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Employee/Retiree Responsibilities


Employee/Retiree Responsibilities
As a participant in the New York City Health Benefits Program, you receive health benefits and have certain rights and responsibilities. It is important that you know how your health plan works and what is required of you. The following are some of the important things that you need to remember:
  • Complete an enrollment form to add newly-acquired dependents (newborn, adoption, marriage) within 31 days of the event
  • Notify your health plan and your agency in writing when your address changes
  • Provide full-time student status verification annually for dependent(s) ages 19 to 23
  • Review your payroll/pension check to ensure appropriate premiums are deducted
  • Report Medicare eligibility to your health plan and the Health Benefits Program
  • Know your rights and responsibilities under COBRA continuation coverage

Choosing a Health Plan
To select a health plan that best meets your needs, you should consider at least four factors:

Coverage: The services covered by the plans differ. For example, some provide preventive services while others do not cover them at all; some plans cover routine podiatric (foot) care, while others do not.

Choice of doctor: Some plans provide partial reimbursement when non-participating providers are used. Other plans only pay for or allow the use of participating providers.

Convenience of Access: Certain plans may have participating providers or centers that are more convenient to your home or workplace. You should consider the location of physicians' offices and hospital affiliations.

Cost: Plan costs vary in a number of ways:

  • Some plans require payroll and pension deductions for basic coverage.
  • The costs of Optional Riders also differ.
  • Some plans require a co-payment for each routine doctor visit.
  • Some plans require you to pay a yearly deductible and coinsurance before the plans will reimburse you for the use of non-participating providers.
If a plan does not cover certain types of services that you expect to use, you should also consider the out-of-pocket cost of these services.

For more information, call the plans you are interested in for benefits packages and provider directories. Telephone numbers and addresses are listed at the end of each plan description.


Employee Assistance
Employees should contact their agency personnel or payroll office questions related to:
  • Transfer Periods
  • Enrollment
  • Eligibility or paycheck deductions
  • Requests for a Health Benefit Application Employees with questions relating to benefits, services, or claims should write or call their health plan. When writing to a health plan, include your name and address, certificate number, group number, date(s) of service, and claim number(s), if applicable.

For benefits packages and provider directories, contact each plan directly. Telephone numbers and addresses are listed at the end of each plan description.

Retiree Assistance
Retirees with questions about benefits, services, or claims should write or call their health plan. When writing to the plan, include:

  • Social Security number
  • Certificate number (if different)
  • Group number
  • Name
  • Address

Who to Contact After Retirement
Retirees can contact the Health Benefits Program for assistance with:

  • With questions regarding deductions for health benefits taken from your pension check
  • To add or drop dependents
  • To add or drop the optional rider
  • To waive health coverage
  • To change plans (excluding Medicare HMOs, which require a special application from the plan)
  • To obtain information and an application for COBRA benefits
  • To change your address
  • With questions about or problems with health benefits or pension check deductions
  • For notification of enrollment in Medicare
  • For questions regarding Medicare Part B reimbursements
  • If your health coverage has been terminated by your health plan
  • If a dependent has been terminated by your health plan

Retirees contacting the Health Benefits Program should always include the following information:

  • Name
  • Address
  • Telephone number
  • Social Security number
  • Pension number

City of New York Health Benefits Program
40 Rector Street, 3rd Floor
New York, NY 10006
(212) 513-0470
TTY/TDD: (212) 306-7753

Contacting Your Health Plan
Contact your health plan directly for the following issues:

  • If you have questions regarding covered services
  • To obtain written information about covered services
  • For information about status of pending claims or claim disputes
  • For claim allowances (How much will a plan pay towards a claim?) or to obtain a Certificate of Insurance
  • If your health coverage has been terminated by your health plan
  • If a dependent has been terminated by your health plan
  • For health plan service areas and primary care physicians
  • To enroll in a Medicare HMO

Refer to your health plan identification card or plan booklet for telephone numbers.

Contacting Your Union Welfare Fund
Employees and Retirees should contact their union welfare fund for assistance with the following:

  • Prescription drug coverage (if applicable)
  • Vision coverage
  • Dental benefits
  • Life Insurance (if applicable)

Spotlight

Employee Assistance Programs (EAPs)
EAPs are staffed by professional counselors who can help employees and their eligible dependents handle problems in areas such as stress, alcoholism, drug abuse, mental health, and family difficulties.

 Learn More
Quick Links

 PICA Program
 NYC Employee Blood Program
 Collective Bargaining Agreements
 OPA Web site
 NYC.gov