With the latest legal hurdles cleared, all city employees and pre-Medicare retirees in the GHI CBP plan and their dependents will be automatically enrolled in the new NYC Employees PPO plan on Jan. 1, 2026.

Members will receive a NYCE PPO ID card and welcome kit from EmblemHealth and UnitedHealthcare, the new plan administrators, in December. Members will receive one ID card for both medical and hospital coverage instead of the two cards they have had under GHI CBP (EmblemHealth for medical and Anthem BlueCross and BlueShield for hospital). All member information and documents will now be in a single portal.

The NYCE PPO plan locks in premium-free health care for five years for city employees, pre-Medicare retirees and their dependents — a total of 750,000 lives — as health insurance costs continue to skyrocket nationwide. Copayments will remain the same, and participants can keep their current doctors. Read our FAQs on the NYCE PPO plan »

“We look forward to our members and city workers having these expanded health benefits starting on Jan. 1,” UFT President Michael Mulgrew said.

The plan expands the network of health care providers in the New York City/Long Island/Hudson Valley region as well as nationally, with more than 1.6 million new providers through the UnitedHealthcare national Choice Plus Network. It also increases the number of mental health providers locally and nationally.

The NYCE PPO plan cuts in half the number of procedures requiring preauthorizations under GHI CBP. It is a national PPO, meaning members can see in-network doctors anywhere in the country without a referral. Prior authorizations approved under the GHI CBP plan that extend into 2026 will be transferred automatically to the NYCE PPO plan.

In-service members will continue to receive most of their prescription drugs through the UFT Welfare Fund program, which will continue using Express Scripts as the pharmacy benefit manager.

Your pharmacy benefit manager will change if you are a retiree who has the optional prescription drug rider or if you or your dependents take any Affordable Care Act (ACA) or New York State-mandated drugs such as diabetes medication and birth control. Those drugs are covered by EmblemHealth under your city health plan. EmblemHealth is changing its pharmacy benefit manager from Express Scripts to Prime Therapeutics for all its health plans, including the new NYCE PPO plan. Any prescriptions you currently have with the GHI CBP plan will be automatically transferred to the new plan on Jan. 1.

Prime Therapeutics’ drug formulary is about 40% larger than that of Express Scripts. Members will continue to have access to both retail and mail-order pharmacy options.

Less than 2% of members will have to switch to an alternate medication as a result of this switch in the pharmacy benefit manager. To ease the transition, Prime Therapeutics will allow a one-time refill of current medications in 2026.

There are no changes to the New York City PICA program for specialty medications, such as chemotherapy drugs, which will continue to be managed by Express Scripts.