Health Benefits Program : Mandated Benefits July 1, 2020
Health Benefits Program Update
1) EmblemHealth: GHI/CBP for Active Employees:
EmblemHealth will be distributing new ID cards beginning May 26, 2020, through June 20, 2020, (staggered mailing) to all employees directly via regular mail to the addresses on EmblemHealth's database.
New Cards Effective Date: July 1, 2020.
All members can use their current ID cards through June 30, 2020.
The mailing packet will include the following items:
Changes to ID cards:
Please note that the old ID cards will not be active after June 30, 2020.
- ID numbers are different for medical and hospitalizations (11 digits for EmblemHealth and 9 digits for Empire Blue Cross)
- ID cards will indicate the name of each person who is covered under the health plan (each eligible dependent will receive a separate ID card with their name on it)
Accessing New ID Cards Via On-Line or Contacting the Customer Service:
If you have not received the new ID card(s) or need replacements, you may log into the health plan's portal to download the replacement ID card(s) on or after July 1, 2020. Members may also contact the health plan's customer service to request new ID cards on or after July 1, 2020.
2) PICA: Express Scripts:
Express Scripts will be distributing new PICA ID card(s) to employees enrolled in GHI/CBP PPO program in June for the effective date of July 1, 2020. There is a 10-digit number on this card (see PICA Card [nyc.gov]). PICA cards, as usual, will be issued to the employee's name on record. Therefore, eligible dependents will continue to use PICA with the employee's name on the card.
3) 45-Day Extension of Health Coverage for Dependents of Active Employees Who Passed From COVID-19:
For those family members where the employee passed between 3/1/20 and 5/15/20 due to COVID-19, letters are being sent (with an application on the back of the letter) advising family members that they can apply for the 45-day extension by submitting documentation of the death as COVID-19 related, as indicated on the death certificate or a medical document indicating a positive test result.
For those family members who submit information to the Office of Human Resources about the passing of the employee from 5/16/20 going forward, we will provide the information to the family members and the form to be completed in order to apply for the extension.
The City of New York will also accept the extension application from the family member with the documentation mentioned above. The form can be obtained on the Health Benefits website, which indicates the link where it is to be submitted. Once approved, the health carrier will be informed, and the family member will be sent a confirmation. If the family member elected COBRA coverage following the passing of the employee, the COBRA coverage will be for 36 months, beginning on the 46th day following the death after the City coverage stopped or If they want the COBRA payments to be refunded, and then they will be refunded.
4) Adding or Dropping Dependents:
The Joint Notice designates a period of time, called the "Outbreak Period," that begins on March 1, 2020, and ends 60 days after the announced date of the end of national emergency related to COVID-19 or such other date announced by EBSA (Employer Benefits Security Administration) and IRS (Internal Revenue Service).
Changes in Family Status - Adding or Dropping Dependents:
Changes include adding a dependent due to marriage, domestic partnership, birth or adoption of a child, and to drop dependents due to death, divorce, termination of domestic partnership, or a child reaching an ineligible age.
- Extension of the 30-day period to request to add/drop dependents.
- Employees should report all changes in family status to our office no later than 30 days after the end of the Outbreak Period.
5) COBRA Delays Announced by the Federal Government on 5/4/20: Due to COVID-19, Beginning 3/1/20 and Lasting Until 60 Days After the End of the National Emergency (As Yet Undetermined):
- The COBRA Notice of the Qualifying Event. Instead of 60-days to elect COBRA, the family has until 60 days after the end of the Outbreak Period.
- The Extension of the date for making COBRA Payments. The premiums for COBRA coverage during the Outbreak Period must be paid within 30 days after the end of the Outbreak Period.
These changes are explained in detail on the NYC Health Benefits Program website [nyc.gov] under "Browse Coronavirus Related Information."
Health Plans Update for July 1, 2020
1) In-Vitro Fertilization (IVF) and Fertility Preservation:
Who is Eligible for IVF Coverage?
Employees covered by the New York City Health Benefits Program seeking IVF coverage must be diagnosed with infertility, which is defined as a disease or condition characterized by the incapacity to impregnate another person or to conceive, due to the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after six months of regular unprotected sexual intercourse or therapeutic donor insemination for a female 35 years of age or older. Earlier evaluation and treatment may be warranted based on an individual’s medical history or physical findings.
What’s Covered, Other Services?
The New York City Health Benefits Program covers three cycles of IVF, including all treatment that starts when preparatory medications are administered for ovarian stimulation for oocyte retrieval with the intent of undergoing IVF using a fresh embryo transfer or medications are administered for endometrial preparation with the intent of undergoing IVF using a frozen embryo transfer.
Any treatments completed prior to July 1, 2020, will not count toward the IVF three-cycle per lifetime limit.
Medications, including prescription drugs, are covered under the IVF coverage. Injectable medications used to treat IVF are available through the PICA Program. Please refer to Health Benefits program SPD of the PICA Program under Section VII – Summary of Health Plans available at nyc.gov/hbp [nyc.gov].
The New York City Health Benefits Program shall provide coverage for standard fertility preservation services for individuals when a medical treatment will directly or indirectly result in “iatrogenic infertility,” which is an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
Age restrictions are not permitted for any covered infertility services.
2) Antiretroviral Pre-Exposure PROPHYLAXIS (“PrEP”) Health Benefits Coverage to Reduce the Risk of Contracting Human Immunodeficiency Virus (“HIV) Infection:
Who is Eligible for PrEP Coverage?
Employees covered by the New York City Health Benefits Program.
What’s Covered, Other Services?
The New York City Health Benefits Program shall cover the cost of health care services and medicines for the detection and prevention of HIV, including screenings and PrEP. Coverage for PrEP for the prevention of HIV infection and coverage for screening for HIV infection shall be provided with no cost-sharing, including copays, coinsurance, or deductibles.
Please refer to the Health Benefits Program Summary Program Description, which will be updated for July 1, 2020, in June 2020 when we receive all of the information from the health plans. Those eligible employee and eligible dependents who need further information may visit their health plan's website or contact them directly by referring to the number on the back of their ID card.
Submitted on: JUN 25, 2020
Category: HR Announcements | Human Resources