ExchangeCoverageHigh impact
2025 Commercial Networks and Benefits Plan Changes
EmblemHealth·NY · Endocrinology, Family Medicine, Internal Medicine +2 more·Provider News
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Effective January 1, 2025, EmblemHealth will waive all cost-sharing (copays, coinsurance, deductibles) for diabetic patients with Essential Plan or individual/family plans for diabetes-related services, prescriptions, and supplies. Similar cost-sharing waivers apply to pregnant and postpartum members for most outpatient services and prescriptions.
Action Required
By January 1, 2025: Billing team must update system to eliminate copays, coinsurance, and deductibles for diabetic patients with Essential Plan or individual/family plans for all diabetes-related services, supplies, and prescriptions. Update patient registration to identify eligible plan types and diabetes diagnosis. Configure system to waive cost-sharing for pregnant and postpartum members with individual/family plans for outpatient services and prescriptions. Train front desk staff to verify plan eligibility and apply appropriate cost-sharing waivers.