How do I find out if my doctor accepts NYCE PPO?
You can visit nyceppo.com or call Customer Service at 212-501-4444 (TTY: 711) to find out if your doctor is in NYCE PPO’s network.
Can I receive care from a UnitedHealthcare provider with my NYCE PPO plan?
With NYCE PPO, you’ll have access to care from an expanded EmblemHealth network of more than 78,000 world-class providers in New York City, Long Island, and the Hudson Valley (Dutchess, Orange, Putnam, Rockland, Ulster, and Westchester counties) – up from 64,000 in the current network. Outside of the downstate EmblemHealth coverage area, you’ll have access to UnitedHealthcare’s national Choice Plus network. You can choose from more than 1.6 million providers nationwide as part of your network. Please note that if you choose a UnitedHealthcare provider within the downstate EmblemHealth coverage area, they will only be considered in-network if they are also affiliated with EmblemHealth’s network. If not, they will be considered out-of-network, and you will use your out-of-network benefits for any visits.
Are the same downstate 13-county hospitals currently in the GHI CBP/Anthem BlueCross and BlueShield plan covered by NYCE PPO?
With NYCE PPO, you still have access to the same EmblemHealth providers you see today – more than 78,000 premier providers and all hospitals in the 13 downstate New York counties. This includes these highly utilized hospitals and health systems:
- Hospital for Special Surgery
- Memorial Sloan Kettering Cancer Center
- Montefiore Health System
- Mount Sinai Health System
- New York Presbyterian Health Care System
- New York City Health and Hospitals (H+H) Corporation
- Northwell Health
- NYU Langone Health System
View the full list of hospitals
What providers and hospitals are part of the NYCE PPO network in New Jersey?
In New Jersey, NYCE PPO plan members will have access to care from:
• 82 hospitals.
• 486 urgent care centers.
• More than 53,000 doctors and health care professionals.
• More than 15,000 mental health providers.
This includes but is not limited to large health systems such as:
• RWJ Barnabas.
• Hackensack Meridian Health.
• Atlantic Health System.
• Summit Medical Group.
• Valley Hospital.
Does NYCE PPO have providers in Puerto Rico?
NYCE PPO members traveling to or living in Puerto Rico have in-network coverage through the MAPFRE network of health care professionals. Look for the MAPFRE logo and contact information on the back of your member ID card. You must bring your member ID card when visiting a MAPFRE provider.
How do I find a durable medical equipment (DME) provider?
Using the “find a provider” tool, search under the Hospital/Facility tile.
What if my doctor is not in NYCE PPO’s network?
Your doctor can join EmblemHealth’s or UnitedHealthcare’s network. If your doctor cannot join the network, please see the “Transitioning care” section of this FAQ. You can also continue seeing this doctor using NYCE PPO’s out-of-network benefit, which generally costs more than seeing in-network providers.
If I see an out-of-network doctor, what can I expect to pay?
Like the current plan, NYCE PPO has a deductible for out-of-network doctors. However, you will typically pay less out of pocket than the current plan when you see out-of-network doctors because NYCE PPO will pay out-of-network doctors the Medicare allowed amount, which is generally more than the current plan pays.
Where can my providers direct questions?
Prior to January 1, 2026, providers can visit emblemhealth.com/nyceppo and uhcprovider.com/ny or call 212-501-4444 (TTY: 711) with any questions. Providers can also reach out to their relationship manager.
Will I need a primary care provider (PCP)?
No, a PCP is not required with this plan. However, choosing a PCP can save you time, reduce stress, and help you get the most out of your health benefits. Having a PCP means having someone who knows you — and your health — personally. Your PCP is your go-to for everyday care, preventive checkups, and managing ongoing conditions. They help you stay healthy, catch issues early, and coordinate care if you ever need to see a specialist.
What is a preferred provider?
Preferred providers are a selection of doctors, health care professionals, and facilities through which NYCE PPO members will likely pay less or even $0 for certain health care services.
Preferred providers are only available in the downstate New York coverage area of New York City, Long Island, and the Hudson Valley (Dutchess, Orange, Putnam, Rockland, Ulster, and Westchester counties). They include AdvantageCare Physicians New York and New York City Health + Hospitals locations, as well as Memorial Sloan Kettering Cancer Center facilities and Hospital for Special Surgery facilities. See the NYCE PPO Summary Plan Document, or SPD, for more details on preferred providers.
Please note: A doctor, health care professional, or facility is only considered a preferred provider when offering treatment within the downstate coverage area. If you visit a preferred provider with locations outside the downstate coverage area, the provider would not be preferred.
How does coverage for applied behavioral analysis (ABA) therapy work? Does NYCE PPO follow New York State mandates?
Yes, all NYCE PPO benefits either meet or exceed New York State mandates as of December 2025. ABA therapy usually requires prior authorization through the UnitedHealthcare behavioral health network. There is no limit on the number of visits. Learn more about New York State’s ABA mandate from the Department of Financial Services website
