Funding Options

EmblemHealth offers a full complement of funding arrangements including: Community Rating for groups with fewer than 51 eligible enrollees, Experience Rating for groups with 51 or more eligible enrollees, and Deferred Premium Arrangements for eligible groups with Retrospective Experience Rating that have more than 500 eligible enrollees.

We now offer a funding arrangement called Premium Rewards that enables groups with 100 or more employees enrolled in an EmblemHealth EPO or PPO plan to earn back a percentage of their premium dollars if their actual claim costs are lower than expected.

Administrative Services Only (ASO)

EmblemHealth offers groups of 250 or more members ASO arrangements for hospital, medical, dental and pharmacy benefits, enhancing cash flow by allowing the group to reimburse EmblemHealth solely on the basis of paid claims plus administrative fees.

Groups may choose to participate in case management services from EmblemHealth, taking advantage of our medical management and member assistance through all aspects of these types of complex cases. Groups may also supplement their benefit program with EmblemHealth's disease management programs, through which we identify claims for conditions ranging from cardiac health to diabetes to asthma, and work with members and their physicians to improve adherence to treatment plans, resulting in improved medical treatment and lower claims experience.