New York City Office of Labor Relations Health Benefits Program

New York City Office of Labor Relations

Health Benefits Program

hbp

Annual Transfer Period for Active Employees ? Fall 2021

The Fall 2021 Annual Health Benefits Program Transfer Period begins November 1, 2021 and ends November 30, 2021. Health plan changes requested during the Transfer Period will be effective January 1, 2022 and the new payroll deduction, if applicable, will begin with your first full paycheck in January 2022.

Employees who do not wish to make any changes to their current health plan do not need to do anything during the Transfer Period.

During the Annual Transfer Period, you may:

? Transfer into any health plan listed in this notice for which you are eligible, ? Add or drop the Optional Rider, or ? Add or drop dependent(s).

Family Status and Other Changes:

? If you have changed your address, please update your address through your ESS or your agency HR/Personnel. ? If you changed your marital status, contact NYCAPS Central or your agency HR/Personnel. ? If you changed your domestic partnership status, contact NYCAPS Central, your agency HR/Personnel and

union/welfare fund. This is important for taxation purposes. ? You must contact your union/welfare fund so that your records can be updated accordingly.

To make changes, complete a Health Benefits Application. To obtain an application, contact one of the following offices:

? Employees of NYCAPS centralized agencies contact NYCAPS at (212) 487-0500 ? DOE employees contact HR Connect at (718) 935-4000 ? NYC H+H employees contact the HR Share Services Benefits Department office at (646) 458-5634 ? All other employees and employees of non-NYCAPS centralized agencies should contact their agency

HR/Personnel Office

Employee Self-Service (ESS): Employees with access to Employee Self-Service may make changes to their health benefits online.

Health Benefits Application: Employees who do not have access to ESS can make changes to their health benefits by completing this application, which is available on our website at hbp. Completed applications should be submitted to your agency HR/Personnel Office for processing.

If you are making changes to your health benefits plan/option, please review the following Health Benefits Program materials on our website at hbp:

? Health Plan Rate Chart for Employees ? Summary Program Description (SPD) ? Summary of Benefits and Coverage (SBC) ? Links to the Health Plans' websites for additional health plan and contact information

Many of the health plans will be offering informational webinars for employees to learn more about their health plan offering. Please visit the Health Benefits Program website at hbp for registration information.

Prescription Drug Coverage:

? If your union/welfare fund provides prescription drug coverage, and you are selecting either HIP HMO or GHI-CBP, then prescription drug coverage (aside from those covered under the basic plan) will be available only through your union or welfare fund and not through the Optional Rider.

? If you are selecting any other health plan, you are eligible to select the Optional Rider for prescription drugs in addition to your union or welfare fund's prescription drug coverage. Your health premium deduction will be adjusted accordingly.

? Contact your union/welfare fund for your prescription coverage information.

Health Plan Coverage for Employees Hired On or After January 1, 2022:

City of New York employees, and employees of Participating Employers, hired on or after January 1, 2022, and their eligible dependents, will be eligible to enroll in all City Health Benefits Program health plan options.

Health Plan Coverage for Employees Hired prior to January 1, 2022 who have not yet met the 365-day requirement:

City of New York employees, and employees of Participating Employers, hired prior to January 1, 2022, and their eligible dependents, will only be eligible to enroll in the EmblemHealth HIP HMO Preferred Plan, and must remain in the HIP HMO Preferred Plan for the first year (365 days) of employment.

After 365 days of employment, the employee will have the option of either remaining in the HIP HMO Preferred Plan or selecting a different health plan within 30 days before the end of the 365-day period. If a new health plan is selected, the new plan will be effective on the 366th day. Only after the 365th day can the employee participate in any Annual Fall Transfer Period.

MSC Health Benefits Buy-Out Waiver Program:

To enroll in the Medical Spending Conversion (MSC) Health Benefits Buy-Out Waiver Program, please complete the MSC Health Benefits Buy-Out Waiver Enrollment/Change Form and a Health Benefits Application to receive annual incentive payments.

The annual incentive payment for the MSC Health Benefits Buy-Out Waiver Program for Plan Year 2022 will be $500 (individual) and $1,000 (family).

MSC Health Benefits Premium Conversion Program:

Health premiums are deducted on a pre-tax basis. If you wish to have deduction on a post-tax basis, you must fill out an MSC Premium Conversion Enrollment/Change Form.

For information about MSC Program and to download forms, visit fsa.

Summary of Benefits and Coverage: Each health plan has prepared an SBC as required by the Patient Protection and Affordable Care Act. To review the SBC of a particular plan, please visit the Health Benefits Program website or contact the health plan directly.

CIGNA HealthCare GHI HMO HIP HMO Gold Preferred Plan MetroPlus Gold Vytra Health Plans

Health Maintenance Organizations

(800) 244-6224 (877) 244-4466 (833) 269-4653 (877) 475-3795 (800) 447-8255

city city Plans/City-Employees/gold city

Point of Service, Exclusive Provider Organization, and Participating Provider Organizations/Indemnity Plans

Aetna EPO DC37 Med-Team (DC37 members only) Empire Blue EPO Empire Blue Access Gated EPO GHI-CBP/Empire BlueCross BlueShield

Group Health Incorporated:

Empire BlueCross BlueShield: HIP HMO Gold Preferred Plan

(800) 445-8742 (800) 624-2414 (800) 767-8672 (833) 924-1055

(212) 501-4444 (800) 433-9592 (833) 269-4653

city nyc nyc

city nyc city

WEEKLY

EMPLOYEE Health Plan Rates as of July 2021 (Rates are subject to change)

These rates are in effective July 1, 2021 and will be reflected as of your first full payroll period in July 2021

INDIVIDUAL Basic Prescription Drugs Rider Other*

Total (Basic + Rider)

Aetna EPO $96.46

$457.12 $0.00

$553.58

CIGNA DC37 Med Team

$227.79

$0.00

$71.09 $0.00

$0.00 $0.00

Empire Blue Access

Gated EPO

Empire EPO GHI-CBP/EBCBS

$69.80

$236.78

$0.00

$70.98 $0.00

$70.98 $0.00

$17.51 $0.95

$298.88

$0.00

$140.78

$307.76

$18.46

GHI HMO $55.04 $99.04 $0.00

$154.09

HIP HMO Gold Preferred Plan Optional Rx Rider (Grandfathered)

$0.00 $71.63

$2.09

HIP HMO Gold Preferred Plan Optional Standard Rx Rider

$0.00 $32.62

$2.09

HIP POS

MetroPlus Gold Optional Rx Rider (Grandfathered)**

MetroPlus Gold Optional Rx Rider

(Standard)**

$271.30

$0.00

$0.00

$77.86 $0.00

$58.68 $0.00

$29.23 $0.00

Vytra

$43.68 $84.46

$0.00

$73.72

$34.70 $349.17

$58.68

$29.23 $128.14

FAMILY

Basic Prescription Drugs Rider Other*

Aetna EPO

$396.08 $1,292.88

$0.00

CIGNA DC37 Med Team

$614.71

$0.00

$215.09 $0.00

$0.00 $0.00

Empire Blue Access

Gated EPO

Empire EPO GHI-CBP/EBCBS

$209.71

$601.53

$0.00

$174.02 $0.00

$174.02 $0.00

$32.10 $2.41

GHI HMO

$158.91 $252.60

$0.00

HIP HMO Gold Preferred Plan Optional Rx Rider (Grandfathered)

$0.00 $175.49

$5.12

HIP HMO Gold Preferred Plan Optional Standard Rx Rider

$0.00 $59.80

$5.12

HIP POS

MetroPlus Gold Optional Rx Rider (Grandfathered)**

MetroPlus Gold Optional Rx Rider

(Standard)**

Vytra

$664.69

$0.00

$0.00 $149.23

$190.77 $0.00

$146.71 $0.00

$53.58 $219.72 $0.00 $0.00

Total (Basic + Rider) $1,688.96 $829.81

$0.00

$383.72

$775.55

$34.51

$411.51

$180.62

$64.92 $855.46

$146.71

$53.58 $368.95

* For GHI-CBP/EBCBS, "Rider Other" is for enhanced major medical coverage. For HIP HMO, "Rider Other" is for private duty nursing & durable medical equipment. **Please note that effective August 1 2021, the grandfathered rider will be closed and the only rider available will be the standard rider.

BI-WEEKLY

INDIVIDUAL Basic Prescription Drugs Rider Other*

Total (Basic + Rider)

Aetna EPO $192.91 $914.24 $0.00

$1,107.15

CIGNA DC37 Med Team

$455.58

$0.00

$142.17 $0.00

$0.00 $0.00

Empire Blue Access

Gated EPO

Empire EPO GHI-CBP/EBCBS

$139.60

$473.56

$0.00

$141.96 $0.00

$141.96 $0.00

$35.02 $1.91

$597.76

$0.00

$281.56

$615.52

$36.92

GHI HMO $110.08 $198.09 $0.00

$308.17

HIP HMO Gold Preferred Plan Optional Rx Rider (Grandfathered)

$0.00 $143.26

$4.18

$147.44

HIP HMO Gold Preferred Plan Optional Standard Rx Rider

$0.00 $65.23

$4.18

$69.41

HIP POS

MetroPlus Gold Optional Rx Rider (Grandfathered)**

MetroPlus Gold Optional Rx Rider

(Standard)**

Vytra

$542.60

$0.00

$0.00 $87.36

$155.73 $0.00

$117.37 $0.00

$58.45 $168.91 $0.00 $0.00

$698.33

$117.37

$58.45 $256.28

FAMILY

Basic Prescription Drugs Rider Other*

Aetna EPO

$792.16 $2,585.76

$0.00

CIGNA DC37 Med Team

$1,229.43

$0.00

$430.19 $0.00

$0.00 $0.00

Empire Blue Access

Gated EPO

Empire EPO GHI-CBP/EBCBS

$419.42 $1,203.07

$0.00

$348.03 $0.00

$348.03 $0.00

$64.20 $4.82

GHI HMO

$317.82 $505.21

$0.00

HIP HMO Gold Preferred Plan Optional Rx Rider (Grandfathered)

$0.00 $350.99

$10.25

HIP HMO Gold Preferred Plan Optional Standard Rx Rider

$0.00 $119.59

$10.25

HIP POS

MetroPlus Gold Optional Rx Rider (Grandfathered)**

MetroPlus Gold Optional Rx Rider

(Standard)**

Vytra

$1,329.38

$0.00

$0.00 $298.46

$381.54 $0.00

$293.42 $0.00

$107.17 $439.44 $0.00 $0.00

Total (Basic + Rider) $3,377.92 $1,659.61

$0.00

$767.45 $1,551.10

$69.02

$823.03

$361.23

$129.84 $1,710.92

$293.42

$107.17 $737.90

* For GHI-CBP/EBCBS, "Rider Other" is for enhanced major medical coverage. For HIP HMO, "Rider Other" is for private duty nursing & durable medical equipment. **Please note that effective August 1 2021, the grandfathered rider will be closed and the only rider available will be the standard rider.

SEMI-MONTHLY

INDIVIDUAL Basic Prescription Drugs Rider Other*

Total (Basic + Rider)

Aetna EPO $209.57 $993.15 $0.00

$1,202.71

CIGNA DC37 Med Team

$494.91

$0.00

$154.45 $0.00

$0.00 $0.00

Empire Blue Access

Gated EPO

Empire EPO GHI-CBP/EBCBS

$151.65

$514.44

$0.00

$154.22 $0.00

$154.22 $0.00

$38.04 $2.07

$649.35

$0.00

$305.87

$668.65

$40.11

GHI HMO $119.59 $215.19 $0.00

$334.77

HIP HMO Gold Preferred Plan Optional Rx Rider (Grandfathered)

$0.00 $155.63

$4.54

$160.17

HIP HMO Gold Preferred Plan Optional Standard Rx Rider

$0.00 $70.86

$4.54

$75.40

HIP POS

MetroPlus Gold Optional Rx Rider (Grandfathered)**

MetroPlus Gold Optional Rx Rider

(Standard)**

Vytra

$589.44

$0.00

$0.00 $94.91

$169.17 $0.00

$127.50 $0.00

$63.50 $183.49 $0.00 $0.00

$758.61

$127.50

$63.50 $278.40

FAMILY

Basic Prescription Drugs Rider Other*

Aetna EPO

$860.53 $2,808.94

$0.00

CIGNA DC37 Med Team

$1,335.54

$0.00

$467.32 $0.00

$0.00 $0.00

Empire Blue Access

Gated EPO

Empire EPO GHI-CBP/EBCBS

$455.62 $1,306.91

$0.00

$378.07 $0.00

$378.07 $0.00

$69.75 $5.24

GHI HMO

$345.26 $548.81

$0.00

HIP HMO Gold Preferred Plan Optional Rx Rider (Grandfathered)

$0.00 $381.28

$11.13

HIP HMO Gold Preferred Plan Optional Standard Rx Rider

$0.00 $129.92

$11.13

HIP POS

MetroPlus Gold Optional Rx Rider (Grandfathered)**

MetroPlus Gold Optional Rx Rider

(Standard)**

Vytra

$1,444.12

$0.00

$0.00 $324.22

$414.47 $0.00

$318.75 $0.00

$116.42 $477.37 $0.00 $0.00

Total (Basic + Rider) $3,669.47 $1,802.86

$0.00

$833.69 $1,684.98

$74.98

$894.07

$392.41

$141.05 $1,858.59

$318.75

$116.42 $801.59

* For GHI-CBP/EBCBS, "Rider Other" is for enhanced major medical coverage. For HIP HMO, "Rider Other" is for private duty nursing & durable medical equipment. **Please note that effective August 1 2021, the grandfathered rider will be closed and the only rider available will be the standard rider. For new enrollees into MetroPlus Gold, effective August 1, 2021, there will be a new optional pharmacy available. Current MetroPlus Gold members may remain in their current rider or transfer to the new pharmacy rider. Additional information and rates will be available as soon as possible.

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