health-retiree-choosing-a-health-plan

Office of Labor Relations


EmployeeNon-Med RetireeRetireePlans & Rates

Health Benefits Videos
Forms and Downloads
Responsibilities & Health Benefits Assistance
Choosing a Health Plan
Enrollment
Changes in Status
Effective Dates of Coverage
Health Plan Premiums
Medicare Part B & IRMAA
Coverage for Medicare-Eligible Retirees
Termination and Reinstatement
COBRA
Special Continuation of Coverage
Disability Benefits
Contact the Health Benefits Program

Health Benefits Videos

Forms and Downloads

Responsibilities & Health Benefits Assistance

Choosing a Health Plan

Enrollment

Changes in Status

Effective Dates of Coverage

Health Plan Premiums

Medicare Part B & IRMAA

Coverage for Medicare-Eligible Retirees

Termination and Reinstatement

COBRA

Special Continuation of Coverage

Disability Benefits

Contact the Health Benefits Program


NYC Health Benefits Program

Choosing a Health Plan

Contact all the plans in which you are interested for benefits packages and provider directories. 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. 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 or pension deduction. Additional benefits (e.g., prescription drug coverage) may be available through an Optional Rider. These costs are compared on charts available on this website. Some plans require copayments for certain services. 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.

Optional Rider - All health plans, except DC 37 Med-Team, have an Optional Rider consisting of benefits that are not part of the basic plan.

Creditable coverage is a health insurance or health benefit plan that meets a minimum set of qualifications as set forth by the Centers for Medicare & Medicaid Services (CMS). Some examples include group and individual health plans, student health plans, and government-provided plans.

If your welfare fund does not provide credible coverage and you are enrolled in teh City's Medicare advantage/HMO plan, you will be required to purchase the optional rider through the City health plan.

With some health plans you may be able to obtain Medicare Part D coverage through the individual market place.

The tables below provide what your options are if your welfare fund's prescription drug coverage is considered Medicare Part D credible coverage.

Medicare Eligible Retirees - Credible Coverage

City Health Plan
Union/Welfare fund provides Creditable Prescription Coverage.
Can the retiree purchase the City's Optional Rider?
Can the retiree purchase a rider on the Individual Market Place?

Medicare Advantage Plan

Aetna MA PPO ESA (NY, NJ,PA)

Aetna MA PPO ESA (all other areas)

Cigna Health Spring (AZ)

Empire Mediblue Freedom PPO

United Healthcare Medicare Advantage plan (NY)

United Healthcare Medicare Advantage plan (NJ)

HIP VIP Premier (HMO)

Humana Gold Plus (FL)

Yes
No

Medicare Supplemental Plan

GHI Senior Care

GHI HMO Medicare Senior Supplement

Empire Medicare-Related

DC-37 Med-Team Senior Care*

Yes

No

*N/A

Yes

Medicare Eligible Retirees - No Credible Coverage

City Health Plan
Union/Welfare fund provides Creditable Prescription Coverage.
Can the retiree purchase the City's Optional Rider?
Can the retiree purchase a rider on the Individual Market Place?

Medicare Advantage Plan

Aetna MA PPO ESA (NY, NJ,PA)

Aetna MA PPO ESA (all other areas)

Cigna Health Spring (AZ)

Empire Mediblue Freedom PPO

United Healthcare Medicare Advantage plan (NY)

United Healthcare Medicare Advantage plan (NJ)

HIP VIP Premier (HMO)

Humana Gold Plus (FL)

No
Yes, Forced Optional Rider
No

Medicare Supplemental Plan

GHI Senior Care

GHI HMO Medicare Senior Supplement

Empire Medicare-Related

DC-37 Med-Team Senior Care*

No

Yes

*N/A

Yes

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. Eligible dependent children must all be enrolled as dependents of one parent. If either spouses or domestic partners are eligible and one is enrolled as the dependent of the other, the dependent may pick up coverage in his or her own name if the other’s contract is terminated.

Health Plan Rate Chart for Retirees