GHI CBP Allowance Calculator

Using a health care professional in GHI’s network is a cost-effective way to use your GHI City of New York Employees and Retirees benefits plan. However, with your benefit plan, you have the choice to get covered services outside of GHI’s network. Please note, though, that the amounts GHI will pay you for services rendered by professionals outside of GHI’s network are based on GHI’s 1983 reimbursement rates. This means that the reimbursement will most likely be significantly less than the cost your doctor bills for the service. You are responsible for the rest of the doctor’s bill. If you choose to get services outside of GHI’s network, you can use the GHI CBP Allowance Calculator, which you can access by logging into your City of New York Employees/Retirees member account page, to get an estimate of how much GHI may reimburse you for the pre-scheduled service, prior to applying deductibles and co-insurance. You can also call Customer Service at 800-624-2414 for an estimate, or visit the member walk-in center located at EmblemHealth, 55 Water Street, in New York City, to review the schedule of allowances. In order to utilize these resources, you will need the current medical procedure code(s) (CPT code) for the service and the location where the service is going to be performed, which you can obtain from your doctor. These resources can help you make a decision about whether or not to use a provider who is not in GHI’s network.

If you would like more information regarding the use of providers outside of GHI’s network, including an example of the typical out-of-pocket costs for receiving care from out-of-network providers, please visit the GHI CBP Provider Network Page.