CommercialAdministrativeHigh impact
The 2025-2026 Annual Provider Notice Is Here
EmblemHealth·NY·Provider News
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
EmblemHealth announced multiple major changes for 2026 including vendor switches (DentaQuest replacing HealthPlex for dental, Prime Therapeutics replacing ExpressScripts for pharmacy), new plan offerings (NYCE PPO replacing GHI CBP), and elimination of EmblemHealth-ConnectiCare network reciprocity. These changes affect provider networks, pharmacy benefits, and patient eligibility verification processes.
Action Required
Before January 1, 2026: Billing team must update patient eligibility verification systems to reflect new plan names (NYCE PPO instead of GHI CBP), remove ConnectiCare from EmblemHealth network reciprocity lists, update pharmacy benefit management processes from ExpressScripts to Prime Therapeutics, and verify dental coverage through DentaQuest instead of HealthPlex. Front desk staff must retrain on new plan verification procedures to avoid claim denials.