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Termination and Reinstatement
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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

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Information and Update: $15 copays to resume January 1, 2025 for the EmblemHealth-GHI portion of the GHI/Anthem Senior Care Plan

Senior Care members—As you may know, $15 copays for the EmblemHealth-GHI portion of the GHI/Anthem Senior Care Plan were previously suspended by court order. Now, in accordance with a more recent court order, $15 copays will resume on January 1, 2025.

Senior Care members will receive a new ID card before January 1, 2025.

Clarification in response to questions from GHI/Anthem Senior Care members with respect to the October 18, 2024 letter sent by EmblemHealth to Senior Care members:

As set forth in the updated letter, the copays are limited to one copay of $15 per provider per date of service. See November 2024 letter from EmblemHealth and the Health Benefits Summary Program Description reflecting this information.

As of January 1, 2025, Senior Care members will be required to pay a $15 copayment each time they use the health services listed below:

Primary Care Physician Office Visits: $15 Copayment per visit

Specialist Office Visit: $15 Copayment per visit

Allergy testing/injections: $15 Copayment per visit

X-rays: $15 Copayment per visit

Laboratory tests: $15 Copayment per test

Complex diagnostic and radiology services: $15 Copayment per visit

Radiation therapy: $15 Copayment per visit

Urgent Care Services: $15 Copayment per visit

Emergency Care (Professional Component): $15 Copayment per visit

Mental Health Care (Outpatient): $15 Copayment per visit

Substance Use Disorder Services (Outpatient): $15 Copayment per visit

Physical, Occupational, and Speech Therapy: $15 Copayment per visit

Cardiac Rehabilitation: $15 Copayment per visit

Pulmonary Rehabilitation: $15 Copayment per visit

Chiropractic Care: $15 Copayment per visit

Podiatry Care: $15 Copayment per visit

Vision Care: $15 Copayment per visit

Please note, that Senior Care members are responsible for the annual Medicare Part B deductible and $50 GHI Senior Care deductible.

For questions, please call the EmblemHealth Customer Service phone number on the Senior Care member ID card.

Visit the Plans & Rates page of the Health Benefits Program wesbite to review other City’s health plan options for Medicare eligible retirees and their Medicare eligible dependents.

Medicare Part B & IRMAA Reimbursement

Medicare Part B Reimbursement

2023 Medicare Part B reimbursements were issued during the third week of April 2024.

Please check your bank account/statement (or the mail, if you are receiving a physical check).

Learn more about Medicare Part B Reimbursement

IRMAA 2023 Reimbursement

Medicare-eligible retirees and their Medicare-eligible dependents can submit an IRMAA application if they paid above the standard amount of $164.90 per month ($1,978.80 annually). If you did not pay more than the standard amount then you are not eligible for IRMAA.

IRMAA 2023 annual reimbursements were issued during the third week of October 2024.

Learn More about IRMAA Medicare Part B Reimbursement

View the IRMAA FAQs

IRMAA Medicare Part B Reimbursement Application (for 2023, 2022 & 2021)

Important - Please do not submit your application more than once. Submitting your application multiple times or ways will only delay the processing time. You will receive a confirmation letter in the mail 4-6 weeks from the date you submit your application. Payment will be issued in October 2024.

Information and updates regarding the Aetna Medicare Advantage PPO Plan - August 11, 2023

There is no Opt-Out or Waiver deadline in effect due to an injunction issued by the court.

All current health plans remain in effect. No retiree will be moved into the new Medicare Advantage PPO Plan.

No opt-out requests made through Aetna via their call center or website will be processed at this time.

No waiver of City health benefits, enrollment into the Aetna Medicare Advantage PPO Plan or adding the prescription drug rider that has been submitted on the Retiree Special Enrollment/Waiver Form will be processed at this time.

Please check back frequently for additional information and updates.

Retiree Responsibilities and Assistance

Medicare Part B and IRMAA Reimbursement

Information about Medicare and IRMAA Reimbursement Learn More

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Medicare Part B 2022 Reimbursement

The City reimburses retirees and their eligible dependents for Medicare Part B premiums paid, excluding any penalties. You must be receiving a City pension check and be enrolled as the contract holder for City health benefits in order to receive reimbursement for Part B premiums.

For most retirees, the refund is issued automatically by the Health Benefits Program. The reimbursement amount is based on the standard Medicare Part B premiums.

Medicare Part B reimbursements are issued to eligible retirees annually during the month of April. 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 will be separate from your pension payment. If you don’t have EFT or direct deposit, you will receive a check in the mail.

What is IRMAA?

The Income-Related Monthly Adjustment Amount (IRMAA) is an additional amount that you are required to pay for your monthly Medicare premiums if you have higher annual earnings.

Medicare-eligible retirees and their Medicare-eligible dependents can submit an IRMAA application if they paid above the standard amount per month. If you did not pay more than the standard amount then you are not eligible for IRMAA. Please do NOT submit an IRMAA application if you are not eligible for reimbursement.

IRMAA reimbursements are issued to eligible retirees annually during the 3rd week of October. If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement is deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you will receive a check in the mail.

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.

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Your Responsibilities

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