Dear PSC member,
The NYC Office of Labor Relations announced an agreement on August 28 with Municipal Labor Committee (MLC) representatives on a replacement of the current comprehensive health benefits plan (CBP). The current CBP, provided by Emblem Health (GHI) and Anthem, enrolls roughly ¾ of the city’s active employees and pre-65 retirees and their dependents – including many PSC members. As I wrote on June 5, Emblem Health (GHI) and United Healthcare collaborated on the proposal that prevailed in the negotiated acquisition process. The member unions of the MLC must vote to approve any new plan before it can be implemented. If approved, the City seeks to implement the new plan, called the New York City Employees PPO plan, starting January 1, 2026.
The MLC has provided a four-page chart comparing elements of the NYCE PPO plan with the current plan. It is available here for your review. Details about the financial arrangements between the City and Emblem/United are limited so far. The PSC has some critical questions that still need to be answered regarding how the new plan will save the city money and other matters.
PSC representatives are in the process of examining the proposed plan, including the contract with Emblem and United Healthcare, and will share a fuller assessment as soon as possible. An opportunity for PSC members to discuss the proposed plan and ask any questions will be scheduled on Zoom and announced shortly. Elected representatives to the PSC Delegate Assembly will discuss and vote on it before the MLC vote takes place.What do we know at this point?
- No premiums. The MLC prioritized maintaining a zero-premium plan and achieved this goal in negotiations.
- Networks and copays. Any hospital or provider that is currently in-network will remain in-network. In-network copays will remain the same or, in some cases, be reduced (NY Health & Hospitals and Advantage Care Physicians NY will both have zero copays). The current network will expand beyond the current Emblem/Anthem network, particularly with respect to mental health care and out-of-state doctors.
- Participant access. A single website and portal, and a single i.d. card for medical and hospital services, rather than separate cards and online access for each.
- Maximum in-network out-of-pocket cost. Remains $7,150 for individuals and $14,300 for families annually.
- Prior authorizations. Substantial decrease in services requiring prior authorization, including elimination for MRIs, CT scans, orthopedic surgeries, office-based dermatology, pain injections, and home health visits.
- Plan monitoring. Representatives from Emblem/United Health, the City, and the MLC will meet monthly to review plan implementation and data. Disputes subject to mediation and binding arbitration.
- NYC self-insure to achieve savings. Health care costs have increased dramatically. By assuming the role of paying claims directly, the City will save money on administrative expenses and taxes. This change will not affect the experience of the plan participant.
The comprehensive benefits plan refers to medical and hospital services. Supplemental health benefits, including vision, dental, hearing, disability, and prescription drugs, will continue to be provided through the PSC-CUNY Welfare Fund. The city offers several other health plans for active employees and pre-65 retirees besides the comprehensive benefits plan and will continue to do so.
Published: September 5, 2025
