09/11/2025
There is expected to be a new five-year Health Care plan for active city employees and pre-Medicare eligible retirees effective this coming January 1st. CSBA Business Agent/ Grievance Advocate Lee Gordon and I attended the two-plus hour presentation/ question and answer session yesterday morning at DC37 along with scores of representatives from the other municipal unions. [FYI, I also examined the underlying written agreement Monday afternoon].
Here's our understanding:
Most everything remains the same: the co-pays remain nearly identical, there's still no annual premium for us to pay (it was extremely hard to keep it premium-free); it's a PPO not an HMO; you can continue to use the same doctors; EmblemHealth (successor to GHI) still administers the "Downstate Counties" including NYC, Long Island, Westchester, Orange, Rockland, Putnam, Dutchess & Ulster Counties, and the downstate panel of participating physicians within Emblem Bridge network has 78,000 doctors up from the 64,000 currently in the Emblem CBP network.
Behavioral / Mental Health coverage has a lot more participating providers. That's the one aspect of the plan which has shifted for us "downstaters" from Emblem into the United Behavioral Network.
The PICA drug program, which covers diabetic medicines, birth control, certain injectibles and chemotherapy medicines, which had run out of funds, will now be funded by the city and will still be administered by Express Scripts for 2026.
The annual transfer period (for active city employees to change health plans) will be delayed until November 1 - November 30. Information including the Summary Plan Description ("SPD") is expected to be sent out by mid-October. Shortly before then, we're told, there will be a so-called micro-site containing a lot of online plan information.
We'll see what happens, but we are guardedly optimistic and believe that relatively speaking, it sounds like a good plan.
These changes are expected to be approved on or about September 30th and to go into effect January 1st. We'll keep you posted.