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NYC Health Benefits Program

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The NYC Medicare Advantage Plus Plan, a Custom Program for City Retirees. Pending court approval, it is anticipated that the plan will begin on January 1, 2022.

The opt-out period has been extended until further notice.

 

The City and the Municipal Labor Committee selected an alliance between Empire BlueCross BlueShield and Emblem Health to provide the NYC Medicare Advantage Plus Plan to retirees and their eligible dependents. The NYC Medicare Advantage Plus Plan is a Medicare Advantage plan which is an alternative to the traditional Medicare program. It will replace the current Senior Care program, which is a supplement to traditional Medicare, as the program that is free to all retirees. Retirees will automatically be enrolled in the new NYC Medicare Advantage Plus Plan. Pending court approval, it is anticipated that the plan will begin on January 1, 2022. . Retirees can only opt out of the NYC Medicare Advantage Plus Plan in order to remain in their current retiree health plan. The opt-out period for the NYC Medicare Advantage Plus Plan is extended until further notice.

For additional information, you can call the special Alliance call center at 1-833-325-1190, Monday to Friday, 8 a.m. to 9 p.m.


Notice of Special Contract Public Hearing and Draft Contract for the Provision of Health Benefits Services in the form of Medicare Advantage Plan  Learn More

 


Enrollment Guides:

Medical Benefits and Rate Charts:

Plan Design Comparison Charts:

Evidence of Coverage

The Evidence of Coverage defines those Covered Services and benefits available to Members enrolled in the NYC Medicare Advantage Plus Plan. The Evidence of Coverage also defines the rights and responsibilities of the Members enrolled in the NYC Medicare Advantage Plus Plan.


Additional Information and Resources:


Retiree Responsibilities and Assistance

 

IRMAA or Medicare Part B Reimbursements  Learn More

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Medicare Part B 2020 Reimbursement

Medicare Part B 2020 reimbursements were issued in April 2021. Please check your bank account/statement (or the mail, if you are receiving a physical check) for your payment.

  • If you already submitted your Medicare Part A & B card to the Health Benefits Program, this payment is automatic and you will receive it annually.

Medicare Part B 2019 Differential Reimbursement 

Medicare Part B 2019 differential reimbursements were issued in March 2021. Please check your bank account/statement (or the mail, if you are receiving a physical check) for your payment.

  • For those retirees/eligible dependents who are not eligible for IRMAA, Medicare Part B 2019 differential payments up to $318 will be issued once the Medicare Part B and IRMAA payments are processed in calendar year 2020. 
  • Those retirees/eligible dependents who are eligible for 2019 Medicare Part B differential reimbursements must submit the Medicare Part B 2019 Reimbursement Differential Request Form, along with required documentation.
  • Please submit this form, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net


IRMAA 2020 Reimbursement 

IRMAA 2020 reimbursements will be issued in October 2021. 

  • If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement will be deposited directly into your bank account.  This is separate from your pension payment.  If you don’t have EFT or direct deposit, you should receive a check in the mail. 
  • Please submit the IRMAA 2020 Reimbursement Application, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net

 

IRMAA 2019 Reimbursement 

IRMAA 2019 reimbursements were issued during October and November 2020.  Please check your bank account/statement (or the mail, if you are receiving a physical check) for your payment.

  • If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement was deposited directly into your bank account.  This is separate from your pension payment.  If you don’t have EFT or direct deposit, you should have received a check in the mail. 
  • If you did not receive your IRMAA reimbursement by December 1, 2020 or if you did receive the reimbursement and you believe the amount is incorrect, you must resubmit the IRMAA 2019 Reimbursement Application. 
  • Please submit this application, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net

IRMAA 2019 Differential Reimbursement 

IRMAA 2019 Differential payments were issued at the end of November 2020.

  • For those retirees/eligible dependents of a retiree with a Medicare Part B effective date prior to 2016, they received an additional amount up to $318. 

The Medicare Part B Reimbursement Program video provides information about the different types of Medicare Part B reimbursements that the City provides, as well as information to help you to see whether you qualify to receive these payments, and how to apply.    

Play the video


Please note that if you were Medicare-eligible prior to 2016, you must complete the Medicare Part B Differential Form for 2019 in order to receive the Medicare Part B differential payment.  The payment is based on the amount that you paid in 2019.

If you are applying for IRMAA, you will be receiving the differential payment once IRMAA 2019 payments are processed in October 2020.

If you were enrolled in Medicare Part B effective after 2016, then you are already receiving the full payment and do not need to complete the Medicare Part B Differential Form.

Learn more

Your Responsibilities

It is important that you know how your health plan works and what is required of you.  Read More

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Here are some important things that you need to remember:

 

  • Complete an enrollment form to add new dependents (newborn, adoption, marriage) within 30 days after the event;
  • Notify the NYC Health Benefits Program and your health plan in writing when your address changes;
  • Review your pension check to ensure appropriate premiums are deducted;
  • Know your rights and responsibilities under COBRA continuation coverage.

If You Need Assistance

Who you should contact for assistance and when you should contact them. Read More

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Retirees with questions about benefits, services, or claims should write or call their health plan.

When writing to the plan, give your certificate number, name and address.

The Health Benefits Program is also available to provide service and information to City retirees who have questions about or problems with their health benefits or pension check deductions.

Retirees contacting the Health Benefits Program should always include the following information (please print clearly):


Name, Address and Telephone Number
Complete Social Security Number
Pension Number 

 

Inquiries and questions can be emailed to healthbenefits@olr.nyc.gov

Who Do I Contact After Retirement?

Find out who you should contact after retirement. Read More

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Retirees can contact the Health Benefits Program:

  • For questions concerning eligibility and enrollment
  • For questions regarding deductions for health benefits taken from your pension check
  • For Transfer Period information
  • To obtain applications to make changes to your coverage such as adding/dropping dependents, adding/dropping the optional rider, waiving health coverage and to change plans (excluding Medicare HMOs, which require a special application from the health plan).
  • For notification of enrollment in Medicare
  • For questions regarding Medicare Part B premium reimbursements
  • To obtain information and an application for COBRA benefits
  • To change your address
  • If health coverage has been terminated for you and/or your dependents 

When Should I Contact My Health Plan?

Find out when you should contact your Health Plan.Read More

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(Refer to your health plan identification card or plan booklet for telephone numbers.)

 

  • If you have questions regarding covered services
  • To obtain written information about covered services
  • For information about the status of pending claims or claim disputes
  • For claim allowances (How much will a plan pay towards a claim?)
  • For health plan service areas

 

When writing to a health plan, include your name and address, certificate number, date(s) of service, and claim number(s), if applicable. Some plans also allow inquiries through their web sites.

When Should I Contact My Union/Welfare Fund?

Find out when you should contact your Union/Welfare Fund.Read More

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For information about:

  • Prescription drug coverage (if applicable)
  • Vision benefits
  • Dental benefits
  • Life Insurance (if applicable)

 
The Health Benefits Program is also available to provide service and information to City retirees who have questions about or problems with their health benefits or pension check deductions.

Retirees contacting the Health Benefits Program should always include the following information (please print clearly):

 

Name, Address and Telephone Number
Complete Social Security Number
Pension Number

 

 

Inquiries and questions can be emailed to healthbenefits@olr.nyc.gov 

Visit the Contact Us page

Health Plan Rate Chart for Retirees