Skip to main content
Full Menu
News Stories

Some changes coming to city health plans

New York Teacher

UFT members employed by the Department of Education as well as retirees who are not yet eligible for Medicare will see changes in the coming months to their city health benefits plan. The changes, announced on Feb. 23, were negotiated by the city and the Municipal Labor Committee, the umbrella group of municipal labor unions of which the UFT is a member.

“As part of our last collective-bargaining agreement, we agreed to achieve health care savings,” said UFT Welfare Fund Executive Director Arthur Pepper. “By collaboratively working with the city and the other unions, we have been able to preserve access to quality health care while meeting our savings obligation.”

Public school educators and all other New York City municipal employees will continue to have access to health coverage without an annual premium. GHI subscribers currently pay $15 when they visit their primary care physician, the most utilized service in the plan. That co-pay will not change.

When the changes take effect in the next several months, the co-pay for using physicians at the Advantage Care Physician (ACP) offices will be eliminated. Certain other GHI and HIP co-pays will, however, increase, including the co-pay for hospital-based emergency room visits and the co-pays to see specialists and receive various diagnostic tests from other providers in the GHI network.

Members seeking to keep their health care costs down should consider visiting one of the 36 Advantage Care Physician centers created by EmblemHealth in New York City and in Nassau and Suffolk counties. Members who receive care, including urgent care, at one of these sites will not have a co-pay for their treatment, including high-tech radiology.

GHI subscribers will no longer have co-pays for preventive health care. All preventive health services — including immunizations, mammography, prenatal vitamins, colonoscopies and prescriptions for birth control — will soon be available to GHI subscribers free of cost.

One of the most expensive forms of care is hospital-based emergency room visits, which should be used only in a genuine emergency. The cost to the health plan for a visit to the ER is several times that of a visit to a doctor’s office. The unions’ data show that some members are overutilizing hospital emergency rooms.

To discourage the use of ERs when a doctor’s visit would suffice, the co-pay for hospital-based ER visits will increase from $50 to $150. Members can see a doctor at short notice at one of EmblemHealth’s Advantage Care Physician offices with no co-pay or at a participating Urgent Care facility with a $50 co-pay. EmblemHealth is looking to have ACP-affiliated physicians in the Bronx as well as in Westchester and Rockland counties.

As part of the union’s wellness programs, the union also will introduce telemedicine, which will allow members immediate access to an Internet-based physician who can guide their care and even provide a prescription. All members in a New York City health plan also will be able to join Weight Watchers at a substantial discount.

HIP subscribers also will see changes in their health plan. HIP is introducing a new plan called HIP Preferred. HIP subscribers may use their HIP doctor with no co-pay if he or she is in the HIP Preferred network. HIP subscribers now will have a $10 co-pay if their doctor is not in the HIP Preferred network.

GHI changes that will take effect in the coming months
  Current Co-pay New co-pay
Primary care physician (participating GHI doctor) $15 $15
Advantage Care Physician – generalist $15 No co-pay
Advantage Care Physician – specialist $20 No co-pay
Non-Advantage Care Physician specialist $20 $30
Hospital emergency-room visit $50 $150
Urgent care facility $15 $50
MRI/CT (hi-tech radiology) $15 $50
Diagnostic lab (such as blood or X-ray) $15 $20
Physical therapy $15 $20
All preventative care services including immunizations, mammography, colonoscopy and prescriptions for contraceptives   No co-pay
Changes affecting HIP subscribers
  Current Co-pay New co-pay
HIP Preferred Network (new) No co-pay No co-pay
HIP Non-Preferred Physician No co-pay $10
Related Topics: News Stories