The following email from UFT President Michael Mulgrew was sent to Retired Teachers Chapter members on Thursday, Dec. 15, 2022, regarding an arbitrator's ruling on the creation of a new Medicare Advantage plan for city retirees.
As we expected, an independent arbitrator today ruled that the city and the Municipal Labor Committee should create a new Medicare Advantage plan for Medicare-eligible city retirees. The ruling stated that the unions have 25 days to negotiate with Aetna to make sure the plan is the best it can be.
We will use this time to negotiate fiercely, and as I have said before, if we cannot come to an agreement that ensures our retirees' benefits are the same or better than they have now, we will oppose going forward with Aetna.
We are committed to making sure any plan we move forward with provides the same high quality care and broad network of providers that our retirees are accustomed to and deserve.
The arbitrator also said that unless the City Council amends the New York City Administrative Code within 45 days, GHI SeniorCare and all other current “pay-up” plans will no longer be offered once the premium‑free Medicare Advantage plan launches.
Here are the other main points of his ruling:
- The new Medicare Advantage Plan should be administered by Aetna and has a projected implementation date of July 1, 2023.
- The new agreement should include a robust, verifiable and enforceable procedure for addressing denials of claims submitted by retirees.
- When finalized, the agreement with Aetna will go to the MLC for a vote.
- Failure to ratify the new Medicare Advantage agreement "shall result in finding another revenue source which, inevitably, shall lead to premium contributions."
Read the full ruling >>
Where we go from here
During the next 25 days, we will push Aetna hard on these fronts:
- Increase the size of its provider network in parts of the United States where large numbers of UFT retirees live with the goal of getting 98% of the doctors that UFT retirees use in Aetna’s network.
- Ensure that out-of-network doctors who provide services to our retirees are reimbursed by Aetna at the traditional Medicare rate without our retirees being billed.
- Create a real accountability system that ensures that Aetna delivers all rights and benefits to retirees as agreed upon in the agreement; and set up a clear, fast process to rectify any issues.
- Ensure there is an expedited appeals process for denial of care where specialists in the particular field/procedure make the final determination. ·
- Ensure every retiree, regardless of pre-existing conditions, is accepted in the new plan.
You have my promise that the UFT will not move forward with the new plan until we have agreed on a high-quality plan our retirees deserve.
To learn what brought us to this point, see our timeline >>
See our health care campaign page for more information and resources about the health care crisis we face and our concerted push to amend the administrative code to preserve health care choices for retirees.
We will keep you up to date with any developments.