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NYC Health Benefits Program
Summary of Plans
A "non-grandfathered health plan" must comply with certain consumer protections under the Affordable Care Act (ACA) and cover certain in-network preventive services with $0 co-payments to the enrolled participants, such as those listed below:
– Routine physicals
– Immunizations
– Colonoscopies
– Mammograms
– Birth control prescriptions and other preventive prescriptions
For a complete list of preventive services and medications, please contact the applicable health plan.
Effective July 1, 2017, the HIP Preferred HMO plan offered to City employees through the City of New York Health Benefits Program is a “non-grandfathered health plan” under the Affordable Care Act.
Effective July 1, 2016, the GHI-Comprehensive Benefits Program/Empire BlueCross BlueShield Plan (GHI-CBP) offered to City employees through the City of New York Health Benefits Program is a “non-grandfathered health plan” under the Affordable Care Act.
Effective July 1, 2016, the DC 37 Med-Team offered to DC 37 City employees through the City of New York Health Benefits Program is a “non-grandfathered health plan” under the Affordable Care Act.
Effective January 1, 2016, the MetroPlus Gold plan offered to City employees through the City of New York Health Benefits Program is a “non-grandfathered health plan” under the Affordable Care Act.
The City of New York believes that all of the other health plans currently, as of July 2017, offered as health benefits coverage to City employees through the City of New York Health Benefits Program are “grandfathered health plans” under the Patient Protection and Affordable Care Act (the Affordable Care Act).
As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your health plan coverage may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed, in writing only, to:
City of New York Health Benefits Program
22 Cortlandt Street, 12th Floor
New York, NY 10007
Attention: Grandfathered Plan Status
Health Plans for Employees and non-Medicare Retirees
Click on a Health Plan name in order to see a summary of that Plan (PDF).
| Health Plan | Plan Type | Phone Number | |
| Aetna EPO | EPO | (800) 445-8742 | |
| CIGNA HealthCare | HMO | (800) 244-6224 | |
| DC 37 Med-Team (DC 37 members only) | PPO | (800) 624-2414 | |
| Anthem EPO | EPO | (800) 767-8672 | |
| Anthem Blue Access Gated EPO | EPO | (833) 924-1055 | |
|
GHI-CBP/Anthem Blue Cross and Blue Shield GHI Emblem Health |
PPO |
(800) 624-2414 |
|
| GHI HMO | HMO | (877) 244-4466 | |
| HIP HMO | HMO | (833) 269-4653 | |
| HIP Prime POS | PPO | (800) 447-6929 | |
| MetroPlus Gold | HMO | (877) 475-3795 |
|
| Vytra Health Plans (underwritten by HIP Health Plan) | HMO | (800) 448-2527 | |
Health Plans for Retirees
Click on a Health Plan name in order to see a summary of that Plan (PDF).
Medicare Supplemental Plans
The traditional Medicare supplemental plan allows for the use of any provider and reimburses the enrollee who may be subject to Medicare or plan deductibles and coinsurance.
The following are supplemental plans:
| Supplemental Health Plan | Plan Type | Phone Number | |
| DC 37 Med-Team Senior Care (DC 37 members only) | Supplemental | (800) 624-2414 | |
| Anthem Medicare-Related Coverage | Supplemental | (800) 767-8672 | |
|
GHI Health Incorporated |
Supplemental |
(800) 624-2414 |
|
Medicare HMOs
Medicare HMO plans are those in which medical and hospital care is only provided by the HMO. Any services, other than emergency services, that are received outside the HMO, that have not been authorized by the HMO, will not be covered by either the HMO or Medicare. Any cost incurred would be the responsibility of the enrollee.
The following plans are approved Medicare HMOs and Medicare Advantage Plans:
|
Health Plans Available in NY Metro Area |
Plan Type | Phone Number | |
| Aetna Medicare Plan (PPO) with an Extended Service Area (ESA) | Advantage Plan | (800) 307-4830 | |
| Elderplan | HMO | (718) 921-7898 | |
| Anthem Medicare Preferred PPO | Advantage Plan | (833) 924-1055 | |
| HIP VIP Premier Medicare Plan | HMO | (800) 447-6929 | |
| United HealthCare Group Medicare Advantage Plan | HMO | (800) 203-5631 | |
|
Health Plans Available Outside of NY Metro Area |
Plan Type | Phone Number | |
| Aetna Medicare Plan (PPO) with an Extended Service Area (ESA) | Advantage Plan | (800) 307-4830 | |
| AvMed Medicare Plan (FL Only) | HMO | (800) 782-8633 | |
|
BlueCross BlueShield of Florida Health Options, Inc. (CLOSED TO NEW ENROLLMENTS) |
HMO |
(800) 876-2227 |
|
| Cigna Medicare (Arizona Only) | HMO | (800) 592-9231 | |
| Humana Gold Plus (Florida Only) | HMO | (800) 833-1289 | |
Medicare Coordination of Benefit Plans
| Health Plan | Plan Type | Phone Number |
| GHI HMO Medicare Senior Supplement | HMO | (877) 244-4466 |
IMPORTANT: Retirees wishing to enroll in a Medicare HMO must complete a special application directly with the health plan he or she elects to join. To enroll the retiree must complete the specific health plan application (each enrollee must complete a separate application) and return it to the health plan. A copy of the application is sent to the Health Benefits Program (HBP) from the health plan in order for HBP to update its files and to make sure that the correct deductions, if applicable, are taken from the retiree’s pension check.