New York City

1 New york city summary Program Description (SPD). Health Benefits Program The city of New york Office of Labor Relations Employee Benefits Program Health Benefits Program TABLE OF CONTENTS. Table of Contents .. 1. The city of New york 's Health Benefits Program .. 4. Introduction .. 4. Choosing a Health plan .. 4. Section I What Employees Need to Know .. 5. Enrollment .. 6. Waiver of Health Benefits .. 7. Pre-Tax Benefits Program .. 7. Effective Dates of Coverage .. 8. For Employees .. 8. For Eligible Dependents .. 8. Health plan Premiums .. 8. Optional Riders .. 8. Changes in Enrollment Status.

2 9. Changes in Family Status - Adding or Dropping Dependents .. 9. Health Benefit Changes .. 9. Leave of Absence Coverage .. 9. Family and Medical Leave Act (FMLA) .. 9. Special Leave of Absence Coverage (SLOAC) .. 9. Transfer from One city Agency to Another .. 10. Change of Union or Welfare Fund Membership .. 10. Termination and 10. Options Available When city Coverage 11. Special Continuation of Coverage Under NYS Chapter Law 436 .. 11. Special Provisions for Medicare-Eligible Employees .. 11. Section II What Retirees Need to Know .. 13. Enrollment .. 14. Effective Dates of Coverage.

3 16. For Retirees .. 16. For Eligible Dependents .. 16. Health plan Premiums .. 16. Changes in Enrollment Status .. 17. Changes in Family Status - Adding or Dropping Dependents .. 17. 1|P a g e Health Benefit Changes .. 17. Termination and 17. Options Available When city Coverage Terminates .. 18. Special Continuation of Coverage under NYS Chapter Law 436 .. 18. city Coverage for Medicare-Eligible Retirees .. 18. Medicare Enrollment .. 19. Medicare and Retiring Employees .. 19. Medicare Part B Reimbursement .. 19. Section III - COBRA .. 20. COBRA Eligibility .. 20. COBRA Periods of Continuation for Dependents.

4 20. COBRA Notification Responsibilities .. 21. Election of COBRA Continuation .. 21. COBRA Transfer Opportunities .. 21. SECTION IV Disability Benefits .. 22. SECTION V - Coordination of Benefits (COB) .. 22. Section VI - Transgender Inclusive Health Benefits Coverage .. 22. What's Covered, Other Services? (Affirmatively covering transgender-related services, as with other services.) .. 22. SECTION VII summary of Health Plans .. 24. Glossary of Important Terms .. 25. Health Plans & PICA Program for Employees and non-Medicare Retirees .. 27. Aetna EPO .. 28. Cigna.

5 30. DC 37 Med-Team .. 32. Empire EPO .. 35. Empire HMO .. 38. GHI-Comprehensive Benefits plan /Empire BlueCross BlueShield Hospital plan (GHI-CBP) .. 40. GHI 45. HIP HMO .. 47. HIP Prime POS .. 50. MetroPlus Gold .. 53. Vytra Health Plans .. 55. PICA Program .. 58. Health Plans for Medicare-Eligible Retirees and Their Medicare-Eligible Dependents .. 61. Important Information about Health plan Enrollment and Disenrollment .. 61. Medicare Supplemental 62. Medicare HMOs & Medicare Advantage Plans .. 62. Medicare Coordination of Benefit Plans .. 62. 2|P a g e DC 37 Med-Team Senior Care.

6 63. Empire Medicare-Related Coverage .. 64. GHI/EBCBS Senior Care .. 65. Aetna Medicare Advantage plan (PPO) and Aetna Medicare Advantage plan with an Extended Service Area (ESA) .. 66. Elderplan .. 68. Empire MediBlue HMO .. 69. VIP Premier (HMO) Medicare (formerly HIP VIP Medicare) .. 71. United HealthCare Group Medicare Advantage plan .. 72. AvMed Medicare Choice HMO .. 73. BlueCross BlueShield of Florida Health Options - Medicare & More (Florida Residents) .. 74. Cigna-Healthspring (Arizona Only) .. 75. Humana Gold Plus .. 76. GHI HMO Medicare Senior Supplement.

7 77. SECTION VIII The city of New york 's Employee Assistance Programs .. 78. SECTION IX The Employee Blood Program .. 79. Current as of January 2018. 3|P a g e THE city OF NEW york 'S HEALTH BENEFITS PROGRAM. 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. These benefits are intended to provide you with the fullest possible protection that can be purchased with the available funding. This summary Program Description (SPD) provides you with information about your benefits under the New york city Health Benefits Program.

8 CHOOSING A HEALTH plan . Contact the health plans in which you are interested for benefits packages and provider directories. Telephone numbers, addresses and web sites are listed at the beginning of each plan description. To select a health plan that best meets your needs, you should consider at least four factors: Coverage - The services covered by the plans differ. For example, some provide preventive services while others do not cover them at all; some plans cover routine podiatric (foot) care, while others do not. Choice of Doctor - Some plans provide partial reimbursement when non-participating providers are used.

9 Other plans only pay for, or allow the use of, participating providers. Convenience of Access - Certain plans may have participating providers or centers that are more convenient to your home or workplace. You should consider the location of physicians' offices and hospital affiliations. Cost - There is no cost for basic coverage under some of the health plans offered through the city Health Benefits Program, but others require a payroll deduction. Additional benefits ( , prescription drug coverage) may be available through an Optional Rider. These costs are compared on the rates charts which are available on the Health Benefits Program Web site at Some plans require copayments for certain services.

10 Some plans require you to pay a yearly deductible and coinsurance before the plans will reimburse you for the use of non-participating providers. If a plan does not cover certain types of services that you expect to use, you must also consider the out-of-pocket cost of these services. The plan you have chosen will send you information regarding your health benefits coverage when you enroll. NOTE - DOUBLE city COVERAGE PROHIBITED. If a person is eligible for the city program as both an employee/retiree or a dependent, the person must choose one status or the other. No person can be covered by two city health contracts at the same time.