March 3, 2022
Effective April 1,
2022, more than 200,000 Medicare-eligible City of New York retirees will transition to the NYC Medicare Advantage Plus plan.
The NYC Medicare Advantage Plus plan is a Medicare Advantage PPO group retiree offering through an alliance between Empire BlueCross BlueShield (Empire) and EmblemHealth. The plan allows retirees to visit any doctor nationally that accepts Medicare while
ensuring the health care provider is paid their negotiated contractual rate or 100 percent of the Medicare allowed rate if non-contracted (less any member copay).
Are You In-Network?
If you are contracted with Premera’s Medicare Advantage network, you are already an in-network provider participating in this plan. You should continue to see your City of New York retiree patients and submit claims to Premera.
Are You Out-of-Network?
You can see City of New York retirees and still get paid 100 percent of the Medicare allowed rate — no contract required:
- You can continue seeing these members as long as you are eligible to receive payments from Medicare.
- Your reimbursement is the same as under original Medicare.
- Members are not required to obtain a referral before they see a provider.
How to submit claims: You should submit all claims to Premera. Please include the amount the member paid when you submit a claim. The member’s copay amount is listed on their member ID card for commonly used services. To submit:
- By mail: Submit paper claims to Premera. Include the three-digit alpha prefix, N6Y, that precedes the member ID number listed on the front of their card.
- By electronic submission: Submit electronically to Premera.