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 list 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
40 Rector Street, 3rd Floor
New York, NY 10006
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
Empire EPO EPO  (800) 767-8672
Empire HMO HMO (800) 767-8672

GHI-CBP/Empire BlueCross BlueShield

GHI Emblem Health
Empire BlueCross BlueShield

PPO

 

(800) 624-2414
(800) 433-9592

GHI HMO HMO  (877) 244-4466
HIP Preferred HMO HMO (800) 447-6929
HIP Prime POS PPO (800) 447-6929
MetroPlus Gold HMO  (800) 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
Empire Medicare-Related Coverage Supplemental (800) 767-8672

GHI-CBP/EBCBS Senior Care

GHI Health Incorporated
Empire BlueCross BlueShield

Supplemental

 

(800) 624-2414
(800) 767-8672

 

 

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) 445-8742
Elderplan HMO (718) 921-7898
Empire MediBlue HMO (800) 767-8672
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) 445-8742
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 HealthSpring (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.