A federal health reform law (PPACA) provision exempting those already involved in a regulated activity from new regulations. With respect to health reform, the term "grandfathering" refers to those situations when certain provisions of the law may not apply to plans that were in effect on or before March 23, 2010, as long as those plans have not made changes that would cause them to lose their grandfathered status.
A drug which is the pharmaceutical equivalent to one or more brand name drugs. Such generic drugs have been approved by the Food and Drug Administration as meeting the same standards of safety, purity, strength and effectiveness as the brand name drug.
A request to change an adverse determination that was based on administrative policies, procedures or guidelines.
The Group Contract is the Agreement EmblemHealth has with your group to provide health insurance.
This number identifies the subscriber's employer or Union Benefits Fund.
A complaint process whereby you, or your duly authorized representative, may seek review of benefit determinations or other determinations made by EmblemHealth relating to your health plan.