| Medicare Advantage Plan Updates
IMPORTANT UPDATE AUGUST 11, 2023: JUDGE PERMANENTLY BLOCKS IMPLEMENTATION OF AETNA MEDICARE ADVANTAGE PLAN; CITY APPEALS
| When we learn anything new, we will post it on this page with the most recent developments first. You should also regularly check the phone hotline or the Weekly Newsline section of this site for updates. 5/23/24 UPDATE: The New York State Supreme Court Appellate Division issued a 4-0 unanimous ruling in the "Aetna" case rejecting the City's appeal of Judge Lyle Frank's permanent restraining order against the elimination of all health care choices for Medicare-eligible retirees except a new Medicare Advantage Plan administered by Aetna. Oral arguments in the case took place in March and appear in the update below. For those who would like to read the full decision, we link it below, along with an article from The Chief newspaper about the case. The City has already announced its intention to request permission from New York's highest court, the Court of Appeals, to appeal the Appellative Division's decision. If the Court of Appeals grants the hearing, two cases will be scheduled to be before them, this case and the "Alliance" case. Descriptions of the cases appear in the 3/15/24 update below. The final case, over the imposition of copays on the GHI Senior Care plan from January 2022 to January 2023 is due to be heard soon in the Appellate Division. Decision Of The Appellate Division Upholding A Permanent Injunction Against the Aetna MAP plan Article in the Chief About the Appellate Division Ruling 3/22/24 UPDATE: On Thursday, March 21, 2024, the New York State Supreme Court Appellate Division heard oral arguments in the "Aetna" case in which the City appealed Judge Lyle Frank's permanent restraining order against the elimination of all health care choices for Medicare-eligible retirees except a new Medicare Advantage Plan administered by Aetna. Oral arguments in the case appear in this clip starting at 15 minutes 19 seconds in the session and ending at 39 minutes 32 seconds. A decision by the Appellate Division could take weeks or months.
3/15/24 UPDATE: Three appeals of prior decisions made in the lower courts (Supreme Court and Appellate Division) have been filed by the City and have been slowly moving their way to hearings in the higher courts. The first to be heard will be the "Aetna Case," in which the NYC Organization of Public Service Retirees successfully challenged the City's attempt to remove traditional Medicare from the options Medicare-eligible retirees enjoy in City-funded health plans. As will be recalled, the City was attempting to force all Medicare-eligible retirees into a Medicare Advantage Plan administered by Aetna. Supreme Court Judge Lyle Frank had issued a permanent restraining order in August 2023 against the City's plan. That case will now have a hearing in the Appellate Division of State Supreme Court. Also in the Appellate Division without a hearing date, as yet, is the "GHI Copay Case," in which the NYC Organization of Public Service Retirees successfully challenged the City and Emblemhealth/GHI's imposition of copays on the GHI Senior Care Plan, starting in January 2022. Judge Frank issued a restraining order against imposition of those copays and, as of January 2023, those copays have no longer been collected. Among the issues to be decided is whether City retirees, who were granted class action status, should have the copays reimbursed from the year they were collected. Finally, the third case, the "Alliance Case," will eventually be heard in the NYS Court of Appeals after the Appellate Division upheld Judge Frank's decision barring the City from imposing a premium to remain in traditional Medicare with supplemental coverage (as in GHI Senior Care) while offering Medicare Advantage without premium. 10/20/23 UPDATE: Judge Lyle Frank today issued an order granting class action status to the suit by the NYC Organization of Public Service Retirees and several named plaintiffs over the imposition by the City and Emblemhealth GHI of copayments on the GHI Senior Care plan during the period from January 2022 to January 2023. You can read the judge's order at the following link: Judge Lyle Frank's Order Granting Class Action Status in Copayment Lawsuit The City meanwhile has appealed Judge Frank's issuance of a permanent injunction against implementation of the Aetna Medicare Advantage PPO plan. This case will now go to the Appellate Division of State Supreme Court. On the legislative front, Intro 1099, the City Council bill introduced by Councilmember Charles Barron which would amend the City Administrative Code to mandate provision of traditional Medicare plus a Medicare supplement plan as one of the options for Medicare-eligible retirees now has 18 co-sponsors. The bill needs 34 co-sponsors to be "veto-proof." 8/11/23 VERY IMPORTANT UPDATE: Judge Lyle Frank today issued a permanent restraining order against the implementation of the City's plan to move all Medicare-eligible retirees into the Aetna Medicare Advantage PPO Plan, with traditional Medicare and a Medicare supplement only available to those who waived City health coverage. The Judge acted when both sides agreed that no additional arguments would be made or materials submitted in the case. The Judge's Permanent Restraining Order can be read at the following link: Permanent Restraining Order Blocking Aetna Plan Implementation The key sentence is "ORDERED that the Respondents are permanently enjoined from requiring any City retirees, and their dependents from being removed from their current health insurance plan(s) and from being required to either enroll in an Aetna Medicare Advantage Plan or seek their own health coverage." The City announced in press coverage that it intends to appeal the judge's decision to the Appellate Division of State Supreme Court. Therefore, you do not need to take further action and you will remain in your current health plan and drug rider pending any further appeals court decision. Meantime, the City Council bill introduced by Councilmember Charles Barron (Intro 1099) which would amend the City Administrative Code to mandate provision of traditional Medicare plus a Medicare supplement plan as one of the options for Medicare-eligible retirees now has 16 co-sponsors. The bill needs 34 co-sponsors to be "veto-proof." 7/21/23 UPDATE:The City has now filed an appeal of Judge Frank's Temporary Restraining Order with the Appellate Division of NY State Supreme Court. The appeal document is posted at this link: City's Appeal of Judge Frank's Temporary Restraining Order A reminder, no further action needs to be taken and you will remain in your current health plan and drug rider. The only exception are those individuals who may have elected to contract for their own Medicare supplement and Part D drug plan in anticipation of exiting City health coverage. Those retirees should be sure to contact your insurance broker or the health plan you had intended to start in September and discuss how to pause the plan or withdraw from it. 7/7/23 VERY IMPORTANT UPDATE:Today, Judge Lyle Frank issued an order granting a Temporary Restraining Order blocking the implementation of the Aetna Medicare Advantage PPO Plan. The decision puts on hold until further court action ANY implementation of the Aetna plan. You DO NOT have to waive City coverage or opt out of Aetna into HIP VIP by July 10th. All current health coverage remains in place as it currently exists. If you are in GHI Senior Care you remain in that plan. If you are in another plan, you remain in your current plan. Those retirees who may have already arranged to purchase a private medigap plan and drug plan, be sure to contact your insurance broker or the health plan you intended to start in September and discuss how to pause the plan or withdraw from it. If you have already filed a special waiver form with the City to end your City coverage, nothing will happen.You will remain in your present plan. The Court's order is posted at the following link: Temporary Restraining Order Against The Implementation Of the Aetna Medicare Advantage Plan 7/6/23 UPDATE:Judge Lyle Frank held oral arguments on Thursday, July 6th, in the case seeking a Temporary Restraining Order on implementation of the Aetna Medicare Advantage PPO Plan. On Thursday, the judge also issued two decisions in the case, denying the motion to intervene by both Aetna and the Municipal Labor Committee but permitting each to submit amicus curiae briefs. His orders are posted below: Order Denying Aetna and the MLC's Requests to Intervene 6/23/23 UPDATE:The Retirees have now submitted its memorandum of law in response to the City's reply to their initial brief. You can view it at the following link: Retirees' Memorandum of Law In Response to the City In the meantime, at the June 22nd City Council Stated Meeting, Councilmember Charles Barron, joined by Councilmembers Inna Vernikov, Lynn C. Schulman, Linda Lee, Alexa Aviles, Shahana K. Hanif, Kristin Richardson Jordan, Christopher Marte, Shekar Krishnan, Joann Ariola , Vickie Paladino, and Ari Kagan introduced a bill to amend the City's Administrative Code to mandate the provision of a Medigap plan to Medicare-eligible City retirees. The bill was referred to the Civil Service and Labor Committee. You can read the bill as introduced here: 6/16/23 UPDATE: A conference between the parties and Judge Lyle Frank was held on Friday, June 16th. In order to accomodate the Judge's schedule, it was agreed that the "opt-out" date by which you will have to waive City health coverage or move into HIP VIP will be voluntarily extended to July 10th. The Court said it intends to have oral argument on the petitioners' preliminary injunction after July 4th and before the 10th. In the meantime, the retiree group behind the lawsuit has announced that Councilmember Charles Barron will introduce legislation at the June 22nd stated council meeting which would require the City to offer Medicare-eligible retirees a Medigap/Medicare Supplement plan. On June 16th, the City filed its response to the Retirees' papers. you can read their response at the link below. The Retirees' response is due on June 20th. City's Response To The Lawsuit In addition, the Municipal Labor Committee has filed papers with NYS Supreme Court seeking to also intervene in the lawsuit. Below are two of the MLC's submissions to the court. 6/13/23 UPDATE: Aetna has now filed papers with NYS Supreme Court seeking to intervene in the lawsuit over the Medicare Advantage Plan which we outlined in our June 6th update below. Meantime, City Comptroller Brad Lander refused to register the contract for the Aetna Medicare Advantage Plan, returning it to the Mayor's Office of Labor Relations. Comptroller Lander's explanation for his position can be found at the linked news release below. 6/6/23 UPDATE: At the end of May, the NYC Organization of Retired Public Service Employees filed court papers in NYS Supreme Court seeking to block the City from implementing the new Aetna Medicare Advantage Plan. In addition, the group sought a Temporary Restraining Order that would put a hold on further implementation of the plan while the case is heard in State Supreme Court. Below are the two major documents in the new court case: Petition From The NYC Organization of Retired Public Service Employees Memorandum of Law From the NYC Organization of Retired Public Service Employees On June 6th, the NYC Organization of Retired Public Service Employees announced that the case had been assigned to Judge Lyle Frank who heard the prior lawsuit against the Emblem/Anthem Medicare Advantage Plan. In a YouTube video, they indicated that the City's reply to the suit is due by June 16th, with the Organization's response due by June 20th. On June 6th, Judge Frank issued an interim decision that did not at this point grant the request for a Temporary Restraining Order but did allow the case to move forward to submission of materials and perhaps oral arguments after June 20th. At this time it remains unclear if Judge Frank will ultimately grant the TRO, deny the TRO or push forward the June 30th deadline for waiving City health benefits. On June 14th, OSARC's June membership meeting will feature a guest speaker from the NYC Department For the Aging outlining options for seeking supplemental health and drug plans for those who opt to remain in traditional Medicare. As you know by now, to do so, you must waive your City health benefits. In waiving those benefits, you will be giving up your Medicare Part B reimbursement by the City (and any income related monthly adjustment amount) and the union's partial subsidy of your drug rider costs. You will also be facing monthly premiums for the Medicare supplement and for the Medicare Part D drug plan you choose. If you are seriously considering this option, you need to explore plans that would be suitable for you as an individual, based on what they cover and what the premiums are. On another front, the Appellate Division of State Supreme Court has upheld the NYS Supreme Court decision blocking the City and Emblemhealth from collecting co-pays on GHI Senior Care health visits which were implemented on January 1, 2022 and blocked by a Temporary Restraining Order in January of 2023. That case will move forward in the lower court. 4/28/23 UPDATE: As of the end of April, the City plans to discontinue GHI Senior Care and all other plans for Medicare eligible retirees on September 1, 2023. The only options remaining will be the new Aetna Medicare Advantage PPO Plan and HIP VIP, both Medicare Advantage plans. It is the City's intention to automatically enroll all Medicare-eligible retirees and Medicare-eligible dependents, except for HIP VIP members, in the new plan on September 1st. From May 1, 2023 through July 10, 2023, Medicare-eligible retirees can choose to opt out of the new Aetna plan and enroll in HIP VIP or waive City health coverage. Here are several scenarios. Opting Out of the Aetna Medicare Advantage PPO Plan and enrolling in HIP VIP If you reside in the HIP VIP service area (Manhattan, Brooklyn, Bronx, Staten Island, Queens, Nassau, Suffolk, Westchester, Rockland and Orange counties) and wish to participate in HIP VIP instead of the Aetna Medicare Advantage PPO Plan, you should contact Aetna at 1-855-648-0389 or visit their website at CONY.AetnaMedicare.com. Indicate that you wish to "opt out" of the Aetna Medicare Advantage PPO Plan. The City says no opt-out form will be required. Retirees must contact the call center (TTY: 711), Monday to Friday, 8 a.m. to 9 p.m. between May 1, 2023, and July 10, 2023 in order to do this. HIP VIP members who wish to leave HIP VIP and enroll in the Aetna Medicare Advantage PPO Plan must complete the Health Benefits Program Retiree Special Enrollment/Waiver Form. Completed forms should be returned to the Health Benefits Program. HIP VIP members who wish to remain in that plan do not have to do anything. Waiving City Health Coverage Retirees who do not want to be enrolled in the Aetna Medicare Advantage PPO Plan or HIP VIP can waive City health coverage. Retirees must complete the Health Benefits Program Retiree Special Enrollment/Waiver Form to waive City health coverage. Completed forms should be returned to the Health Benefits Program. Retirees who waive health coverage are not eligible for Medicare Part B reimbursement. Retirees who waive their City health coverage can re-enroll should they experience a loss of coverage or during the annual Retiree Transfer Period. The Special Enrollment/Waiver Form can be downloaded at the following link: Health Benefits Program Retiree Special Enrollment/Waiver Form Plan documents are posted here but can also be found on the plan website, linked below. To Attend A Webinar About The Aetna Plan, Sign Up At This Site: Aetna Webinar Sign-Up Site To sign up for an In-Person Aetna Introductory meeting on the plan go to this link: Aetna In Person Plan Seminar Registration Page
To look up providers in the new plan and obtain other plan information, visit Aetna's plan website:
Aetna Medicare Advantage Plan Website
You can contact the Aetna NYC Retiree dedicated call center at 1-855-648-0389 (TTY: 711), Monday to Friday, 8 a.m. to 9 p.m. Aetna will assist in answering questions about the benefits, the network, or clinical transition questions.
3/31/23 UPDATE: On March 30th, Mayor Adams signed the contract with Aetna for its Medicare Advantage Plan set to cover Medicare-eligible City retirees as of 9/1/23.
Aetna has produced further forms and information about its plan, including these publications concerning continuity of care for retirees with procedures and treatments that will continue beyond the 9/1/23 plan start date.
Aetna Continuity of Care Letter
Aetna Continuity of Care Brochure
In addition, the NYC Organization of Public Service Retirees has now filed its brief in the case against Emblemhealth for the charging of copayments on GHI Senior Care. You can read it here:
NYC Organization of Public Service Retirees Brief In GHI Senior Care Copayments Case
3/21/23 UPDATE: On March 21st, a hearing on the new Aetna Medicare Advantage Plan was held by the City and many retirees testified. The hearing was conducted in the form of a conference call. The City's Office of Labor Relations recorded the hearing and posted it on its website as an mp3 file. You can reach it at the following URL:
City Hearing On The New Aetna Medicare Advantage Plan
In addition, The City has now posted new flyers and brochures about the plan which we re-post here:
Brochure For Your Doctor Introducing The Aetna Plan
Frequently Asked Questions About The Aetna Plan
Information About Prior Authorizations On The Aetna Plan
Updated List of Webinars and Seminars About the Aetna Plan
Aetna - How To Find A Provider Brochure
Aetna Brochure For Participating Providers
Aetna Brochure For Nonparticipating Providers
3/10/23 VERY IMPORTANT UPDATE: On March 9th, the Municipal Labor Committee voted to approve the new Aetna Medicare Advantage Plan by a weighted vote of 79% to 21%. OSA, along with the Doctors Council, the New York State Nurses Association and a number of other unions abstained.
The City has now posted several important documents on its website and we are making them available here:
Letter From the City's Office of Labor Relations to Retirees About The Aetna Plan
Aetna Medicare Advantage Plan Evidence of Coverage
Comparison of GHI Seniorcare, HIP VIP and Aetna
Drug Rider Evidence of Coverage - Silver Script
Drug Rider Formulary On Silver Script
Summary of the Aetna Silver Script Drug Rider
Comparison of Drug Riders On GHI Seniorcare, HIP VIP and Aetna
Aetna Webinars Introducing The New Plan
To sign up for an Aetna webinar, go to this link: Aetna Webinar Sign-Up Page
To sign up for an In-Person Aetna Introductory meeting on the plan go to this link: Aetna In Person Plan Seminar Registration Page
3/2/23 VERY IMPORTANT UPDATE: Aetna presented an overview of the Medicare Advantage plan they have been negotiating with the City and the Municipal Labor Committee at a special meeting of the MLC General Membership. We are posting the documents circulated about the plan prior to the meeting at the links below:
Summary of Proposed Aetna Medicare Advantage Agreement
Comparison of GHI Senior Care and Aetna MAP Plan
Comparison of GHI Senior Care and Aetna MAP Plan Drug Riders
At the MLC Membership meeting, it was agreed that a vote would be taken on the Aetna MAP plan at a General Membership meeting to be held on March 9, 2023, assuming answers to questions raised at today's meeting were provided by Aetna by Monday, March 6th. If the plan is approved, the only two health plans available to Medicare-eligible retirees as of September 1, 2023 would be the new Aetna MAP plan and HIP VIP, another Medicare Advantage plan. GHI Senior Care would no longer be an option offered by the City.
Aetna provided the following document to the MLC which contains its answers to the questions raised by MLC unions at the MLC general membership meeting held on March 2, 2023:
Responses to MLC Questions From The March 2nd Presentation By Aetna On Their Medicare Advantage plan
And this is the slide presentation made by Aetna on March 2nd to the MLC General membership:
Slide Presentation Made By Aetna To The MLC On March 2nd
2/13/23 UPDATE: GHI Senior Care co-pays should not be collected for visits after 1/12/23. If your doctor or facility seeks to collect a co-pay after that date, have the doctor's office call Emblemhealth at the number on the back of your membership card. You may also choose to carry with you a copy of the Preliminary Injunction, which we posted in the update for 1/11/23 so that you may show it to the staff at your physician's office. For service dates prior to 1/12/23, you may try the same procedure. However, we recommend you do not jeopardize your care and, if needed, pay those co-pays. However, be sure to collect your bills and proofs of payments so that you will have a record of your 2022 and early 2023 bills and payments for submission should the court case result in a ruling that those earlier copays must be reimbursed.
The City and the MLC have indicated that they continue to negotiate with Aetna on a new Medicare Advantage plan and that progress has been made in eliminating approximately 75% of prior authorization requirements for treatments and procedures in the plan Aetna is proposing. According to the MLC, both Memorial Sloan Kettering and the Hospital For Special Surgery have both agreed to be in-network for the plan under negotiation.
New briefs have been posted in the court case over the co-payments. We post them at the links that follow.
Amended Complaint by Retirees In Co-Pay Case
City's Appeal To Reverse Preliminary Injunction in Co-Pay Case
1/11/23 UPDATE: State Supreme Court Justice Lyle Frank issued a preliminary injunction against Emblemhealth in the GHI Senior Care co-payment case: the $15 copays introduced in January 2022 cannot be collected, at least while the case is adjudicated. You can read the judge's order at the following link:
Preliminary Injunction Against Co-Pay Collection By GHI Senior Care
Meantime, the New York City Council let it be known in the media that no vote would be taken on the Amendment to Administrative Code Section 126-12 at its January 19th full meeting and that, for the time being anyway, the change to the Administraitve Code was "off the table."
In addition, the City and the MLC stated they were continuing to negotiate with Aetna on a new Medicare Advantage plan but various supposed deadlines in negotiating an agreement were passed with no further developments.
1/10/23 UPDATE: The New York City Council Civil Service and Labor Committee held a hearing on Monday on the proposal by the City and the Municipal Labor Committee to amend Administrative Code Section 126-12 to permit the setting of a separate benchmark for health plans serving Medicare-eligible retirees and a different benchmark for actives and non-Medicare retirees. The hearing lasted nearly 12 hours! It featured testimony by representatives of the City's Office of Labor Relations and the leadership of the MLC, as well as representatives of the NYC Organization of Public Service Retirees and unions opposed to the Administrative Code amendment, along with scores of retirees. You can watch the entire hearing at the following link: Video of the January 9, 2023 Civil Service & Labor Committee Hearing
In addition, recently the City and Emblemhealth have filed their reply memoranda in the lawsuit over the imposition of co-pays on GHI Senior Care. You can read the memoranda of law at the following links:
NYC Organization of Public Service Retirees Reply
1/3/23 UPDATE: The City is pushing the City Council to amend Administrative Code Section 126-12 to permit the setting of a separate benchmark for health plans serving Medicare-eligible retirees and a different benchmark for actives and non-Medicare retirees. Over the New Years 2023 weekend, City Council Speaker Adrienne Adams and Civil Service and Labor Committee Chair Carmen De La Rosa announced they would be introducing legislation to amend Section 126-12 on January 4, 2023 and that a Civil Service and Labor Committee hearing on the bill would be held on Monday, January 9th. The NYC Organization of Retired Public Service Employees, the group which filed the initial lawsuit against the MA plan is organizing testimony and actions opposing the change. Information is available on their website: https://www.nycretirees.org.
12/2/22 UPDATE: The NYC Organization of Retired Public Service Employees has filed a second lawsuit against the City, Emblemhealth and GHI seeking reversal of the co-payments imposed on GHI Senior Care enrollees as of January 1, 2022. You can read the Petition and Memorandum of Law from the case at the links below. As of now, there has been no legal response from the City or Emblemhealth.
Memorandum of Law in Co-Pay Lawsuit
11/25/22 UPDATE: The Appellate Division of New York State Supreme Court upheld Judge Frank's ruling in the Medicare Advantage Plus Plan case, ruling against the City in its appeal of Judge Frank's decision. Below is a link to the court's decision and an article in the Chief newspaper about the decision.
Appellate Division Ruling in the Medicare Advantage Case
Chief Article About The Decision
10/27/22 UPDATE: Oral arguments in the appeal of Judge Frank's ruling in the Medicare Advantage Plus Plan case were heard on 10/27/22. You can view the arguments in this video of the Appellate Division's session. The case occupies the last segment of the video and runs approximately 20 minutes starting about the 2 hour and 27 minute point in the video, which you can reach at the following link and which is pre-set to start at about that point:
9/17/22 UPDATE: In the appeal of Judge Frank's ruling in the Medicare Advantage Plus Plan case, the Organization of NYC Public Service Retirees filed a brief with the Appellate Division of State Supreme Court on September 7th and the City has filed a reply brief on September 16th. You can download and read both at the links below:
Retiree Appellate Brief Submitted To The Court On 9/7/2022
City Reply Brief Submitted To The Court On 9/16/22
The oral arguments in the case remain set for the October Term on a date to be determined.
Over the Summer, the Alliance (Emblem/Anthem) withdrew from the NYC Medicare Advantage Plus Plan. As a result, the Retirees Organization dropped its cross-appeal of the Judge's ruling, arguing that its cross-appeal was based on the specific terms of the plan as constructed by the Alliance. They state that they reserve the right to reintroduce the issues raised in their cross-appeal should they be relevant to any future contract awarded by the City.
In addition, the City and the MLC agreed in early September that the City may go forward to negotiate with Aetna (the losing bidder in the original Medicare Advantage negotiated acquisition process) on a replacement Medicare Advantage plan.
Finally, the City and the MLC have agreed to propose jointly to the City Council that an amendment be made to Section 12-126 of the Administrative Code that governs the requirement of health care provision to active and retired City employees. The amendment would allow the City, if agreed to by the MLC, to establish more than one benchmark health insurance plan, one for actives and non-Medicare retirees and the other for Medicare-eligible retirees. The City has been pushing the City Council to take up this question but, as of late October, the Council has not done so.
7/19/22 UPDATE:On July 19, 2022, the union was informed by the Municipal Labor Committee of the following new development in the Medicare Advantage Plus Plan implementation story: "We were exploring several paths to advance the program so that it could begin on January 1, 2023. Despite being continually apprised of our efforts, Anthem/Empire recently demanded that the City/MLC unconditionally guarantee that the program would start on January 1, 2023 regardless of any change or Court decision. This was not something we or the City could or should do. Anthem/Empire has now informed us that they will not continue with the program. The City and the MLC are exploring our options for providing a substitute Medicare Advantage program that will provide quality care on a premium free basis."
So, the status quo remains, including the co-payments on GHI Senior Care introduced in January of 2022. We will keep you updated (as we have been for more than a year) as we learn of new developments. We have not removed the history of the plan and the court case surrounding the NYC Medicare Advantage Plus Plan impelementation below for those who may wish to refer to some of the older information.
Should you wish to review the history of the introduction and collapse of the original proposed Medicare Advantage plan, we have left the updates below for the time being:
CITY AND MLC AGREE ON A NEW GROUP MEDICARE ADVANTAGE PLAN On March 3, 2022, the Court considering a lawsuit against the new plan decided that retirees opting out of the new NYCMAPP plan can not be charged a basic plan premium except insofar as it exceeds an existing statutory cap in the NYC Administrative Code. As a result, on March 4, 2022, the City posted on its website that IT WOULD NOT BE IMPLEMENTING the new plan on April 1, 2022. In addition, the City filed an appeal of the judge's order with the Appellate Division of State Supreme Court. That appeal is set for hearing in October of 2022. For more information, see the update for March 4, 2022 below. Updates appear in date order, starting back in October of 2021.
In mid-July 2021, the City and the Municipal Labor Committee, which brings together more than 100 unions representing NYC municipal workers, agreed on a new group Medicare Advantage health plan for Medicare-eligible City retirees, the New York City Medicare Advantage Plus plan (NYCMAPP). Current enrollees in all of the health plans for Medicare-eligible City retirees were to be transferred into the new plan effective April 1, 2022 unless they completed a request to "opt-out" of the new plan by March 31, 2022.That date has now been postponed by the City.
Meanwhile, we are providing information to help you decide which health plan works for you and whether you wish to accept the new plan or "opt-out" and remain in the plan you presently have.
OSA retirees will still have to purchase a Medicare Part D enhanced drug rider, should you elect to enroll in one. For example, the GHI Senior Care drug rider is $125 per month per person after January 1, 2022, down from $150.30 monthly per person in 2021. (The union Welfare Fund will continue to reimburse $50 monthly per covered member and spouse/partner toward that drug rider cost for any City-provided health plan.)
Below, we are posting the complete video of a special OSA Retirees Club meeting held virtually on Zoom on February 23, 2022 in which representatives of the NYCMAPP plan and the City's Office of Labor Relations presented information about the new plan and took questions from OSARC members. This is the third OSARC session devoted to the new plan. The other two were held in September and October of 2021. Videos of those sessions are also posted further down on this page.
Below the video, we post updates about the implementation of the new plan and the court case which was filed last fall and which has resulted in postponement of the start date of the new plan. After those updates, we post plan documents and other information about the new plan and other City health plans to help you make your decision.
ORGANIZATION OF STAFF ANALYSTS RETIREES CLUB SPECIAL SESSION ON THE NEW YORK CITY MEDICARE ADVANTAGE PLUS PLAN
The process of implementation of the NYCMAPP plan has been rocky. In the early fall of 2021, The NYC Organization of Public Service Retirees filed a lawsuit in State Supreme Court challenging both the introduction and implementation of the plan.
We are placing updates about the implementation of the new Medicare Advantage plan in this section organized by date. As we receive new information, we are posting it here. You should also check the Weekly Newsline page and the OSA Newsletter page for any additional information.
10/21/21 UPDATE The New York State Supreme Court has issued a restraining order against the City on implementation of the new Medicare Advantage Plus Plan. Therefore, the City will not be allowed to go forward with the 10/31 opt-out date and has been ordered to cure defects in its implementation of the Plan and present a revised plan to the Court for approval. In the meantime, the City has been ordered to leave Medicare-eligible retirees in the health plans they presently have. You can read the restraining order at the following link:
New York State Supreme Court Restraining Order On The New Medicare Advantage Plus Plan
11/15/21 UPDATE The Court directed the City to submit for review a supplemental plan of implementation to address, among other matters, better information as to provider participation. In the interim, the Court put on hold any deadline for deciding whether to opt-out of the new plan. The City submitted its plan Friday, November 5th and the retiree group submitted its view of the new implementation plan on November 12th. You can view both the new implementation plan and the response at the links below. They are being reviewed at present by the judge in the case.
The City's New Implementation Plan
The Petitioner Retiree Organization's Response To The Plan
11/19/21 UPDATE The Court has ordered an all attorneys meeting, according to the website of the NYC Organization of Public Service Retirees, the group that filed the lawsuit. The meeting will be held on Tuesday November 23rd at 10am. According to the website you can can watch the meeting by livestream.
12/6/21 UPDATE On 11/23, so many retirees attempted to log onto the livestream that it crashed. The City argued it needed an opt out date of 11/30 so that the plan could be implemented on January 1, 2022. After much legal back and forth over the next week, the judge continued his restraining order against implementation of the plan on 11/29 leaving everyone in their current health plan, at least for the time being. You can read the judge's message continuing his restraining order here:
Judge Lyle Frank's Message Continuing His Restraining Order
On 12/6 the City posted on the OLR website that it would not be implementing the new plan on January 1st. It posted a new rate chart for the existing plans, including GHI Senior Care, which we post below. They also updated their FAQ document, which we also post below.
12/14/21 IMPORTANT UPDATE: Today, Judge Lyle Frank issued a new order in the case. We post his order here:
Judge Frank's New December 14th Order
He has continued the preliminary injunction against implementation of the plan until several conditions are met:
12/20/21 IMPORTANT UPDATE:Today, the City's Office of Labor Relations posted a seven page letter on its website outlining the most current information about the new Medicare Advantage Plan, its implementation, the opt-out deadline and how the implementation will work. You can download the letter at the following link:
Update Letter From the Office of Labor Relations to Retirees Posted 12-20-21
12/22/21 UPDATE: Emblemhealth has now sent all GHI Senior Care enrollees a letter dated December 17th in which the plan announces the January 1, 2022 imposition of a $15 copayment for a range of services. After the Senior Care enrollee meets their annual $233 Medicare Part B deductible and their $50 Senior Care deductible, a $15 copay will be assessed for visits to/for: primary care providers, specialists, x-rays, lab tests, allergy testing/injections, podiatry, vision and chiropractic visits if Medicare covered, mental health and substance abuse, urgent care, physical, occupational and speech therapy, cardiac and pulmonary rehabilitation, radiation therapy, and complex diagnostic tests and radiology tests.
The letter added that these are the major services for which a copay of $15 will be assessed, but not an exhaustive list. The letter did not specifiy whether a new membership card would be forthcoming. The letter directed questions to the customer service number on your present membership ID card.
12/31/21 UPDATE: The New York City Organization of Public Service Retirees (the petitioning organization in the current lawsuit) has written to Judge Lyle Frank seeking his intervention to prevent implementation of the new co-pays for GHI Senior Care, contending they are part of the judge's temporary restraining order. The City has responded to the judge that the co-pays were planned separately from the new Medicare Advantage Plus plan and are not subject to the Judge's order. As of the end of the year, the judge has not responded to the petitioner's request. Therefore, you should be prepared to pay the $15 co-pays on Senior Care starting January 1, 2022. If we learn of a response, we will post it here.
1/4/22 UPDATE: The Alliance has created a new digital opt-out form for those who do not wish to be automatically enrolled in the new NYC Medicare Advantage Plus plan on April 1st. If you have not made a decision yet on whether or not you wish to be enrolled in the new plan or remain in your present plan, you have until March 31, 2022 to either complete and submit the online opt-out form OR to return the opt-out form from your pre-enrollment guide via mail, fax or email. If you submit the form manually, it must be postmarked no later than March 31, 2022. Each Medicare-eligible participant (i.e. retiree, spouse or dependent) must complete a separate opt-out form.
The online opt-out form can be reached at this link:
The City has also posted an updated version of the Plan Enrollment Guide. You can download it at this link:
Revised Medicare Advantage Plus Plan Enrollment Guide - 12/30/21
The Alliance indicates that there are a number of plan overview webinars for the new NYC MAPP plan scheduled for January - March. To sign up for one go to this page and scroll down: Alliance NYC MAPP Plan Page
1/13/22 UPDATE: The Alliance has posted on its website a revised introductory webinar about the NYC Medicare Advantage Plus Plan. You may wish to view it at the following link:
Updated Alliance (Anthem/Emblem) Webinar
OLR has posted a letter providing an explanation of various drug rider questions that have arisen out of plan webinars and outreach sessions. You can read it at this link:
Drug Rider Frequently Asked Questions
They have also posted an updated Frequently Asked Questions Document at this link:
MAPP Plan Frequently Asked Questions Updated 1-22-22
2/1/22 UPDATE: In the approximately two weeks since the last update we posted on this website, the City has provided at least two updates to Judge Lyle Frank on its progress in improving outreach to retirees and medical providers about the new MAPP plan. The New York City Organization of Public Service Retirees, the group which filed the lawsuit against the MAPP plan, has provided updates of its own to the judge.
As we understand it, the court has scheduled two conferences, one on February 7th and another on February 23rd. The hearing on the 7th is planned to hear from both parties on the efforts made by the City and the Alliance under the temporary restraining order to correct defects in the outreach and information efforts for the MAPP plan. The February 23rd session was intended to be an opportunity for the judge to hear arguments by the two sides on the underlying claims made by the Retirees group in filing its lawsuit which center on the legality of the City's actions in making its proposed changes to retiree health coverage.
The Retirees group has submitted the following Memorandum of Law outlining its arguments on why it feels the judge should block the MAPP plan entirely:
Petitioner's Memorandum of Law
The City has responded to the Petitioner's Memorandum of Law with the following filing. They have also asked the Court to move arguments on the underlying claims made by the Petitioners up to February 7th.
2/5/22 UPDATE: The City filed on 2/4/22 an update on its efforts to improve outreach to retirees and medical providers and the New York City Organization of Public Service Retirees, the group which filed the lawsuit against the MAPP, has submitted a filing in response on 2/5/22:
City Update on Outreach Efforts
Retirees Response to City Update
2/8/22 UPDATE: Judge Lyle Frank held a hearing on Monday, February 7th in the MAPP case. He kept the temporary restraining order on plan implementation in place. He set February 28th as the date for oral arguments by the City and the NYC Organization of Public Service Retirees on the underlying argument by the Retirees about the City's ability to make changes in retiree health care. The judge indicated he would not immediately rule on the merits of the case on February 28th. Therefore, it appears any court decision will not occur until sometime after March 1st and the temporary restraining order on implementation of the plan will not be lifted and transfer of retiree data to the Alliance will not occur before that time.
At the same time, Mayor Adams, in a statement issued on Sunday, February 6th, indicated his support for the implementation of the MAPP plan while Comptroller Lander expressed his concerns about the plan and its implementation.
A reminder that the deadline for opting out of the new plan remains, at least for now, March 31st. For those OSA retirees who have decided to opt out of the MAPP plan, the Office of Labor Relations provides three ways to opt-out: an opt-out webform, mail submission of the physical opt-out form and a request to the Alliance's hotline at 833-325-1190. If you make your request on the hotline, you may wish to ask the name of the customer service rep who helps you as well as a reference number for your conversation. Make a note of it, along with the date of your opt-out request and/or ask for a confirmation email. If you make your request by mail to the post office box on the opt-out form, be sure to keep a copy. You may choose to send it by certified mail. If you submit by webform, you may wish to take a photo of your screen before you submit it digitally.
2/16/22 UPDATE: The Municipal Labor Committee and the vendor, the Alliance (Anthem/Emblemhealth), have filed memoranda of law with Judge Lyle Frank in support of the City's legal position in the MAPP lawsuit. You can read them at these links:
Municipal Labor Committee Memorandum of Law
2/19/22 UPDATE: The City has provided its latest update to the Court on its outreach efforts to retirees and providers. You can read it at this link:
City's Update To The Court On Outreach Efforts To Retirees and Providers
OLR has also posted a revised version of the Frequently Asked Questions Document dated February 17, 2022 on its website. You can read it at this link:
Updated Frequently Asked Questions Document About the NYC Medicare Advantage Plus Plan
2/24/22 UPDATE: In advance of the upcoming Court session on February 28th, when oral arguments will be made before Judge Lyle Frank on the underlying questions about the City's obligations on health coverage for retirees, the petitioning Retirees have now filed a Memorandum of Law in reply to the Municipal Labor Committee and Alliance memoranda filed on 2/16/22. You can read it at this link:
NYC Organization of Public Service Retirees Memorandum of Law In Reply To The MLC And Alliance
3/4/22 VERY IMPORTANT UPDATE: On Thursday, March 3rd, State Supreme Court Justice Lyle Frank issued his decision in the lawsuit filed against the NYC Medicare Advantage Plus Plan. The judge ruled that:
You can read the judge's decision at the link below, along with two filings submitted to the Court the day before the decision:
Judge Lyle Frank's Decision and Order on the NYC Medicare Advantage Plus Plan
City filing with the judge before his decision
Retirees Organization filing with the judge before his decision
The day after the judge's decision, the City filed an appeal to the Appellate Division of State Supreme Court. See the appeal filing here:
City appeal filing with the Appellate Division of State Supreme Court
Also on Friday evening, March 4th, the Office of Labor Relations posted on its website that it was NOT IMPLEMENTING the new plan on April 1st and that all retirees would remain in their present health plans until further notice. They added that additional information would be forthcoming at a later date. OLR said the opt-out deadline was being postponed as well.
If you wish to opt-out nevertheless, you can use either of the following tools.
The online opt-out form can be reached at this link:
The print opt-out form can be reached at this link:
3/15/22 UPDATE: On Tuesday, March 15th, counsel for the NYC Organization of Public Service Retirees filed a notice of cross-appeal from Justice Frank's decision on the NYCMAPP plan issued on March 3rd. The group asks the Appellate Division to review his decision for error in allowing the NYCMAPP plan to go forward and with an opt-out process, implementing co-payments on GHI Senior Care, and diminishing what it says are vested health care benefits. The Notice of Cross Appeal can be read here:
Notice of Cross Appeal with the Appellate Division of State Supreme Court
3/23/22 UPDATE: On Monday, March 21st, counsel for the City filed its brief with the Appellate Division of State Supreme Court. They also asked for the case to be heard in the June 2022 term, which would require the NYC Organization of Public Service Retirees to file its brief and other material with the Court by April 20th. The Retirees asked the court to delay that deadline by a month. The City asked the court to keep to the June scheduling request. The City's brief, the request for June term scheduling and the Retirees' and City's answers can be read here:
City's Appeal Brief to the Appellate Division of State Supreme Court
City's Request for appeal to be heard in the June 2022 term
Retirees' Request for extension of time to file its brief, etc.
City's Response to Retirees' Request
3/31/22 UPDATE: On Wednesday, March 30th, City Comptroller Brad Lander returned the NYCMAPP contract to the administration, unregistered, and requested additional information. You can read his statement at the following link:
4/2/22 UPDATE: The Alliance (Emblemhealth/Anthem) has now submitted a request to the Appellate Division for status as amicus on the City's side and has filed the following brief in support:
Alliance Proposed Brief As Amicus Curiae On The Appeal In The NYC MAPP Case
4/12/22 UPDATE: The Appellate Division of State Supreme Court has ordered that the NYC MAPP case be heard in the September court term, rejecting the City's request that it be calendared for the June court term. You can read their order here:
Appellate Division Calendar Decision In The NYC MAPP Case
6/21/22 UPDATE: The Appellate Division of State Supreme Court has ordered the City to file its brief in the appeal by July 19, 2022, for the Retirees Organization to file its reply brief by August 8, 2022 and for the City to file its reply brief to the Retirees Organizations' cross appeal by August 29, 2022. You can read the order here:
Appellate Division Briefing Schedule In The NYC MAPP Case
We provide a link below to the video of the OSARC meeting held on September 14, 2021 on Zoom that was addressed by Kim Parker, a representative from the "Alliance," the insurance partnership between Emblemhealth and Anthem/Empire Blue Cross-Blue Shield which will be administering the new NYC Medicare Advantage Plus Plan. In addition, OSA Chair Bob Croghan took questions from members about the effect of the new plan on OSA's Welfare Fund Benefits and other aspects of the transition to the new plan.
You can watch the video of the OSARC meeting held on October 13, 2021 on Zoom which provided an opportunity for follow-up questions and answers to OSA Chair Bob Croghan and representatives of the Alliance, Emblemhealth and the City's Office of Labor Relations.
You can watch the video of a webinar about the new plan previously hosted by the "Alliance" at the following link.
Alliance webinar on the new health plan.
New webinars can be attended by signing up on the Alliance's website at this link.
You may wish to download the September 2021 edition of the OSARC Newsletter, which provided an overview of the new plan and its features and background information on why the plan was established.
To reach the Alliance by phone with questions about the new Medicare Advantage Plus Plan, call the special call center at 1-833-325-1190, Monday to Friday, 8 a.m. to 9 p.m. Eastern Time, except holidays.
You can obtain more information about the new plan or search to find if your provider is in-network on the Alliance's website at this link.
Below are links to other documents you may wish to review regarding the new plan, existing plans, and the transition and opt-out process:
Members requested that we post the November 2021 OSARC meeting featuring Mary Ellen Doran, a licensed social worker, discussing a variety of planning issues of importance to seniors. The second part of the meeting has additional information on the status of the NYC Medicare Advantage Plus Plan roll-out as of November 10th (which predates the release of the City's new implementation plan and the response from the petitioning Retiree Organization, which are posted earlier on this page.
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