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Glossary of Terms
View the Full Summary Plan Description (SPD)
View the Rate Charts
View the Summary of Benefits and Coverage (SBC)
Employee Blood Progam

Health Benefits Videos

Glossary of Terms

View the Full Summary Plan Description (SPD)

View the Rate Charts

View the Summary of Benefits and Coverage (SBC)

Employee Blood Progam


NYC Health Benefits Program

Summary of Plans

See List of Health Plans for Employees & Non-Medicare Retirees

See List of Health Plans for Retirees

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

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
Anthem Blue Cross and Blue Shield

PPO

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

GHI HMO
HMO
(877) 244-4466

HIP HMO
HMO
(833) 269-4653

HIP Prime POS
PPO
(800) 447-6929

MetroPlusHealth 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-CBP/Anthem 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) 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.