The NYC Employees PPO (NYCE PPO) health care plan will replace the GHI CBP plan for in-service city workers and pre-Medicare retirees on Jan. 1, 2026. The following are answers to members’ most common questions. For additional information, visit the New York City Employees PPO Plan section of this website and its comprehensive set of  FAQs.

Overview

What is the new NYCE PPO plan, and which city health plan is it replacing? 

The NYCE PPO plan is a new, premium-free health plan for in-service New York City employees and pre-Medicare retirees, offered jointly by EmblemHealth and UnitedHealthcare. It provides coverage for doctors, hospitals and other medical services — all under one health plan and one member ID card. The NYCE PPO plan will replace the current GHI CBP plan for in-service members and pre-Medicare retirees on Jan. 1, 2026. No other city health plans are affected.

Why did the city and the Municipal Labor Committee (MLC) negotiate a new health care plan?

Members have raised concerns about the GHI CBP plan, the city’s most widely used health plan. It has become harder to find in-network doctors, especially out of state, and to access mental health providers. The UFT has consistently fought to prevent copay increases even as health care costs have nearly doubled since 2015, threatening the continuation of premium-free coverage. The MLC and the city put the health care contract out to bid and used the negotiated acquisition process to hammer out the final plan to preserve premium-free health care while addressing members’ concerns. The resulting NYCE PPO plan addresses these issues.

What will happen to the GHI CBP plan? 

The GHI CBP plan will no longer exist on Jan. 1, 2026. The NYCE PPO plan will replace it.

Will other city health plans still be available?

Yes. All other current city health plans, such as HIP HMO, will continue to be available and are not affected by the creation of the NYCE PPO plan.

If I am currently in the GHI CBP plan, how do I enroll in this new plan? 

No action is required. Members currently enrolled in the GHI CBP plan, along with their eligible dependents, will be automatically enrolled in the NYCE PPO on Jan. 1, 2026. Coverage will continue seamlessly without interruption.

Can I switch health plans before Jan. 1, 2026?

Yes. Members who do not wish to be enrolled in the NYCE PPO plan may switch to another city health plan during the city’s annual open enrollment period in November. Members currently enrolled in HIP HMO or another city plan who wish to join the NYCE PPO plan may also make that change during open enrollment. All changes take effect on Jan. 1, 2026.

When will I get my new medical and hospital ID cards?

You will no longer have separate medical and hospital ID cards. Instead, you’ll have one NYCE PPO member ID card for all your medical needs. Your health plan member ID number will not change. Your new NYCE PPO member ID card will arrive in the mail before your coverage starts on Jan. 1, 2026. Remember to use only your new card after the new city health plan takes effect in January 2026.

Will my dependents still have their own member ID cards? 

Yes.

Is there a new member portal?

Yes, you’ll have a single, brand-new member portal designed to help you get the most from your benefits. While it will be different from your current EmblemHealth and Anthem member portals, you will have all your plan information in one convenient place.

You’ll receive your NYCE PPO welcome package — with instructions for using the new portal and other important plan details — before Jan. 1, 2026. Once you receive it, you’ll be able to:

• Register for the new portal
• Choose paperless or paper communications

If you have adult dependents, they can register separately and authorize you to view their information.

Will any benefits be lost in the transition from GHI CBP to the NYCE PPO plan?

No. All benefits and services currently offered under the GHI CBP plan will be included in the NYCE PPO plan — plus additional features and enhancements.

What kinds of specialty health programs will the new plan offer?

The plan will include programs focusing on wellness, disease management, maternity care, virtual care and more. Details on these programs will be released soon.

Can the city or insurance companies change the NYCE PPO plan without MLC approval?

No. Any change must first be approved by the MLC. The city and insurance carriers cannot unilaterally increase costs or reduce coverage. The unions can approve beneficial changes, such as lowering a copay, and reject unfavorable ones.

Doctors and hospitals

Will I still have access to the same EmblemHealth providers under the NYCE PPO plan?

Yes. Providers currently contracted with EmblemHealth for the GHI CBP plan in the 13 downstate counties (the five boroughs, Long Island, and Dutchess, Orange, Putnam, Rockland, Ulster and Westchester counties) will remain in-network under the NYCE PPO plan.

Do I need referrals from my doctor to see specialists?

No. The NYCE PPO plan does not require referrals.

What mental and behavioral health services will be available under the NYCE PPO plan?

UnitedHealthcare will manage mental and behavioral health services. Members will have access — in person and virtually — to a nationwide network of behavioral health providers. The NYCE PPO plan includes:

• 39,000 mental health providers in New York State (up from 12,000 under the GHI CBP plan)
• 418,000 providers nationwide (up from 61,000)
• Access to 22 specialty mental and behavioral health organizations (up from seven), including Charlie Health, Hazelden Betty Ford, InStride Health and Talkspace

Can I see doctors while traveling or living outside New York without a referral?

Yes. The NYCE PPO plan is a true national PPO, which means that members can see in-network doctors anywhere in the country without a referral. This includes coverage for dependents living out of state, such as college students. You do not have to live in a particular location to see a provider.

What hospital networks are included?

The NYCE PPO plan includes all major hospital networks nationwide. In the New York downstate area, coverage through EmblemHealth includes NYU Langone, Northwell Health, NewYork-Presbyterian, Mount Sinai, Montefiore, Memorial Sloan Kettering Cancer Center, Hospital for Special Surgery and NYC Health + Hospitals. Outside this area, members can access UnitedHealthcare’s Choice Plus network, one of the nation’s most extensive PPO hospital networks.

Will I still need to purchase an optional rider if I want out-of-network emergency hospital reimbursement?

No. The rider will no longer be needed or available because the new plan offers a vastly expanded national provider network, making out-of-network hospital use virtually unnecessary.

Prescription drugs

Will prescription drug coverage change?

In-service UFT members will continue to receive most prescription benefits through the UFT Welfare Fund, which is not affected by the NYCE PPO plan. Express Scripts remains the pharmacy drug manager for the UFT Welfare Fund plan.

In-service members who receive certain ACA- and NYS-mandated drugs through their city plan, such as diabetes medication and birth control, will continue to receive them under the NYCE PPO plan via the city’s new pharmacy benefit manager, Prime Therapeutics.

Pre-Medicare retirees who purchase an optional rider for prescription coverage will receive their benefits through Prime Therapeutics, with both retail and mail-order options.

Will I need new prescriptions once I’m enrolled in the NYCE PPO plan?

No. All existing prescriptions covered under the GHI CBP plan will automatically transfer to the NYCE PPO plan.

I use the PICA program for certain specialty drugs. Will anything change?

No. The New York State PICA program, which covers certain specialty medications such as injectable and chemotherapy drugs, is not changing. Express Scripts will remain the pharmacy benefit manager.

Prior authorization

How will prior authorization differ in the new plan?

The NYCE PPO plan will require prior authorization for many fewer procedures than the GHI CBP plan. Many frequently used services — such as CT scans, most MRIs, orthopedic surgeries, office-based dermatology, pain injections and home health visits — will no longer require prior authorization.

Items are regularly being added or removed from the list of services and procedures requiring prior authorization. A review committee, including union representation, will monitor prior authorizations monthly to ensure members retain access to commonly needed services.

If I’m currently receiving treatment, will I need new prior authorizations?

No. All approved prior authorizations under the GHI CBP plan will transfer to the NYCE PPO plan.

Deductibles and out-of-pocket expenses

Will copays change?

No. Copays will remain the same as under the GHI CBP plan, and additional services will now have no copays. The UFT continues to fight to stop insurance companies from increasing copays.

Will deductibles change?

No.

• For in-network care, there will continue to be no deductible except for durable medical equipment, which carries a $100 deductible reimbursable by the UFT Welfare Fund for eligible members.
• For out-of-network care, the deductible remains $200 for individuals and $500 for families.

Will the out-of-pocket maximum change?

No. The total in-network out-of-pocket maximum will be $7,150 for individuals and $14,300 for families. Unlike the bifurcated GHI CBP plan, where the maximum was split in two, the NYCE PPO plan has one unified maximum for both medical and hospital coverage. As before, there is no out-of-pocket maximum for out-of-network services.