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GHI Co-pays Increase

February 26, 2016 pm29 6:22 pm

Emergency Room 200% ↑
Urgent Care  233% ↑
Surgical and Dermatological Specialists 50% ↑
All Other Specialists 100% ↑
Blood Work  33% ↑
MRI 233% ↑
Physical Therapy 33% ↑

When we were presented the last contract to vote on, there was  blank for health care. We warned, I warned, how can you vote on changes to health care when we do not know what will change. The agreement called for UNSPECIFIED health care savings of $400 million the first year, and then $300 million for the second (this) year, then $300 million, then $300 million, for a total of $1.3 billion, BILLION, dollars.

The UFT’s Unity leadership told us we could achieve cost savings without affecting our health care. That was not true.

Below please find the language from the Memorandum of Agreement. Following that, find the announcement about the increase in co-pays.

We need a leadership that will be honest with the members. – jd

H. Healthcare Savings
a. The UFT and the City/DOE agree the UFT will exercise its best efforts to have the MLC agree to the following:
i. for fiscal year 2015 (July 1, 2014-June 30, 2015), CONTRACT AGREEMENT 2014 there shall be $400 million in savings on a citywide basis in health care costs in the NYC health  care program.
ii. for fiscal year 2016 (July 1, 2015-June 30, 2016), there shall be $700 million in savings on a citywide basis in health care costs in the NYC health care program.
iii. for fiscal year 2017 (July 1, 2016-June 30, 2017), there shall be $1 billion in savings on a citywide basis in health care costs in the NYC health care program.
iv. for fiscal year 2018 (July 1, 2017-June 30, 2018), there shall be $1.3 billion in savings on a citywide basis in health care costs in the NYC health care program.
v. for every fiscal year thereafter, the savings on a citywide basis in health care costs shall continue on a recurring basis.
vi. The parties agree that the above savings to be achieved on a Citywide basis are a material term of this agreement.
vii. In the event the MLC does not agree to the above citywide targets, the arbitrator shall determine the UFT’s proportional share of the savings target and, absent an agreement by these parties, shall implement the process for the satisfaction of these savings targets.
viii. Stabilization Fund: (1) Effective July 1, 2014, the Stabilization Fund shall convey $1 billion to the City of New York to be used in support of the pro rata funding of this agreement. (2) Commencing on July 1, 2014, $200 million from the Stabilization Fund shall be made available per year to pay for ongoing programs (such as $65 welfare fund contribution, PICA payments, budget relief).
In the event the MLC does not agree to provide the funds specified in this paragraph, the arbitrator shall determine the UFT’s proportional share of the Stabilization Fund monies required to be paid under this paragraph.

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Dear Jonathan,

I am writing to inform you about coming changes to the city health care plans negotiated by the city and the Municipal Labor Committee, the umbrella group of municipal labor unions of which the UFT is a member.  These changes affect our in-service members and our retirees who are non-Medicare eligible. As part of our last collective-bargaining agreement, we agreed to achieve health care savings.  By collaboratively working with the city, we have been able to preserve access to quality health care while meeting our savings obligation.

We are proud that public school educators and all other New York City municipal employees have access to health coverage without an annual premium. That will continue. When the changes take effect in the next several months, certain GHI and HIP copays will be adjusted.  Some will increase, but we also made certain to eliminate other copays to make low or no-cost options available for many health care services.

GHI subscribers currently pay $15 when they visit their primary care physician, the most utilized service in the plan. That copay will not change. Members using physicians at the Advantage Care Physician (ACP) offices will have no copay.  There will, however, be copay increases to see specialists and receive various diagnostic tests from other providers in the GHI network.

Members seeking to keep their health care costs down should consider visiting one of the 36 Advantage Care Physician (ACP) centers created by EmblemHealth in New York City and in Nassau and Suffolk counties. Members who receive care, including urgent care, at one of these sites will have no copays for their treatment, including high-tech radiology. Bronx-based members will have access to ACP-affiliated physicians at various Bronx locations to be announced.  We will also be working on extending this coverage north to Westchester, Rockland and other counties.

GHI subscribers will no longer have any copays for preventive health care. All preventive health services — including prescriptions for birth control, immunizations, mammography, prenatal vitamins and colonoscopies — will soon be available to GHI subscribers free of cost. Members will receive more information from EmblemHealth in the next few months.

One of the most expensive forms of care is hospital-based emergency room visits, which should only be used in a genuine emergency. The cost to the health plan for a visit to the ER is several times that of a visit to a doctor’s office. Our data show that some members are over-utilizing hospital emergency rooms. To discourage the use of ERs when a doctor’s visit would suffice, the copay for hospital-based emergency-room visits will increase from $50 to $150.  Please be aware that you can see a doctor at short notice at one of EmblemHealth’s Advantage Care Physician offices with no copay or at a participating Urgent Care facility with a $50 copay.

As part of our Wellness programs, we will also be introducing telemedicine, which will allow members immediate access to an Internet-based physician who can guide their care and even provide a prescription if necessary.  All members in a New York City health plan will also be able to join Weight Watchers at a substantial discount.

HIP subscribers will also see changes to their health plan. HIP is introducing a new plan called HIP Preferred. HIP subscribers can continue to use their HIP doctor with no copay if he or she is in the HIP Preferred network. HIP subscribers will now have a $10 copay if their doctor is not in the HIP Preferred network.

The chart below lists the GHI changes that will take effect in the coming months:

GHI – CBP Benefits Current Copay New Copay

The following chart shows the changes affecting HIP subscribers:

HIP Benefits Current Copay New Copay
HIP Preferred Network (new) No copay No copay
HIP Non-Preferred Physician No copay $10

Here are a few helpful links:

We will be sharing more information in the New York Teacher and on the UFT website in an effort to answer any questions you might have and prepare you for the various changes.


Arthur Pepper
UFT Welfare Fund Executive Director


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