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NYC Health Benefits Program
New information and Updates regarding the NYC Medicare Advantage Plus Plan
These updates include the start date for the new plan, the timeline to opt in or out, and a new summary of key information about the plan itself.
- For information on Covid-19, including how and where to get tested or vaccinated, visit https://www1.nyc.gov/site/coronavirus/index.page
- To learn more about COVID-19 or to make an appointment to get vaccinated, visit AdvantageCare Physicians (ACPNY) or call 646-680-4227.
Important Notice
The Health Benefits Retiree client service walk-in center remains closed to visitors.
Please submit inquiries and documents as follows:
1) Forms and documents can be submitted electronically through LeapFILE.
- Before you begin, you may wish to view instructions and a short video on how to submit your forms/documents.
- When you are ready, use the following link to submit your forms and documents: https://nycemployeebenefits.leapfile.net
- Please do NOT submit your form/document more than once. This will only delay processing.
- You will immediately receive notification stating "Success! Your file has been received" upon completion of your document upload. You will not receive a separate email confirmation.
- Please allow 30-45 days from the day you submit your document(s) for them to be processed. Coverage will be retroactive to the effective date of retirement.
- Also, please do not send forms or documents via express mail.
2) Inquiries and questions can be emailed to: healthbenefits@olr.nyc.gov - do not send forms through email (see #1 above)
3) For questions regarding the PICA prescription drug benefit program please call 1-800-467-2006.
4) If you are a HIP-HMO member turning 65 or on Medicare due to a disability, please contact HIP at 1-800-447-9169 to enroll over the phone. Please identify yourself as a City of New York retiree or dependent of a retiree. For all other members enrolled in a HMO plan, please contact your health plan at the customer service numbers on the back of your ID card.
Please note that active employees can contact NYCAPS Central by:
1) Phone - (212)487-0500
2) Email - nycapscentral@dcas.nyc.gov Or HealthBenefits@dcas.nyc.gov
Please check our website periodically for updates.
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Introduction
Through collective bargaining agreements, the City of New York and the Municipal Unions have cooperated in choosing health plans and designing the benefits for the City’s Health Benefits Program.
Coverage for Employees 65+
If you're over 65, still working for the City and enrolled in the NYC Health Benefits Program, do not use your Medicare card when you visit your doctor's office. Instead, be sure to use the member ID card provided to you by your current HBP health plan.
These benefits are intended to provide you and your eligible dependents with the fullest possible protection that can be purchased with the available funding.
The OLR website and the NYC Health Benefits Program Summary Program Description (SPD) provide you with information about your benefits under the New York City Health Benefits Program.
Health Plan Websites
Use the links below to visit your health plan where you will be able to find an in-network doctor, urgent care center, lab or pharmacy.
| Learn more about MetroPlus Gold for City Employees. Now available in all 5 boroughs! Play the video |
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NOTE: Hospitalization coverage for GHI CBP is underwritten and administered by Empire BlueCross BlueShield (EBCBS). View the EBCBS Directory of participating NY, NJ, CT hospitals* |
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*Provider information contained in the Empire BlueCross BlueShield Directory is updated on a regular basis and may have changed. Therefore, please check with your provider before scheduling your appointment or receiving services to confirm participation. |
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24/7 Telemedicine Program with Teladoc
(For Those Covered Under the EmblemHealth GHI-CBP, GHI HMO, HIP HMO, HIP POS, and VYTRA plans)
With Teladoc, you can talk with a doctor within minutes rather than days or hours. Teladoc doctors can diagnose, treat and prescribe medication (when medically necessary) for non-emergency medications. This includes treatments for the flu, sore throat, allergies, stomach aches, eye infections, bronchitis, and much more. Copays are waived during the COVID outbreak. To set up your account now so you can talk with one of Teladoc’s board-certified doctors anytime when you don't feel well, call 1-800-Teladoc (1-800-835-2362) or visit Teladoc.com/emblemhealth
View the Teladoc Registration Guide for instructions on setting up your account on Teladoc’s website or mobile app.
List of Health Plans
Listed are the non-Medicare Health Plans offered by the New York City Health Benefits Program to its employees and non-Medicare retirees. View the List of Health Plans
Aetna EPO Basic Plan
Aetna EPO Basic Plan with Prescription Drugs
Cigna HMO Basic Plan
Cigna HMO Basic Plan with Prescription Drugs
DC 37 Med-Team
Empire BlueCross BlueShield Gated EPO Plan with Prescription Drugs
Empire BlueCross BlueShield Gated EPO Plan without Prescription Drugs
Empire BlueCross BlueShield Hospital Plan Only (Companion to GHI CBP Medical Coverage)
GHI CBP Basic Plan
GHI CBP Basic Plan with Enhanced Schedule and Prescription Drugs (Optional Rider)
GHI HMO Basic Plan
GHI HMO Basic Plan with Prescription Drugs
HIP HMO Basic Plan
HIP HMO Basic Plan with DME and PDN
HIP HMO Basic Plan with Prescription Drugs
HIP POS Basic Plan
HIP POS Basic Plan with Prescription Drugs
MetroPlus Gold
Vytra Basic Plan
Vytra Basic Plan with Prescription Drugs
View the Summary of Benefits and Coverage (SBC) for each Plan.
Form 1095-C for Calendar Year 2020
Form 1095-C is a tax form under the Affordable Care Act ("ACA") which contains information about your health care insurance coverage. Form 1095-C is distributed to all full-time employees working an average of 30 hours or more per week, for all or part of the calendar year. For information about Form 1095-B, please contact your health care provider directly. The 1095-B will include all dependent information.
Please note that the 1095-C for the calendar year 2020 will be available for employees in February 2021. Please check Employee Self-Service (ESS), if applicable, in February 2021 in order to obtain the Form 1095-C, or contact your payroll department.