Jan 16, 2002 3:44 PM
D ear Colleague,
The UFT is proud to offer you an excellent array of health insurance plans and options, which we negotiated with other municipal unions on behalf of all city workers. This booklet describes the various choices available to help you select the one that is best for you and your family.
In addition to your basic city health benefits, the UFT Welfare Fund provides you, your spouse or domestic partner and your covered dependents with plans for prescription drugs, dental and optical care, accident and sickness disability benefits, a death benefit and various supplementary benefits. The Welfare Fund spells all of that out in a separate publication called The Red Apple, which is also available on our Web site.
With the cost of health care rising, intense pressures are building to curtail health benefits for working families. For example, in the spring of 2003 the city demanded $600 million in health-care and pension concessions from the municipal unions. The unions resisted, suggesting other savings instead. An impasse emerged and the city chose to lay off several thousand workers.
In the past, the UFT has found ways to save while maintaining or even enhancing quality health-care options for our members. That’s certainly our intent for the future, as it was during the rancorous war of words with the mayor in the spring of 2003. I assure you that health benefits will stay at the top of our agenda.
Naturally, we hope you never have to use anything but preventive health services, but rest assured that if you need them, you can rely upon a great package of health and Welfare Fund benefits – as well as caring people at your union who will help you out.
Sincerely,
Randi Weingarten
President
Before you decide which plan is right for you and your family, we recommend that you study the city’s detailed Summary Program Description booklet. It’s available from your payroll secretary or the Department of Education’s Bureau of Health and Welfare Services at 65 Court St., Brooklyn. Each plan also issues its own informational material (see last section of this booklet for contact information).
To make your choice easier, the UFT’s Welfare Fund each fall sends chapter leaders our Summary Comparison of Health Plans Chart to post on UFT bulletin boards. It also runs in the New York Teacher and is available all year long at www.uft.org/welfare.cfm (click on “comparison of health plans” in the list at the right of your screen).
How do I choose among the plans?
Each plan has its benefits and drawbacks, so we recommend three sets of considerations as you search for the plan that will give you the coverage you want at the price you can afford:
• 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 have problems with your feet, look for the best podiatric care. As your needs change, you can change your plan.• Who are the physicians and what are the hospitals affiliated with the plan? If you want to continue treatment with a physician you’ve been seeing, you should check to see if 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. Telephone numbers for each plan are listed at the end of this brochure so you can check hospital affiliations and get a list of participating physicians.• How does the plan fit into your budget?
Following are brief descriptions of the types of plans that are offered and how they provide coverage.
PPO/Indemnity Plan
A preferred provider organization (PPO) provides an independent panel of participating physicians. The Group Health Inc. Comprehensive Benefits Plan (GHI-CBP) allows members to chose from a list of panelists and pay only $10 per visit. Diagnostic services require an additional $10 copayment. Members who choose to use a non-panel physician are reimbursed according to a schedule of allowances after paying an annual deductible; this schedule of allowances may not reflect the fees that physicians charge, so you may incur out-of-pocket expenses. Hospitalization is covered by Empire Blue Cross/Blue Shield and requires pre-admission certification, which is obtained by contacting the NYC Healthline (800/521-9574), and also is subject to an annual deductible.
HMO
A health maintenance organization (HMO) is an organized system that provides medical and hospital services. There is little or no out-of-pocket expense to the member, but members are limited to physicians and services from within the HMO’s network of providers. Hospitalization is covered through the plan.When joining, members in HMO plans choose a primary care physician who will oversee your medical treatment.There is currently only one HMO — HIP Prime— that is offered at no monthly cost to the member. Additional HMO choices charge fees paid through monthly payroll deductions: AETNA, CIGNA Healthcare, Empire EPO/HMO, HealthNet, GHI-HMO and VYTRA.
POS
A point of service (POS) plan allows members to choose either a participating network panel provider or a non-network panel provider. When using a panel provider, the plan resembles an HMO. When joining, members in POS plans choose a primary care physician to oversee their medical treatment. Hospitalization is covered through the plan.If a non-panel provider is consulted, the plan operates like an indemnity plan, where copayments, deductibles and fee schedules are applicable; the POS’s schedule of allowances may not reflect the fees that physicians charge, so you may incur out-of-pocket expenses. Each POS has its own procedures with regard to obtaining out-of-network medical and hospital benefits.The POS plans include AETNA Inc. Quality Point of Service and HIP Prime POS. These POS plans have monthly payroll deductions and may
Optional Riders
Optional riders provide benefits that supplement your basic plan. If members choose GHI-CBP as their health coverage, they should consider purchasing the optional rider because it provides an enhanced reimbursement schedule for in-hospital related procedures, as well as other benefit improvements.Optional riders provided by the other health plans generally should not be taken because they duplicate benefits already provided to UFT members by the UFT Welfare Fund, such as coverage for prescription drugs.
MEDICAL SPENDING CONVERSION
If you pay for an optional rider or basic health insurance, as some HMO or POS plans require, there’s a way that you can increase your take-home pay.The Medical Spending Conversion plan (MSC) allows such Department of Education and other city employees to make these payments on a pre-tax basis, thereby reducing the salary on which taxes are computed. The amount of savings depends on the health plan, rider choice and whether you have individual or family coverage. MSC does not change your gross salary—only your net—and the overall reduction is shown on the W-2 form at the end of the year.If you have payroll deductions for health benefits, you will be automatically enrolled in MSC unless you decide you do not want to participate.Generally speaking, the UFT recommends that you participate in MSC if you take an optional rider or enroll in an HMO or POS requiring payments.
HOW TO ENROLL IN ANY PLAN
Obtain an ERB form from your school secretary and return it to her/him within 31 days of your employment.
DEPENDENT COVERAGE
If you apply for coverage within 31 days of your employment, your spouse, domestic partner and all unmarried children under age 19 are eligible for health insurance coverage effective on your date of employment. All plans provide coverage to age 23 for all dependent unmarried full-time college students. If you have unmarried children 19 and older who are unable to support themselves because they have a mental or physical disability, you should consult the city’s booklet for information regarding their coverage.
CONSIDERATIONS WHEN SELECTING A PLAN
Consider your family’s needs. Here are some guidelines. First, examine the city’s booklet, which compares the various plans in greater detail. If you want complete coverage with no out-of-pocket cost or claim forms and, if you want the convenience of an organized network of providers, you may want to consider an HMO.If you are satisfied with your current doctor and are willing to absorb out-of-pocket expenses, or if you would like to choose from a panel of doctors at a nominal out-of-pocket fee, you may want to consider GHI-CBP/Blue Cross, HIP Prime POS or the other POS plans.When you are deciding on a plan, remember to take into account any other health insurance you may have, such as through a spouse or domestic partner. If you have questions call your UFT borough office.
Q: May I change my coverage?
A: You may transfer from one plan to another during the transfer period (usually in October). The coverage under the new plan becomes effective the first pay period in January. If you move out of the area covered by an HMO or a POS plan, you may transfer immediately to another plan.Q: How do I change my coverage?
A: Ask your school secretary for an ERB form. Complete and return it to her/him.Q: What is an optional rider and how do I get one?
A: The city offers an optional rider for GHI-CBP that provides additional benefits at an additional cost; a description of its benefits is included in the city’s booklet.
To apply for a rider, obtain and complete an ERB form and return it to your school secretary. You may select a rider only during your initial enrollment or during a transfer period.
Some HMOs offer a rider which may provide benefits such as prescription drug coverage. UFT Welfare Fund members do not need these riders.Q: How do I add a new family member?
A: Ask your payroll secretary for an ERB form. Complete and return it to her/him not more than 31 days after that individual has joined your family. If the form is submitted after 31 days, the family member cannot be added until the next transfer period.
Q: What if both spouses or domestic partners work for New York City?
A: You may either enroll individually or one may enroll as a dependent of the other, but you may not both be dependents on each other’s coverage. If you are a dependent spouse or domestic partner, you should sign a waiver protecting your right to coverage should your spouse cease employment with the city. All of your children must be enrolled under the contract of one parent if you enroll separately.Q: If I die, will my spouse or domestic partner be covered?
A: If you both work for the city, your spouse or domestic partner should complete an ERB form immediately following your death so that he/she can be covered as a city employee.
If your spouse or domestic partner is not employed by the city, there is no city paid coverage available. However, your spouse or domestic partner can apply for coverage by asking your school secretary for a COBRA application (see next question).
Q: What is COBRA?
A: COBRA (the federal Consolidated Omnibus Budget Reconciliation Act of 1985) requires that the city offer employees, retirees and their families the opportunity to continue group health and Welfare Fund benefits at 102 percent of the group rate in certain instances where the coverage would otherwise terminate. The period of coverage varies from 18 to 36 months, depending on the reason of termination. For more information, see the city’s Summary Program Description.Q: How does no-fault insurance affect my coverage?
A: If you or your covered dependents are involved in an auto accident, auto insurance first pays all reasonable and necessary medical and hospital expenses incurred. Your city health coverage and Welfare Fund disability benefits apply only when no-fault benefits are exhausted.Q: What is coordination of benefits (COB)?
A: This limits coverage of overall medical expenses to no more than 100 percent of charges when a person is covered by more than one health insurance plan.
For example: You are covered as a dependent under the health coverage of your spouse or domestic partner and you incur a medical expense of $100. Your health insurance will pay what it considers to be reasonable and customary; if any expense is left, your spouse’s or domestic partner’s insurance may cover the remainder or part thereof. (This is not true when that person also works for the city.)Q: Can I buy additional insurance?
A: Yes. The American Federation of Teachers and the New York State United Teachers offer group insurance plans which cover auxiliary costs as well as life insurance, income protection insurance for members and their beneficiaries, etc. Contact NYSUT and the AFT for more details.Q: What should I do if I have a problem?
A: If it’s a question of eligibility for coverage that your school secretary cannot resolve, contact:
New York City Department of Education
Office of Employee Health & Welfare Program
65 Court Street, Rm 200
Brooklyn, NY 11201
(718) 935-2312
United Federation of Teachers Welfare Fund
52 Broadway • New York, NY 10004
(212) 539-0500
Forms Hotline—(212) 539-0539
Aetna Inc.
Att: NYC Dept.
333 Earle Ovington Blvd • Suite 502.
Uniondale, NY 11553
(800) 445-USHC
CIGNA Healthcare HMO
140 East 45th Street
New York, NY 10017
(800) 832-3211 in New York
(800) 462-6633 in New Jersey
Empire EPO/HMO
P.O. Box 3598
Church Street Station
New York, NY 10008-3598
(800) 767-8672
GHI-CBP
441 Ninth Ave.
New York, NY 10001
(212) 501-4GHI (4444)
GHI-HMO
P.O. Box 4181
Kingston, NY 12402
(877) 244-4466
HIP
7 West 34th St.
New York, NY 10001
(212) 630-5000
(800) HIP-TALK (800-447-8255)
HealthNet
One Far Mill Crossing
P.O. Box 904
Shelton, CT 06484-0944
(800) 441-5741
VYTRA
Corporate Center
395 North Service Rd.
Melville, NY 11747
(800) 448-2527
(631) 694-6565