Important Information about Benefit Changes for City of New York Employees and Non-Medicare Eligible Retirees
Date Issued: 5/10/2016
Beginning on July 1, 2016, new benefit plan configurations will go into effect for City of New York (CNY) employees and non-Medicare eligible retirees. The new benefit plan designs will apply to both the PPO Plan that utilizes the CBP Network and the HMO option that utilizes the Prime Network. The Networks offered to our members will not change. We are introducing a new benefit design that will allow members to enjoy reduced copayments when they obtain care from certain participating provider groups. The new benefit plan was developed jointly with City of New York Labor Relations and the City’s Unions, represented by the Municipal Labor Committee and is constructed to offer members the option to reduce their out of pocket expenses at the time they receive care. At the present time, we are not adding additional physicians/physician groups to the CBP or Prime Networks.
Benefit Plan Highlights
- GHI Comprehensive Benefit Plan (CBP) members will have a zero copayment when they obtain care from providers affiliated with Advantage Care Physicians (aka, ACPNY) practices.
- Please note: GHI CBP members may also obtain care from the Montefiore Health System Employed Physicians group with a $0 copayment.
- There is no change to the Network that is available to CNY members. Regardless of the benefit configuration, members continue to have access to the full GHI CBP Network.
- GHI CBP members will also enjoy additional in-network preventive services for a $0 copayment. Some of these services include:
- Routine physicals
For a full list of services, please check member benefits and eligibility at emblemhealth.com.
- GHI CBP members will, beginning on July 1, have access to a Virtual Office Visit (aka, telehealth) benefit through American Well (AmWell) for a $15 copayment. This will allow your patient to access remote clinical health care via online video interaction or telephone. Please provide your patients with your email address so if they do take advantage of this new service, they can arrange for a visit summary to be sent to you.
- No changes to hospital network or respective copayment amounts.
- There are no additional changes to the prior authorization process that went into effect on January 1, 2016. You should call the NYC Healthline at 1-800-521-9574 for pre-certifications including:
- In-patient admissions
- Within 48 hours of an emergency admission
- Ambulatory surgery
- Physical and speech therapy after the 16th visit
- Emergency room copayment will increase from $50.00 to $150.00 on July 1, 2016. For non-emergency care, members may utilize a participating urgent care, retail clinic or a Virtual Office Visit, all at a lower copayment, or the Nurse Advice Line free of charge.
All benefit plan changes were developed jointly with City of New York benefit leadership.
Prior to July 1, all CBP PPO members will receive a new ID card, see sample below:
HIP HMO Preferred
- Developed jointly with City of New York benefit leadership and constructed to offer members interested in a lower copayment option, Prime HMO members will continue to enjoy reduced copayments when they choose a PCP and obtain care from providers affiliated with:
- Montefiore (includes all participating Montefiore providers)
- Health Care Partners
- St Barnabas
- Middletown Medical Group
- Middletown Community Health Center
This includes both PCP and specialty care clinicians affiliated with these groups.
- There is no change in the Network offered to these members. Regardless of the benefit configuration, members continue to have access to the full Prime Network.
- Members must select a Prime Network preferred PCP affiliated with one of the above listed groups to take advantage of the $0 copayment for primary and specialty care office visits when referred by a Prime Network Preferred PCP. Please note, there is a $0 copayment for all specialists when the member has selected a Prime Network preferred PCP.
- Additional services, such as diagnostic and lab tests, will also be provided with a $0 copayment when the member selects a Prime Network Preferred PCP. Check emblemhealth.com member benefits and eligibility for additional benefit information.
- Members that select any other PCP in the Prime Network will have a $10.00 copayment for both PCPs and specialists. These members will be issued new ID cards.
- No changes to network hospitals, respective copayment amounts or prior authorization requirements.
Always Use Participating Labs
Quest Diagnostics (Quest) is our preferred free-standing, independent commercial lab. Using Quest may help members lower their out-of-pocket expenses and facilitate clinical outcome data reporting to EmblemHealth. Members should be directed to the nearest contracted laboratory Patient Service Center and be given the requisition form to hand carry. If you need to establish an account with Quest, please contact them at 1-866-697-8378.
For specialty lab tests not available from Quest, you may use one of the other contracted free-standing, independent commercial labs listed in the Directory chapter of the Provider Manual.
Members may also receive services at hospital-affiliated labs, where covered under the hospital agreement with us.
Reminder - After Hours Care
Members that require non-emergency care after regular office hours may be directed to a participating Urgent Care Center or Walk-in Clinic or to call our toll-free Nurse Advice Line at 1-877-444-7988. Members will speak with a registered nurse who can help them decide the best course of action, if the need to call 911 is not immediately apparent. GHI CBP members should be encouraged to access a Virtual Office Visit for minor care when you are not available.
All CNY members and non-Medicare eligible retirees will also have access to the following additional benefits:
Beginning June 1, 2016, CNY employees and non-Medicare eligible retirees will be able to take advantage of special pricing, along with monthly discounted pricing when they join Weight Watchers. Members will be able to attend workplace meetings, where available, and unlimited meetings in their local community, or choose to follow the plan online with digital and mobile tools through Weight Watchers OnlinePlus.
Zocdoc is an online service available to CNY employees and non-Medicare eligible retirees to locate and book appointments with in-network doctors. For more information, visit zocdoc.com.
For members that have questions about their benefits, please direct them to emblemhealth.com/city.