DC37 Med-Team

Welcome to your new plan. Here are your changes for July 1, 2016: Click here to view the letter.

The DC37 Med-Team gives you the freedom to choose in-network or out-of-network doctors. You can see any network doctor without a referral. In most cases, when you see a network doctor, your cost will just be a copay. When you choose to use out-of-network doctors, payment for covered services will be made under your plan. You will be responsible for any difference between the provider’s fee and the amount of the reimbursement, in addition to deductibles and coinsurance; therefore, you may have a substantial out-of-pocket expense. This plan is offered to employees and non-Medicare eligible retirees.

Key Plan Features

DC37 Med-Team offers great coverage everyone can afford. You get:

  • Coverage for in-network services
  • No required primary care physician (PCP)
  • Coverage of out-of-network services
  • Low copays for in-network services
  • No payroll deduction for base coverage
  • No referrals for in-network doctors
Benefits Summary Current Copay July 1, 2016 Copay Out-of-Network Cost
ACPNY PCP $10 copay $25 copay There will be no changes to your current out-of-pocket costs. You will still pay any applicable out-of-network cost-sharing plus the difference between the provider’s fee and GHI’s reimbursement (which may be substantial.)
ACPNY Specialist $10 copay $25 copay
All Other PCPs $10 copay $25 copay
All other specialty providers $10 copay $25 copay
Urgent Care $10 copay $50 copay
Diagnostic/Lab $10 copay $25 copay
MRI/CAT/Hi-Tech Radiology $10 copay $50 copay
Physical Therapy $10 copay $25 copay
Emergency Room $50 copay $150 copay

Benefits are subject to approval by the New York State Department of Financial Services.

Maximum Out-of-Pocket (MOOP)

MOOP generally refers to the maximum amount of in-network cost-sharing expenses that you will pay in each calendar year for covered services received from Participating Providers under your plan. MOOP includes deductibles, coinsurance and copay charge amounts that you must pay for covered in-network services and any applicable riders in a calendar year. Cost-sharing amounts attributable to services received from Non-Participating Providers generally do not count toward MOOP. Amounts incurred for non-covered services and other non-covered expenses, such as amounts in excess of plan allowances as well as any financial penalties do not count toward MOOP. Premiums and/or premium contributions also do not count toward MOOP. The MOOP amount may change from calendar year to calendar year*.

For the period of July 1, 2016 – December 31, 2016

Individual MOOP Family MOOP
GHI MOOP $3,425 $6,850

*For calendar years beginning January 1, 2017 – December 31, 2017 (Subject to indexing by the federal government)

Individual MOOP Family MOOP
GHI MOOP $7,150 $14,300
2016 Summary of Benefits and Coverage (SBC)

See your SBC or check out your benefits at a glance.

Learn More

EmblemHealth Behavioral Management Program

Members can call
1-800-NYC-CITY
(1-800-692-2489)
to seek advice about mental health and substance abuse treatment. This phone line is administered by ValueOptions.