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FAQs
Health Benefits Program


How do I enroll in health benefits upon retirement?
How do I waive health benefits coverage at the time of retirement?
How do I obtain health coverage upon retirement if my spouse or I are eligible for Medicare?
How will I pay for the Optional Rider (or basic health coverage, if applicable)?
What do I do if my dependent or I become eligible for Medicare after retirement?
What if my health plan does not cover persons eligible for Medicare?
How do I add or drop dependents from my health plan after retirement?
What if my dependent(s) become ineligible for coverage?
When can I transfer to another health plan?
Who should I notify if I change my address?
What do I do if my health insurance deductions are incorrect?
When do premiums change for health benefits?

 

How do I enroll in health benefits upon retirement?
After receiving written verification of your retirement date from your pension system or your agency benefit representative, you must obtain a Health Benefits Application form either here or from your agency's benefits office.

This application is to be completed by you and certified by your agency's health benefits officer. The Application should then be forwarded, by either your agency or you, to:

Health Benefits Program
40 Rector Street, 3rd Floor
New York, NY 10006

Please allow 2-3 weeks for processing. Incomplete or uncertified applications will be returned to you unprocessed.

Your health coverage as a retiree will be effective on your date of retirement. If your application is not submitted to the Retiree Health Benefits Program within 31 days of that date, this constitutes a late enrollment, except in the case of a disability retirement. As such, your effective date of health coverage as a retiree will be the first day of the month following the submission of your application.

Special Note: If at any time after you submit an application you either rescind your retirement or change your date of retirement, you must notify your health benefits plan of this change. Failure to do so can delay your enrollment as a retiree, or reinstatement of your coverage as an active City employee.

Download the Health Benefits Application form and instructions (PDF)

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How do I waive health benefits coverage at the time of retirement?
To waive health coverage at the time of your retirement, you must complete an application and check "Waive Benefits" at the top of the application. Submit the application to your agency benefit representative.

If after your retirement you wish to obtain health coverage through the City, you must complete an application from the Health Benefits Program. The effective date of your coverage will be the first day of the month following the submission of your Health Benefits Application after a 90-day waiting period (this waiting period is waived if you are applying for coverage as a result of losing other coverage).

Download the Health Benefits Application form and instructions (PDF)

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How do I obtain health coverage upon retirement if my spouse or I are eligible for Medicare?
Prior to your date of retirement, if you and any of your dependents are eligible for Medicare, you should contact the Social Security Administration and file for Medicare benefits.

If you are enrolled in an HMO at retirement and wish to remain in the same health plan at retirement, the Medicare-eligible person must obtain a special enrollment application directly from the health plan, which must be submitted directly to the health plan prior to your date of retirement. A copy must also be submitted with your Health Benefits Application along with a copy of your Medicare card or Medicare Award Letter.

If you enroll in a Medicare Supplemental Plan, a copy of your Medicare card or Medicare Award Letter must accompany your Health Benefits Application. Delays in submitting the necessary documentation and applications may delay enrollment in a health plan and cause a lapse in coverage.

Special Notes: If you are eligible for Medicare at the time of your retirement, you may transfer your health plan. Also, pleased be advised that not all health plans accept Medicare enrollments and some Medicare HMOs may not be available in your area. Please call your health plan directly for more information.

Medicare-eligible retirees who enroll in a Medicare HMO Plan will receive enhanced prescription drug coverage from the Medicare HMO if their union welfare fund does not provide prescription drug coverage, or does not provide coverage deemed to be equivalent (as determined by the Health Benefits Program) to the HMO enhanced prescription drug coverage. The cost of this coverage will be deducted from the retiree's pension check.

Eligibility for the enhanced prescription drug coverage is determined automatically and cannot be elected or dropped by the retiree.

Download the Health Benefits Application form and instructions (PDF)
Visit the Social Security Administration Web site

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How will I pay for the Optional Rider (or basic health coverage, if applicable)?
Deductions for Optional Rider and Basic Health coverage (if applicable) are deducted directly from your pension check. After retirement, it may take some time before health plan deductions are taken from a retiree's pension check.

Health coverage is continuous throughout the period in which there are no deductions provided all applications have been filed. When deductions do begin, retroactive deductions are made to pay for coverage during the period from retirement to the time of the first deduction.

Subsequent pension checks will contain the normal monthly cost for your health coverage as well as a portion of the retroactive amount owed. Retroactive premium payments will not exceed $35 in addition to the regular per month deduction.

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What do I do if my dependent or I become eligible for Medicare after retirement?
When you or one of your dependents becomes eligible for Medicare at age 65 (and thereafter) or through special provisions of the Social Security Act for the Disabled, your first level of health benefits is provided by Medicare.

The Health Benefits Program provides a second level of benefits intended to fill certain gaps in Medicare coverage. In order to maintain maximum health benefits, it is essential that you join Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) at your local Social security office as soon as you become eligible.

If you do not join Medicare, you will lose whatever benefits Medicare would have provided. The City's Health Benefits Program supplements Medicare but does not duplicate benefits available under Medicare.

Medicare-eligibles must be enrolled in Medicare Parts A and B in order to be covered by a Medicare HMO plan. In order to remain in an HMO, you must complete a special enrollment application with your health plan.

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What if my health plan does not cover persons eligible for Medicare?
You must transfer to another health plan at retirement or prior to becoming Medicare-eligible after retirement.

Learn more about the health plan options

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How do I add or drop dependents from my health plan after retirement?
Changes in your family status may make it necessary, or desirable, for you to change your type of health coverage (e.g. family to individual). Changes in coverage do not happen automatically. You must submit the Health Benefits Application form within 31 days of the event necessitating the change in coverage.

In the event of a divorce, you must submit a copy of the page(s) of your divorce decree that notes the effective date of the divorce.

Coverage for dependent children terminates at age 19 unless they remain full-time students. Full-time students can remain on your coverage until the end of the year of their 23rd birthday, or graduation, which ever occurs first. If your dependent is not a full-time student at the age of 19, you must submit an application to drop him/her from your coverage.

Special Note: The effective date of termination is the date of death and the date of divorce (Please be advised that the City of New York does NOT pro-rate health benefit premiums).

Download the Health Benefits Application form and instructions (PDF)

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What if my dependent(s) become ineligible for coverage?
The Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires that the City offer employees, retirees, and their families the opportunity to continue group health and/or welfare fund coverage in certain instances where the coverage would otherwise terminate. The monthly premium will be 102% of the group rate.

All group health benefits, including optional riders, are available. The maximum period of coverage for dependents of retirees is 36 months. Under the law, the retiree or family member has the responsibility of notifying the Health Benefits Program and the applicable welfare fund within 60 days of the death, divorce, domestic partnership termination, or of a child's losing dependent status.

COBRA packages containing detailed information and an application can be obtained from the Health Benefits Program. Once completed, COBRA applications must be submitted directly to your health plan.

Find out more about COBRA

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When can I transfer to another health plan?
Retiree transfer periods usually occur every even-numbered year. However, the Health Benefits Program may implement a special transfer period if significant changes occur in a health plan. In such cases, the Health Benefits Program will notify you.

Listed below are qualifying events that allow you to transfer plans without having to wait for a transfer period:

  • You move into, or out of, a health plan service area
  • Your health plan is no longer servicing your area
  • You or your dependent become Medicare-eligible and your health plan will not cover the Medicare-eligible person(s)
  • You use your "Once in A Lifetime" option (you must be retired one year to use this option)
Special Note: If you are transferring out of a Medicare HMO voluntarily, you must terminate your health plan coverage in writing, directly to your health plan (or complete a termination form at your local Social Security Administration office).

If both you and your dependent are enrolled in a Medicare HMO, separate termination letters are required. If you transfer into a Medicare HMO, separate applications are required. When enrolling in a Medicare HMO, you should identify yourself as a City of New York retiree.

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Who should I notify if I change my address?
When you change your address, you should contact:
  • The City of New York Health Benefits Program (must be in writing)
  • Your Health Plan
  • Your Union Welfare Fund
  • Your Pension System
Get the Health Benefits Program contact information

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What do I do if my health insurance deductions are incorrect?
If you are having incorrect deductions taken from your pension check for health coverage, you must notify the Health Benefits Program in writing within 31 days of the discrepancy. Corrections will be made as quickly as possible after notification.

Incorrect deductions will be refunded to you directly from the health plan. You may be asked to submit photocopies of pension check stubs (or quarterly statements for those with direct deposit) as proof of incorrect deductions. You should retain all pension check stubs and quarterly statements for your records.

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When do premiums change for health benefits?
There are two times when premiums typically change for retiree health benefits: January and July. Medicare HMOs implement new premiums January 1 (which is reflected in your January pension check). All other plan rate changes usually commence July 1 (which is reflected in your July pension check).

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