CommercialAdministrativeMedium impact
Coming Jan. 1: New Plan for City Employees
EmblemHealth·NY·Provider News
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Effective January 1, 2026, New York City employees will transition to the NYCE PPO plan, a partnership between EmblemHealth and UnitedHealthcare with a unified portal and member ID card system. Claims will be processed using EmblemHealth rates for practices in 13 downstate NY counties and UnitedHealthcare rates for practices outside those counties.
Action Required
Before January 1, 2026: Billing team must complete training on the new UMR-powered provider portal for NYCE PPO plan claims submission. Monitor for education materials and training opportunities to be released in the 90 days prior to launch. Update billing workflows to use appropriate reimbursement rates (EmblemHealth for downstate NY counties, UnitedHealthcare for other locations). Contact relationship manager at 212-501-4444 with questions.