Print icon Print

Health Benefits logo

NYC Health Benefits Program

Display all Page Content



Information and Update: Preliminary Approval of Class Action Settlement of lawsuit involving $15 medical copays during the period January 1, 2022 through January 31, 2023 under the Emblem-administered medical portion of the Senior Care Plan.

Read more about the settlement

 

Hospital Updates

NewYork-Presbyterian (NYP) and EmblemHealth Reach an Agreement to Remain In-Network

NYP remains in the EmblemHealth network, ensuring continued, uninterrupted in-network access for our members.

* Optum Network (NYCE PPO) is continuing to negotiate on behavioral health with NewYork-Presbyterian and will continue to be in-network while negotiations are on-going.


Lehigh Valley Health Network out-of-network for NYCE PPO beginning April 26, 2026

Lehigh Valley Health Network in Pennsylvania is no longer part of the United Healthcare network for the NYCE PPO beginning April 26, 2026. 

Who is affected:

Members enrolled in the NYCE PPO 

What to do:

You can find a NYCE PPO in-network provider near you through the online provider search:

  1. Sign into nyceppo.com
  2. Select Find a provider
  3. Follow the directions to search by various criteria 

You can also call the NYCE PPO at 212-501-4444 (TTY: 711). One of our representatives will be happy to help you find a provider that fits your needs.

In addition, United HealthCare has put together a list of alternate hospitals by proximity to the Lehigh Valley Health Network facilities that are no longer in network.

Download the listing of alternate hospitals in your area (PDF)

What if I am currently receiving care:

Continuation of Care protections are available to minimize disruption for members who are actively receiving treatment if a provider leaves the UnitedHealthcare network. If a NYCE PPO member is undergoing active treatment for certain conditions—such as an ongoing course of care, pregnancy, serious or complex conditions, or an active inpatient admission—the member may be eligible to continue receiving covered services with their current provider for a limited period at in-network benefit levels.

Continuation of Care determinations are administered by UMR and are based on federal requirements, member eligibility, and confirmation of provider termination details supplied by UnitedHealthcare. Providers may continue treating eligible members during the approved continuation period while the member transitions to an in-network provider when appropriate, helping ensure continuity of care and patient safety.

Visit the NYCE PPO Forms Center for the Continuity of Care Form


 

MetroPlus Gold Plan Discount Prescription Drug Program: $0 for Over 100 Popular Medications*

All MetroPlusHealth Gold Plan members can enjoy significant savings with the new Discount Drug Program. MetroPlusHealth offers over 100 of the most commonly prescribed medications at absolutely no cost.  That means no copays, no coinsurance – just essential medications at $0. 

* NOTE: This is a drug discount program, not a prescription drug benefit. Drugs on the list are provided to eligible MetroPlusHealth Gold Plan members at a discounted price of $0 as part of a health and wellness benefit. Coverage for drugs that are not included in the discount program, require purchase of the optional rider and may be subject to copays.

View the Drug Plan List

 


Click here for important information on how to contact us
Close

Important Notice

RETIREE CLIENT SERVICE CENTER: 

Retirees can speak with a Client Service Representative between 10am and 4pm, Monday through Friday, except holidays, by calling (212) 513-0470.  Additional staff have been added to assist callers.

The Health Benefits Retiree Client Service Walk-in Center is open for in-person meetings on Wednesdays only, by appointment only. It remains closed to walk-in visitors. To make an appointment to meet with a Client Service Representative call (212) 513-0470. Appointments will be available on a first-come, first-served basis.


Please submit inquiries and documents as follows:

Image of blue circle with paper circle and upload arrow


1) Forms and documents can be submitted electronically through LeapFILE.

  • Before you begin, you may wish to view instructions and a short video on how to submit your forms/documents.
  • When you are ready, use the following link to submit your forms and documents: https://nycemployeebenefits.leapfile.net
  • Please do NOT submit your form/document more than once. This will only delay processing.
  • You will immediately receive notification stating "Success! Your file has been received" upon completion of your document upload.  You will not receive a separate email confirmation.
  • Please allow 30-45 days from the day you submit your document(s) for them to be processed. Coverage will be retroactive to the effective date of retirement.
  • Also, please do not send forms or documents via express mail.

2) Forms and documents can be mailed to:

NYC Office of Labor Relations
Health Benefits Program
22 Cortlandt Street, 12th Floor
New York, NY 10007

3) Inquiries and questions can be emailed to: healthbenefits@olr.nyc.gov - do not send forms through email (see #1 and #2 above)

4) For questions regarding the PICA prescription drug benefit program please call 1-800-467-2006.

5) If you are a HIP-HMO member turning 65 or on Medicare due to a disability, please contact HIP at 1-800-447-9169 to enroll over the phone. Please identify yourself as a City of New York retiree or dependent of a retiree. For all other members enrolled in a HMO plan, please contact your health plan at the customer service numbers on the back of your ID card.

Please note that active employees can contact NYCAPS Central by: 

1) Phone - (212) 487-0500 

2) Email - NYCAPSCentral@dcas.nyc.gov

Please check our website periodically for updates.



Introduction

Through collective bargaining agreements, the City of New York and the Municipal Unions have cooperated in choosing health plans and designing the benefits for the City’s Health Benefits Program.

Coverage for Employees 65+


If you're over 65, still working for the City and enrolled in the NYC Health Benefits Program, do not use your Medicare card when you visit your doctor's office. Instead, be sure to use the member ID card provided to you by your current HBP health plan.


These benefits are intended to provide you and your eligible dependents with the fullest possible protection that can be purchased with the available funding.


The OLR website and the NYC Health Benefits Program Summary Program Description (SPD) provide you with information about your benefits under the New York City Health Benefits Program. 


Health Plan Websites

Use the links below to visit your health plan where you will be able to find an in-network doctor, urgent care center, lab or pharmacy.

In addition, visit the health plan to find out if you can register to attend an informational webinar to learn more about the benefits offered under that plan.


  • NYCE PPONYCE PPO
  • HIP HMOHIP HMO
  • MetroPlusMetroPlus
  • DC 37 Med TeamDC 37 Med Team
  • GHI HMOGHI HMO
  • HIP POSHIP POS
  • HIP VIPHIP VIP
  • Anthem Non-Medicare Blue Access Gated EPOAnthem Non-Medicare Blue Access Gated EPO
  • Anthem Non-Medicare EPOAnthem Non-Medicare EPO
  • Anthem Medicare Preferred (PPO)Anthem Medicare Preferred (PPO)
  • Anthem Medicare-RelatedAnthem Non-Medicare Preferred (PPO)
  • Aetna EPOAetna EPO
  • Aetna PPO-ESAAetna PPO-ESA
  • HumanaHumana
  • ElderplanElderplan
  • AvmedAvmed
  • United Secure HorizonsUnited Secure Horizons
  • BCBS of FloridaBCBS of Florida
  • VytraVytra
  • CignaCigna
  • GHI CBP AnthemGHI CBP Anthem


Note for GHI-CBP Members: Hospitalization coverage for GHI CBP is underwritten and administered by Anthem BlueCross and BlueShield. View the Anthem Directory of participating NY, NJ, CT hospitals*

*Provider information contained in the Anthem BlueCross and BlueShield Directory is updated on a regular basis and may have changed. Therefore, please check with your provider before scheduling your appointment or receiving services to confirm participation.

Form 1095-C for Calendar Year 2025

Form 1095-C is a tax form under the Affordable Care Act ("ACA") which contains information about your health care insurance coverage. Form 1095-C is distributed to all full-time employees working an average of 30 hours or more per week, for all or part of the calendar year. For information about Form 1095-B, please contact your health care provider directly. The 1095-B will include all dependent information.

Please note that the 1095-C for the calendar year 2025 will be available for employees in February 2026. Please check Employee Self-Service (ESS), if applicable, in order to obtain the Form 1095-C, or contact your payroll department.

Please note: The 1095-B is issued directly from the health plan. If you have questions about your 1095-B, please contact your health plan directly.

Learn more about Form 1095-C


List of Health Plans

Listed are the non-Medicare Health Plans offered by the New York City Health Benefits Program to its employees and non-Medicare retirees.  View the List of Health Plans

Close 

Aetna EPO
Anthem EPO 
Anthem Blue Access Gated EPO 
DC 37 Med-Team (DC 37 members only) 
GHI-CBP/Anthem Blue Cross Blue Shield (discontinued 1/1/2026)
GHI HMO 
HIP HMO 
HIP Prime POS 
MetroPlusHealth Gold
NYCE PPO (available 1/1/2026) 
Vytra Health Plans 


View the Summary of Benefits and Coverage (SBC) for each Plan.