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Employee Non-Med Retiree Retiree Summary of Plans

NYC Health Benefits Program

Important Notice

The Health Benefits Retiree client service walk-in center is closed.

Due to the closure of the office, retirees who mailed or faxed forms or correspondance March 11, 2020 or after, we cannot access or process that form. Please resubmit your documents as follows:

1) Inquries and questions can be emailed to healthbenefits@olr.nyc.gov

2) Forms/documents can be sent via email to NYCRetireesHBP@emblemhealth.com

Please do NOT include your Social Security number, include your Employee ID or pension number only.

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 (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.

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.

Form 1095-C for Calendar Year 2019

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 2019 will be available for employees in February 2020. Please check Employee Self-Service (ESS), if applicable, in February 2020 in order to obtain the Form 1095-C, or contact your payroll department.

Learn more about Form 1095-C

HEALTH PLAN COVERAGE FOR EMPLOYEES HIRED ON OR AFTER JULY 1, 2019

City of New York employees, and employees of Participating Employers, hired on or after July 1, 2019, and their eligible dependents, will only be eligible to enroll in the EmblemHealth HIP HMO Preferred Plan, and must remain in the HIP HMO Preferred Plan for the first year (365 days) of employment.

After 365 days of employment, the employee will have the option of either remaining in the HIP HMO Preferred Plan or selecting a different health plan within 30 days before the end of the 365 day period. If a new health plan is selected, the new plan will be effective on the 366th day.

Only after the 365th day can the employee participate in any Annual Fall Transfer Period.

An employee who needs to request an exemption from the required enrollment in the HIP HMO Preferred Plan can do so by submitting an Opt-Out Request Form to EmblemHealth. An employee, or eligible dependent, must meet certain criteria and the request must be approved by EmblemHealth before the exemption is granted. The Opt-Out Request Form is available on the EmblemHealth website.

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


		Important Changes to the HIP HMO Plan Effective January 1, 2019. Learn More

		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*

*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.

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

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 EPO Plan with Prescription Drugs
Empire BlueCross BlueShield EPO Plan without Prescription Dugs
Empire BlueCross BlueShield HMO with Prescription Drugs
Empire BlueCross BlueShield HMO without Prescription Drugs
Empire BlueCross BlueShield PPO with Prescription Drugs (Hawaii and Alaska Only)
Empire BlueCross BlueShield PPO without Prescription Drugs (Hawaii and Alaska Only)
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