EmblemHealth Essential Plan: How do I use my insurance for the first time? – Support | Kimber Health

I. Understanding The Plan

The EmblemHealth Essential Plan is an HMO type of plan which usually means:

The member needs a Primary Care Provider (PCP)
The PCP is the member's main doctor
The PCP may give referrals for specialists
The member saves money by staying in-network

II. Step-by-step Guide for New Users

Getting the Member ID Card

Essential Plan members need their insurance for booking appointments, buying prescription medicines, or for billing purposes. There are three ways to get the card:
```
- Mailed to the member's home
- Downloaded digitally through the myEmblemHealth member portal
- Replaced if lost
```
EmblemHealth Essential Plan Insurance Card

Front View:

Back View:

2. Creating an Online Account

To create an online account, members have to register through EmblemHealth's member portal so they can do the following:
- View ID cards
- Search doctors
- Check benefits
- See claims
- Pay bills
  
  Registration Page:

Choosing/Updating a PCP

A PCP is the member's first stop for care. The member can either call member services (888-225-6133) or log into the member portal to confirm/update their assigned PCP.

Examples of PCP needs:
```
- Checkups
- Sick visits
- Prescriptions
- Blood tests
- Referrals
```
Booking First Appointment

Best first visit for members would be for Annual Physical / Preventive Checkup. Members can call the PCP's office and say:
```
“I have EmblemHealth Essential Plan HMO. Are you my assigned PCP and in-network?”
```

What to Bring to the Appointment?

- Insurance card
- Photo ID
- Medication list
- Questions/symptoms

What the member should do if they need a specialist?

The member needs to visit their PCP first and get a referral. The PCP will then send the referral.

Examples of Specialists are as follows:
```
- Dermatologist
- Cardiologist
- Orthopedic doctor
- Gastroenterologist
```
Tip: Members should always verify before booking an appointment with a specialist.

Prescription Medicine

Here are things members should need to take note of regarding prescription medicines.

- The doctor gives the prescriptions.
- The member should go to the pharmacy and show their insurance card.
- Many generic medications have low copays.

III. Important Rules and Guidelines

Members must stay in-network before using the following:
```
- Urgent care
- Labs
- Imaging (MRI/X-ray)
- Specialists
- Therapy / mental health
```
***Check if they accept the exact plan.
Emergency Rooms

Members should use the ER only for the following emergencies:
```
- Chest pain
- Trouble breathing
- Severe injury
```

Members can also use the plan for the following reasons:

- Physical exam
- Vaccines
- Bloodwork
- Ongoing symptoms
- Prescription refills

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