-800-624-2414 to obtain this questionnaire. GHI willnotify you in writing of its determination of eligibility. Submit the questionnaire to:GHI Membership DepartmentP.O. Box 2820New York, NY 10116-2820What to Do if You Are No Longer Covered by Your GroupChanges in employment, marital status, or the age of a dependent can bring an end to coverageunder your program. But you may be able to continue coverage for a limited period of time underyour group’s coverage and/or purchase an individual direct payment health insurance contractfrom us. See your Certificate of Insurance for more details.Requesting a Certificate of Creditable CoverageWhen your GHI coverage terminates, we will automatically issue a certificate of creditable coverageto you. The certificate is evidence of the coverage you had with GHI. Under a Federal lawknown as HIPAA, you may need evidence of your prior coverage to reduce a pre-existing conditionexclusion period under another plan, to help you get special enrollment in another plan, or to getcertain types of individual health coverage even if you have health problems. You may request acopy of your certificate of creditable coverage by writing to GHI at:GHIP.O. Box 1701New York, NY 10023-9476Or, you may call us at 1-212-501-4GHI (NYC) or 1-800-624-2414 (outside NYC) to request thiscertificate. You may request this certificate at any time, even if your GHI coverage is still in force.Address ChangeAddress changes should be submitted to your group and GHI in a timely fashion. GHI requiresthat you submit your address change in writing to:GHI Membership DepartmentP.O. Box 2820New York, NY 10116-2820Back to Tableof ContentsDownloadClaim FormsRegister at ​ghi.comDirectory of HealthCare Providers6