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NYC Health Benefits Program
Health Benefits Annual Fall Transfer Period
The Fall 2025 Annual Health Benefits Program Transfer Period for both employees and retirees will be November 1, 2025 - November 30, 2025.
Please note: Health Benefits Program Retiree Applications will be accepted if received by the Health Benefits Program no later than December 15, 2025.
During the Annual Transfer Period, retirees may:
- Transfer into any health plan for which they are eligible
- Add or drop the Optional Rider
- Add or drop the 365-Day Rider (GHI/Anthem Senior Care)*
- Add or drop dependent(s)
- Waive benefits
*New for 2026: If your welfare fund does not provide prescription drug coverage or Medicare-creditable prescription drug coverage to Medicare retirees, then you are eligible to purchase either the prescription drug optional rider (which includes the 365-day hospital coverage) or the 365-day hospital coverage separately. If you only purchase the 365-day hospital coverage option and you do not enroll in a Medicare Part D prescription drug plan, you may be subject to a Medicare Part D late enrollment penalty resulting in an increase in your Part D premiums.
Important: Check with your union or welfare fund or your non-City prescription drug plan to determine if you have Medicarecreditable prescription drug coverage.
Please review the Transfer Period Notices for detailed information about the transfer period and how to make changes:
Any changes made during the annual transfer period will become effective in January 2026.
To learn more about the Health Plans offered, please visit the Summary of Plans & Rates page for the following information:
- Health Plan Rate Chart for Retirees
- Summary Program Description (SPD)
- Summary of Benefits and Coverage (SBC)
- Links to the Health Plans’ websites for additional health plan and contact information
Medicare Part B & IRMAA Reimbursement
Medicare Part B Reimbursement
2024 Medicare Part B reimbursement was issued during the third week of April 2025.
Please check your bank account/statement if you are receiving direct deposit of your reimbursement.
Learn more about Medicare Part B Reimbursement
IRMAA 2024 Reimbursement
IRMAA 2024 annual reimbursements will be issued during the third week of October 2025.
Learn More about IRMAA Medicare Part B Reimbursement
Information and update regarding the Medicare Advantage Plan - June 20, 2025
Mayor Adams stated that the City has found other ways to address health care costs while providing quality health care coverage for city workers, and the City has decided not to move forward with the Medicare Advantage plan at this time.
Please refer to Mayor Adams' June 20, 2025 statement on the future of Medicare Advantage.
Information and Update: $15 copays to resume January 1, 2025 for the EmblemHealth-GHI portion of the GHI/Anthem Senior Care Plan
Senior Care members—As you may know, $15 copays for the EmblemHealth-GHI portion of the GHI/Anthem Senior Care Plan were previously suspended by court order. Now, in accordance with a more recent court order, $15 copays will resume on January 1, 2025.
Senior Care members will receive a new ID card before January 1, 2025.
Clarification in response to questions from GHI/Anthem Senior Care members with respect to the October 18, 2024 letter sent by EmblemHealth to Senior Care members:
As set forth in the updated letter, the copays are limited to one copay of $15 per provider per date of service. See November 2024 letter from EmblemHealth and the Health Benefits Summary Program Description reflecting this information.
As of January 1, 2025, Senior Care members will be required to pay a $15 copayment each time they use the health services listed below:
- Primary Care Physician Office Visits: $15 Copayment per visit
- Specialist Office Visit: $15 Copayment per visit
- Allergy testing/injections: $15 Copayment per visit
- X-rays: $15 Copayment per visit
- Laboratory tests: $15 Copayment per test
- Complex diagnostic and radiology services: $15 Copayment per visit
- Radiation therapy: $15 Copayment per visit
- Urgent Care Services: $15 Copayment per visit
- Emergency Care (Professional Component): $15 Copayment per visit
- Mental Health Care (Outpatient): $15 Copayment per visit
- Substance Use Disorder Services (Outpatient): $15 Copayment per visit
- Physical, Occupational, and Speech Therapy: $15 Copayment per visit
- Cardiac Rehabilitation: $15 Copayment per visit
- Pulmonary Rehabilitation: $15 Copayment per visit
- Chiropractic Care: $15 Copayment per visit
- Podiatry Care: $15 Copayment per visit
- Vision Care: $15 Copayment per visit
Please note, that Senior Care members are responsible for the annual Medicare Part B deductible and $50 GHI Senior Care deductible.
For questions, please call the EmblemHealth Customer Service phone number on the Senior Care member ID card.
Visit the Plans & Rates page of the Health Benefits Program wesbite to review other City’s health plan options for Medicare eligible retirees and their Medicare eligible dependents.
Retiree Responsibilities and Assistance
Medicare Part B and IRMAA Reimbursement
Information about Medicare and IRMAA Reimbursement Learn More
Medicare Part B Reimbursement
The City reimburses retirees and their eligible dependents for Medicare Part B premiums paid, excluding any penalties. You must be receiving a City pension check and be enrolled as the contract holder for City health benefits in order to receive reimbursement for Part B premiums.
For most retirees, the refund is issued automatically by the Health Benefits Program. The reimbursement amount is based on the standard Medicare Part B premiums.
Medicare Part B reimbursements are issued to eligible retirees annually during the month of April. If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement will be deposited directly into your bank account. This will be separate from your pension payment. If you don’t have EFT or direct deposit, you will receive a check in the mail.
What is IRMAA?
The Income-Related Monthly Adjustment Amount (IRMAA) is an additional amount that you are required to pay for your monthly Medicare premiums if you have higher annual earnings.
Medicare-eligible retirees and their Medicare-eligible dependents can submit an IRMAA application if they paid above the standard amount per month. If you did not pay more than the standard amount then you are not eligible for IRMAA. Please do NOT submit an IRMAA application if you are not eligible for reimbursement.
IRMAA reimbursements are issued to eligible retirees annually during the 3rd week of October. If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement is deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you will receive a check in the mail.
The Medicare Part B Reimbursement Program video provides information about the different types of Medicare Part B reimbursements that the City provides, as well as information to help you to see whether you qualify to receive these payments, and how to apply.
Your Responsibilities
It is important that you know how your health plan works and what is required of you. Learn More
Here are some important things that you need to remember:
- Complete an enrollment form to add new dependents (newborn, adoption, marriage) within 30 days after the event;
- Notify the NYC Health Benefits Program and your health plan in writing when your address changes;
- Review your pension check to ensure appropriate premiums are deducted;
- Know your rights and responsibilities under COBRA continuation coverage.
If You Need Assistance
Who you should contact for assistance and when you should contact them Learn More
Retirees with questions about benefits, services, or claims should write or call their health plan.
When writing to the plan, give your certificate number, name and address.
The Health Benefits Program is also available to provide service and information to City retirees who have questions about or problems with their health benefits or pension check deductions.
Retirees contacting the Health Benefits Program should always include the following information (please print clearly):
Name, Address and Telephone Number
Complete Social Security Number
Pension Number
Inquiries and questions can be emailed to: healthbenefits@olr.nyc.gov
Who Do I Contact After Retirement?
Find out who you should contact after retirement. Learn More
Retirees can contact the Health Benefits Program:
- For questions concerning eligibility and enrollment
- For questions regarding deductions for health benefits taken from your pension check
- For Transfer Period information
- To obtain applications to make changes to your coverage such as adding/dropping dependents, adding/dropping the optional rider, waiving health coverage and to change plans (excluding Medicare HMOs, which require a special application from the health plan).
- For notification of enrollment in Medicare
- For questions regarding Medicare Part B premium reimbursements
- To obtain information and an application for COBRA benefits
- To change your address
- If health coverage has been terminated for you and/or your dependents
When Should I Contact My Health Plan?
Find out when you should contact your Health Plan. Learn More
(Refer to your health plan identification card or plan booklet for telephone numbers.)
- If you have questions regarding covered services
- To obtain written information about covered services
- For information about the status of pending claims or claim disputes
- For claim allowances (How much will a plan pay towards a claim?)
- For health plan service areas
When writing to a health plan, include your name and address, certificate number, date(s) of service, and claim number(s), if applicable. Some plans also allow inquiries through their web sites.
When Should I Contact My Union/Welfare Fund?
Find out when you should contact your Union/Welfare Fund. Learn More
For information about:
- Prescription drug coverage (if applicable)
- Vision benefits
- Dental benefits
- Life Insurance (if applicable)
The Health Benefits Program is also available to provide service and information to City retirees who have questions about or problems with their health benefits or pension check deductions.
Retirees contacting the Health Benefits Program should always include the following information (please print clearly):
Name, Address and Telephone Number
Complete Social Security Number
Pension Number
Inquiries and questions can be emailed to healthbenefits@olr.nyc.gov
