NYU Langone Health, Brooklyn, Long Island, NYU Langone Ortho, Rusk Institute of Rehabilitation Medicine and Anesthesia Contract Payor List - as of June, 2021 Medical Only grid - See the grid below for Behavioral Health services. Carrier Name Contracted Plans NYU Facilities

Aetna Health Inc. HMO/POS, PPO, EPO, Medicare, Indemnity & FIDA, Aetna Signature Administrators PPO. NYU Hospital are out of network with AETNA NAP PENN plan, Aetna Premier Care Network, Aetna NY All NYU Langone Facilities Age Well Medicare All NYU Langone Facilities Alpha Care Medicare, FIDA, MLTC All NYU Langone Facilities *American Medical & Life PPO Orthopedic only Amida Care All products Tisch, Orthopedic, RUSK and Brooklyn *Cambridge Network PPO Orthopedic only Canadian Medical Network Global Inc PPO Tisch, Orthopedic, RUSK and Brooklyn CenterLight Healthcare All products All NYU Langone Facilities Centers Plan for Healthy Living All products Tisch, Orthopedic, RUSK and Brooklyn Cigna HMO, POS, PPO, EPO, Indemnity, Open Access, Healthcare Partners. NYU Hospitals are out of network with Cigna State of Illinois All NYU Langone Facilities *Community Care Network PPO, Workers Compensation Orthopedic only Connecticare Commercial Products Only. NYU Hospitals are out of network with Exchange/Medicare/Medicaid Networks All NYU Langone Facilities *Consumer Health Network PPO Orthopedic only *Corvel Workers Compensation Orthopedic only Coventry Health Group PPO Long Island only *Devon PPO Orthopedic only Elderplan All products All NYU Langone Facilities HMO, Indemnity, EPO, PPO, NYS/NYC Employees, Medicare+Choice, Hotel Trades Council, Child Health Plus, Blue Priority, Medicare (Mediblue Extra & Mediblue Select). NYU Hospitals are out of Empire BC/BS network with the Connection Plan. All NYU Langone Facilities

Empire BC/BS Health Plus Child Health Plus, & Health Care Plus (Medicaid), Essential Plans, FIDA, Exchange (eff. 1/1/20) All NYU Langone Facilities Fidelis Medicaid Managed Care, Medicare Advantage, Child Health Plus, Exchange and Essential Plans, HARP, MLTC All NYU Langone Facilities First Health PPO & Workers’ Compensation All NYU Langone Facilities *Galaxy Health Network PPO Orthopedic only Flex Select, PPO Hospital Benefits, Medicare+Choice, HMO Comprehensive Benefits Plan (CBP), Emblem Health Dual Assurance Plan - Medicare Essential, ArchCare Commmunity Advantage Plan - GHI EmblemHealth VIP Prime, GuildNet Gold Plus - VIP Prime, Emblem Bridge Network, Medicare VIP Bold Network, Medicare VIP Reserve Network. NYU Hospitals are out of network with EmblemHealth Millennium All NYU Langone Facilities Network & GHI Network Access Health First All Products including Life Improvement Plan HMO SNP (excludes Health First Senior Health Partners plans) All NYU Langone Facilities Health Republic Health Care of New Jersey Tisch, Orthopedic, RUSK and Brooklyn Hebrew Hospital Home Choices Health Plan Medicare, FIDA Tisch, Orthopedic, RUSK and Brooklyn Child Health Plus, Medicaid, Medicare Advantage, Emblem Health Dual Assurance Plan - Medicare Essential, ArchCare Community Advantage Plan - VIP Prime, GuildNet Gold Plus - VIP Prime, Select Care, Emblemhealth Essential Plan (Essential Plans 1-4), Enhanced Care Plus (Health and Recovery Plan (HARP), Enhanced Care Prime Network, Emblem Health Gold, Emblem Health Platinum, HIP Emblem Health Silver, Emblem Health Bronze, Emblem Health Basic, Emblem Health Healthy New York, Emblem Health Silver Value, Emblem Health Bronze Value, Emblem Health Gold Access Open, All NYU Langone Facilities Emblem Health Bronze HSA, Vytra Health Plans – HMO, POS and PPO, Emblem Bridge Network

Humana PPO, Medicare All NYU Langone Facilities Independence Care System ALL products Tisch, Orthopedic, RUSK and Brooklyn International Health Insurance of Danmark PPO Tisch, Orthopedic, RUSK and Brooklyn Magna Care PPO NYU Hospitals are out of network with Local 272 All NYU Langone Facilities Maksin Group PPO - NYU Students Only Tisch, Orthopedic, RUSK and Brooklyn Med Save PPO Tisch, Orthopedic, RUSK and Brooklyn Medicaid straight All NYU Langone Facilities Medicare A & B All NYU Langone Facilities Metra Comp Workers’ Compensation All NYU Langone Facilities

Metro Plus Medicaid, Child Health Plus, Medicare, Exchange, Essential and FIDA (dual eligible), Metro Plus Gold, Metro Plus Gold Care 2, HARP. NYU Hospitals is out of network with Metroplus Gold Care 1. Tisch, Orthopedic, RUSK and Brooklyn Multi Plan/PHCS PPO All NYU Langone Facilities National Healthcare Solutions Inc. International Tisch, Orthopedic, RUSK and Brooklyn Olympic Airlines PPO Tisch, Orthopedic, RUSK and Brooklyn Freedom (HMO & PPO), Liberty, & Medicare (Secure Horizons), and Mosiac. NYU Langone Hospitals - Tisch, Orthopedic, RUSK and Brooklyn are out of network with the Metro and Garden State Oxford Health Plans All NYU Langone Facilities - Only Long Island accepts Metro & product. Garden State plans Partners Health Plan Medicare/Medicaid; Dual Eligible All NYU Langone Facilities Pomco PPO Tisch, Orthopedic, RUSK and Brooklyn River Spring Health Plan Medicare STAR (HMO I-SNP) and MAP (HMO D-SNP) duals plan Tisch, Orthopedic, RUSK and Brooklyn Senior Whole Health Medicare All NYU Langone Facilities Three Rivers Provider Network PPO, Workers Compensation All NYU Langone Facilities Tricare Military All NYU Langone Facilities HMO, POS-P, POS, EPO, PPO, Indemnity & NPP, Medicare, Medicare Dual Complete SNP, Medicare Regional PPO. NYU Langone Hospitals - Tisch, Orthopedic, RUSK and Brooklyn are non-par with United Healthcare All NYU Langone Facilities - Only Long Island accepts Core, Charter UHC Core, UHC Charter, UHC Compass & All UHC Community Products & Compass plans Unity Care PPO Tisch, Orthopedic, RUSK and Brooklyn Universal Health Care Medicare Tisch, Orthopedic, RUSK and Brooklyn US Family Health Plan All All NYU Langone Facilities VA Commuity Care Network- Optum All NYU facilities are contracted with Optum for the VA Community Care Network. All NYU Langone Facilities VillageCare FIDA, Medicare Advantage Plan (MA), Medicaid Advantage Plus Plan (MAP) Tisch, Orthopedic, RUSK and Brooklyn VNS Choice Medicare Advantage, FIDA, Medicare/Medicaid Advantage All NYU Langone Facilities World Trade Center/Health Smart All All NYU Langone Facilities 1199 National Benefit Fund All Product Plans All NYU Langone Facilities

Notes:

- Plans with an * indicate only NYU Langone Orthopedic participates with this managed care plan. - NYU Diagnostic Lab does not participate with Empire BCBS HMO plans including Child Health Plus and all BCBS Exchange plans; Health Republic of NJ - NYU Diagnostic Lab participates with Medicare Part B only. - Hotel Trades Council plan members are required to secure a referral from Hotel Trades Council for all services. - NYU does not participate with Affinity Health Care - termination date 09/01/2018. - NYU does not participate with Health First Senior Health Partners - NYU does not participate with Magna Care Create Health Plans - NYU does not participate with Quality Health Plan. This plan closed effecve February 29, 2020. - NYU does not participate with Wellcare - NYU does not participate with UHC Community Plan for all products - Par with Emblem Bridge Network via HIP & GHI eff. 9/1/19 - Empire BCBS exchange products moved to Empire Health Plus platform eff. 1/1/20 - NYU Hospital may or may not participate with other products offered by the managed care plan. Please contact the managed care plan. To confirm hospital’s participation in other products not listed above.

Behavioral Health plans Carrier Name Contracted Plans Behavioral Health Carve Out Plan

HMO/POS, PPO, EPO, Medicare, Indemnity & FIDA, Aetna Signature Administrators PPO. NYU Hospital are out of network with AETNA NAP PENN plan, Aetna Premier Care Network, Aetna NY Aetna Health Inc. Signature, Aetna Better Health Medicaid, Aetna Savings Plus & New York Community Plan Call plan to confirm if there is a carve out plan based on member's benefit Age Well Medicare Not applicable, managed by medical plan Alpha Care Medicare, FIDA, MLTC Not applicable, managed by medical plan Amida Care All products Beacon Health Strategies Canadian Medical Network Global Inc PPO Not applicable, managed by medical plan CenterLight Healthcare All products Not applicable, managed by medical plan Centers Plan for Healthy Living All products Beacon Health Strategies Call plan to confirm if there is a carve out plan based on Cigna HMO, POS, PPO, EPO, Indemnity, Open Access, Healthcare Partners. NYU Hospitals are out of network with Cigna State of Illinois member's benefit. Cigna NALC goes to Optum. Cigna also uses Cigna Behavioral Health in some instances. Connecticare Commercial Products Only. NYU Hospitals are out of network with Exchange/Medicare/Medicaid Networks Optum Behavioral Health Not applicable, managed by medical plan. Elderplan FIDA Elderplan All products goes to Beacon Health Strategies HMO, Indemnity, EPO, PPO, NYS/NYC Employees, Medicare+Choice, Hotel Trades Council, Child Health Plus, Blue Priority, Medicare (Mediblue Extra & Mediblue Select). NYU Hospitals are out of Empire BC/BS Not applicable, managed by medical plan, exception is network with the Connection Plan. NYSHIP and BCBS Composite which go to Beacon Empire BC/BS Health Plus Child Health Plus, & Health Care Plus (Medicaid), Essential Plans, FIDA, Exchange (eff. 1/1/20) Not applicable, managed by medical plan Fidelis Medicaid Managed Care, Medicare Advantage, Child Health Plus, Exchange and Essential Plans, HARP, MLTC Not applicable, managed by medical plan First Health PPO & Workers’ Compensation Not applicable, managed by medical plan Flex Select, PPO Hospital Benefits, Medicare+Choice, HMO Comprehensive Benefits Plan (CBP), Emblem Health Dual Assurance Plan - Medicare Essential, ArchCare Commmunity Advantage Plan - GHI EmblemHealth VIP Prime, GuildNet Gold Plus - VIP Prime, Emblem Bridge Network, Medicare VIP Bold Network, Medicare VIP Reserve Network. NYU Hospitals are out of network with EmblemHealth Millennium Network & GHI Network Access Beaon Health Options Health First All Products including Life Improvement Plan HMO SNP (excludes Health First Senior Health Partners plans) Not applicable, managed by medical plan Child Health Plus, Medicaid, Medicare Advantage, Emblem Health Dual Assurance Plan - Medicare Essential, ArchCare Community Advantage Plan - VIP Prime, GuildNet Gold Plus - VIP Prime, Select Care, Emblemhealth Essential Plan (Essential Plans 1-4), Enhanced Care Plus (Health and Recovery Plan (HARP), Enhanced Care Prime Network, Emblem Health Gold, Emblem Health Platinum, HIP Emblem Health Silver, Emblem Health Bronze, Emblem Health Basic, Emblem Health Healthy New York, Emblem Health Silver Value, Emblem Health Bronze Value, Emblem Health Gold Access Open, Emblem Health Bronze HSA, Vytra Health Plans – HMO, POS and PPO, Emblem Bridge Network Beaon Health Options Humana PPO, Medicare Not applicable, managed by medical plan Independence Care System ALL products Not applicable, managed by medical plan International Health Insurance of Danmark PPO Not applicable, managed by medical plan Magna Care PPO NYU Hospitals are out of network with Local 272 Not applicable, managed by medical plan Metro Plus Medicaid, Child Health Plus, Medicare, Exchange, Essential and FIDA (dual eligible), Metro Plus Gold, Metro Plus Gold Care 2, HARP. NYU Hospitals is out of network with Metroplus Gold Care 1. Beacon Health Strategies Multi Plan/PHCS PPO Not applicable, managed by medical plan National Healthcare Solutions Inc. International Not applicable, managed by medical plan Freedom (HMO & PPO), Liberty, & Medicare (Secure Horizons), and Mosiac. NYU Langone Hospitals - Tisch, Orthopedic, RUSK and Brooklyn are out of network with the Metro and Garden State Oxford Health Plans product. Optum Behavioral Health Partners Health Plan Medicare/Medicaid; Dual Eligible Not applicable, managed by medical plan River Spring Health Plan Medicare STAR (HMO I-SNP) and MAP (HMO D-SNP) duals plan Not applicable, managed by medical plan Senior Whole Health Medicare Beacon Health Strategies Tricare Military Managed Health Network United Healthcare HMO, POS-P, POS, EPO, PPO, Indemnity & NPP, Medicare, Medicare Dual Complete SNP, Medicare Regional PPO. NYU Langone Hospitals - Tisch, Orthopedic, RUSK and Brooklyn are non-par with Optum Behavioral Health US Family Health Plan All Magellan VA Commuity Care Network- Optum All NYU facilities are contracted with Optum for the VA Community Care Network. Not applicable, managed by medical plan VillageCare FIDA, Medicare Advantage Plan (MA), Medicaid Advantage Plus Plan (MAP) Not applicable, managed by medical plan VNS Choice Medicare Advantage, FIDA, Medicare/Medicaid Advantage Beacon Health Strategies World Trade Center/Health Smart All Not applicable, managed by medical plan 1199 National Benefit Fund All Product Plans Not applicable, managed by medical plan

Behavioral Health plans Beacon Health Strategies (Affinity, Amidacare, Centers Plan for a Healthy Living, Metroplus and Senior Whole Health) only NYU Langone Hospital Brooklyn is participating Beacon Health Options (Emblem Essential, Emblem Exchange, GHI Medicare, GHI HMO, PPO, CBP - BCBS GHI Composite plan, HIP Commercial, HIP Medicare, HIP Medicaid, VNS, MVP and NYSHIP -The Empire Plan) only NYU Langone Hospital Brooklyn is participating Cigna Behavioral Health (CBH)- NYU Langone Hospital Brooklyn is participating and NYU Tisch/Orthopedic hospitals are participating with CBH NYU students only. Optum (United/Oxford Commercial plans and United Community plans) NYU Langone Hospital Brooklyn is participating with UHC/Oxford Commercial plans & Tisch and Orthopedic are participating with Oxford Commercial and UHC for the NYU Langone Hospitals and School of Medicine Employee plan. All NYU Facilities are not participating with the United Community plans. Managed Health Network (Tricare) only NYU Langone Hospital Brooklyn is participating Magellan Health (US Family Health) only NYU Langone Hospital Brooklyn is participating These contracted medical plans manage behavioral health services in house and do not use a carve out behavioral health plan - Agewell, Aphacare, Centerlight, Elderplan, Empire BCBS, Fidelis, HealthFirst, Humana, Magnacare, Multiplan, Partners Health Plan, VillageCare and Local 1199 - This applies to all NYU Langone Hospitals. The only exception is that Long Island is not contracted with Village Care Max. Please call Aetna and Cigna to determine if they use a carve out plan for behavioral health services