Time to make changes in health insurance coverage

Oct 1, 2009 4:38 PM

Transfer period for in-service members is November

All in-service UFT members will be able to change their health insurance coverage and add or drop optional riders during the transfer period, which this year is the month of November. The changes are effective January 2010.

Each plan has its benefits and drawbacks, so the Welfare Fund suggests three sets of considerations for members and retirees to evaluate as they search for the plan that will provide the best coverage for them at a price they can afford:

• Who are the physicians and what are the hospitals affiliated with the plan? If you want to continue treatment with a physician you have been seeing, you should check whether you can continue coverage through a plan. Another consideration is whether your local hospital, where your local physicians are likely to have privileges, is affiliated with a plan you are considering.
• How does the plan fit your budget? Cost factors are important considerations. For example, some plans require payroll deductions for basic coverage. The cost of optional riders differs. Some plans require a co-payment for each routine doctor visit. Some plans require payment of a yearly deductible before the plan reimburses the cost of using nonparticipating 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.
• What are the individual medical needs of you and your family? If you have a young family, you might emphasize maternity or pediatric benefits. If you suffer from allergies, look for the plan that best meets your needs. As your needs change, you can change your plan during an open enrollment.

To help members make decisions, the tables in this pullout section compare the highlights of the various plans available to New York City employees and retirees.

The city offers the GHI PPO/Indemnity Plan, eight HMO plans and two POS plans. Some of these plans have payroll deductions for basic coverage.

In the POS-type plan, members may receive care from doctors within the plan’s network at little or no out-of-pocket cost, or they may choose physicians outside the network. If nonparticipating providers are used, members must first pay for services and then file a claim.

Reimbursement will be reduced by deductibles and co-insurance and is calculated differently for each plan. Also, out-of-network allowances vary by plan, as do procedures for going outside the network.

This POS-type of plan may be an attractive alternative to some union members. The POS plans are: HIP Prime POS and Aetna Quality Point of Service.

The currently available plans — GHI-CBP/Empire Blue Cross, HIP/Prime, Cigna HealthCare, GHI/HMO, Empire EPO, Empire HMO, Aetna HMO, VYTRA and HealthNet — will continue to be offered.

All plans provide basic coverage for unmarried, dependent children age 19 through 23 who are full-time students in an accredited school that grants a degree or diploma. Coverage terminates at the end of the calendar year of their 23rd birthday or upon graduation, whichever occurs first. Unmarried children under 19 are eligible for health benefits under the basic plan. The member must provide at least 50 percent of the student’s support and the student must be listed as a covered dependent under the city health plan.

The UFT Welfare Fund recommends that in-service members who are enrolled in GHI/CBP consider taking the optional rider because of the enhanced surgical reimbursement schedule it offers.

The Fund, however, recommends that in-service members enrolled in other plans do not take the optional rider because they essentially only cover prescription drugs, a benefit which the Welfare Fund provides to in-service members. But retirees who wish prescription drug coverage would need to take the optional rider.

In-service members wishing to switch or alter their health plans must submit applications no later than Nov. 30. Changes will become effective the first full payroll period next January for in-service members.

In-service members will receive a payroll stuffer informing them of three possible ways of obtaining health plan information. The information and Summary Program Descriptions are available online at www.nyc.gov/html/olr. Click on Forms and Downloads.

To enroll in a health plan, in-service members must file form ERB 2000 with their payroll secretaries.

Since this is an odd-numbered year and retirees are only included in the open enrollment during even-numbered years, retirees will not be able to alter their health insurance during this transfer period. However, retirees may transfer to a different plan or add an optional rider once in their lifetime outside the open enrollment period after they have been retired for at least one year. Generally, these changes become effective on the first of the month following the date that the retiree signs Form ERB 2000.

Retirees must complete ERB 2000 and mail it to: Employees Benefits Program, 40 Rector St., New York, NY 10006.