By Mitch Goldberg Director, Welfare Fund

There have been several changes to health care insurance for New York City employees. By now you should have received a mailing from EmblemHealth outlining the changes. Since these changes may have an impact on your personal health care coverage, you are urged to review these changes carefully.

All changes become effective on July 1, 2016.

Here’s an overview of some of those changes:

GHI CBP Medical Plan

The GHI CBP program will enhance coverage to provide for in-network preventive services such as Routine Physicals, Immunizations, Colonoscopies and Mammograms. Certain prescription drugs, including some preventive prescriptions currently covered by the Teamsters Local 237 Welfare Fund, will now be covered by your GHI plan. These services will be available with $0 copayments. In addition, copayments have been reduced when you visit a primary care physician (PCP) or specialist affiliated with the multi-specialty physician practice of AdvantageCare Physicians (ACPNY). For more information, visit acpny.com.

Empire BlueCross BlueShield Hospitalization Plan

The current copay for the Emergency Room is $50. Starting on July 1, 2016, this will increase to $150, which will be waived if you are admitted to the hospital within 24 hours.

Maximum Out-of-Pocket (MOOP)

MOOP refers to the maximum amount of innetwork cost-sharing expenses that you will pay in each plan year for covered services/essential health benefits received from Participating Providers under the GHI/Empire BlueCross BlueShield plans combined.

MOOP includes deductibles, coinsurance and copay charge amounts that you must pay for covered in-network services and any applicable riders in a policy year. Cost-sharing amounts attributable to services received from Non-Participating Providers generally do not count toward MOOP. Amounts incurred for non-covered services and other non-covered expenses, such as amounts in excess of plan allowances as well as any financial penalties, do not count toward MOOP. Premiums and/or premium contributions also do not count toward MOOP. The MOOP amount may change from plan year to plan year, as determined by the Federal Government.

For July 1, 2016 – December 31, 2016, the GHI Medical MOOP is $2,175 for an individual and $4,350 for a family. The EBCBS Hospital MOOP is $1,250 for an individual and $2,500 for a family.

Telehealth

Effective July 1, you will have access to a Telehealth benefit through American Well (AmWell) for a $15 copayment. This is a Telehealth company which uses technology that allows you to access remote clinical health care via online video interaction or telephone. This service is not a substitute for visiting your PCP, but rather an alternative method for receiving care for minor, everyday ailments which may not require a visit to your doctor.

HIP HMO Members

Your HIP HMO plan continues to offer you $0 copayments for office visits when you choose a Preferred Primary Care Physician (PCP) provider from the Prime Network. If you choose a non-preferred PCP provider within the Prime Network, you will have modest copayments for services.

As a HIP HMO member, you are required to select a participating PCP. When you choose a preferred PCP from among the participating providers, you will have no copayment for primary and specialty care office visits. Additional services, such as diagnostic and lab tests, will also be provided with no copayment. If you choose a PCP that is not a preferred provider, you will have a $10 copayment for primary care and specialty office visits, and diagnostic and lab tests.

Member ID Cards

Preferred PCP: If you are currently using a preferred PCP, you may continue to use the member ID card you already have. Non-Preferred PCP: If you choose a non-preferred PCP, your new member ID card will be mailed to you approximately 10 days prior to the July 1, 2016, effective date of your new plan. Please begin using it when claiming benefits, and be sure to destroy your previous card once you receive your new one.

Additional Enhancements for both GHI/CBP and HIP HMO Plans

Zocdoc

This is an online service you can use to find and book in-network doctors’ appointments, often for the same day. For more information regarding this new benefit, visit zocdoc.com/nyc.

Questions?

If you have any questions about the changes to your GHI CBP medical benefits, please call EmblemHealth Customer Service at 1-800-624-2414, Monday to Friday, 8 am to 6 pm (closed onweekends.) If you have a hearing or speech impairment and use a TTY/TDD, please call 711. Or, visit the website at emblemhealth.com/city. If you have any questions about changes to your Empire BlueCross BlueShield hospital benefits, call 1-800-433-9592. Or visit the website at empireblue.com/nyc. You can also visit the City of New York Office of Labor Relations at NYC.gov/olr.