Information and Forms
- NYC Benefits Summary Plan Description
- Health Plan and Optional Rider Costs (Effective October 2022)
- Health Benefits Enrollment Application (ERB)
- Young Adult Dependent Age 26 Health Insurance
- Dependent Eligibility Documentation
- Domestic Partner Information
- Health Plan Summaries and Contacts
- Health Plan Summary of Coverage and Benefits (SBC)
Fall Transfer Period (2022)
The Fall Transfer Period for both Employees and Retirees will be November 1st through November 30th this year. During this period, employees can:
- Transfer to another health plan
- Add or drop an optional rider
- Add or drop dependents
- Change health premium contribution tax status
- Elect the Health Benefits Buy-Out Waiver Program
Enrollment Dates: November 1, 2022 – November 30, 2022
Flexible Spending Accounts
Enrollment Dates: October 17, 2022- November 18, 2022
Health Benefit Changes for July 2021
- Health Plan Rates (effective July 2021)
- Fall Transfer Period will be held in November 2021. Any changes elected will become effective with the first payroll in mid-January 2022.
- MetroPlus Gold will have a new optional prescription rider, effective August August 1, 2021. Basic coverage has not changed.
Read the full details here in the Employee Rate Change notice.
New PICA Prescription Drug Cards
The New York City PICA Prescription Drug program for self-injectable (not including diabetic medication) and chemotherapy medications has begun issuing new PICA Prescription Benefit Cards. Starting July 1, 2021, please use the new ID cards and discard any previous PICA ID cards you may have. Please give this card to your pharmacy the next time you have a prescription filled for an injectable or chemotherapy medication only.
Express Scripts is sending covered employees these new PICA ID cards because they include a new dedicated phone number exclusively for PICA Members for Express Scripts Patient Customer Service and for Accredo, an Express Scripts Specialty pharmacy.
Each member was issued two cards, for use by the employee and dependents on the plan. If you need assistance, please use the new dedicated customer service number at (866) 832-9585.
Elimination of HIP HMO Requirement for Newly-Hired Employees
The requirement that any newly-hired employees on or after July 1, 2019 enroll in HIP HMO for the first year (365 days) of employment is no longer in effect as of January 1, 2022. Therefore, any employees hired on or after January 1, 2022 will not be subject to this requirement and may enroll in any health plan that they choose. However, any employee who is hired prior to January 1, 2022 must continue to meet the 365-day requirement.
Health Coverage for Employees Hired July 1, 2019 or After
City of New York employees, and employees of participating employers, hired on or after July 1, 2019, 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.
An employee who needs to request an exemption from the required enrollment in the HIP HMO Preferred Plan can do so by submitting a HIP HMO Opt-Out Request Form. An employee, or eligible dependent, must meet certain criteria and the request must be approved by EmblemHealth before the exemption is granted.