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What’s Happening to Our Healthcare

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Breaking

A state appeals court on 11/22/22 unanimously upheld the decision of a lower court (Judge Lyle Frank) that prohibits NYC from charging a premium to municipal retirees for NYC Senior Care.  For more detail, click here.  A PDF of the decision can be read here.

PSC opposes weakening NYC health insurance protections.

Proposed changes in NYC administrative code threaten retiree healthcare and, in the longer term, potentially in-service members.  Read James Davis’ 9/9/22 message and 11/7/22 update to PSC members about these proposed changes.

You may also find this primer, written by a Retiree Chapter Executive Committee member, useful in breaking down the legal complexities of the proposed adminstrative code — and its implications for all union members.

The move to change the administrative code was discussed at the 9/12/22, 10/3/22  and 11/7/22 retiree chapter meetings.  Here is a link to a video of the September  meeting.  The discussion of reitiree healthcare begins at the one hour six minute mark of the video. HERE is a link to a video of the 10/3 chapter meeting.  The second part of the meeting, on retiree healthcare, begins at the one hour fifteen minute mark of the video. HERE is a link to a video of the 11/7 chapter meeting.  The second part of the meeting, on retiree healthcare, begins at the one hour twenty-nine minute mark of the video.

What you can do to oppose the change to the administrative code:


  •  CLICK HERE TO SEND A LETTER to your NYC Council Member to stop the change in the administrative code
  • SIGN UP HERE to join the PSC in lobbying City Council members on this issue.
  • REACH OUT to municipal employees and retirees to take action.  HEREis a short, informative leaflet and outreach tool produced by the PSC Safety Net Committee that explains what is happening.  Two important pieces with a more detailed analysis by Barbara Caress, who teaches health olicy at Baruch and Sarah Lawrence, appeared in CRAINS and URBAN MATTERS.  (The Crains op/ed is unfortunetely behind a paywall).  And here is a petition to the Mayor, the NYC Labor Commissioner and the City Council Speaker that makes the case against the administrative code change.

A PSC proposal to sustain NYC healthcare over the short term while exploring longer term solutions

INSTEAD OF FORCING RETIREES INTO MEDICARE ADVANTAGE

The PSC has a proposal to use the Retiree Benefit Health Benefit Fund as a resource to sustain benefits while NYC healthcare is restructured.  Read the proposal.


OVERVIEW OF THE  RETIREE HEALTHCARE CRISIS:  On Wednesday, July 14, 2021, the Municipal Labor Committee (MLC) voted to approve a contract with the NYC Office of Labor Relations (OLR) to move city retirees, including CUNY retirees, from traditional Medicare with supplemental city insurance to a privatized Medicare Advantage (MA) plan. The PSC was one of five unions to vote against the move to Medicare Advantage and the PSC retirees chapter pushed back against the plan both before and after the July vote.

NYC set 1/1/22 as the target date for moving retirees to an Anthem/Empire Medicare Advantage Plus plan. Municipal retirees were to choose one of two options:

  • Move by default into a premium-free Medicare Advantage plan or;
  • Opt out in order to stay in traditional Medicare with supplemental City insurance (originally premium-free but now with a premium of $191.57 a month per person).

But in December 2021, a judicial injunction pushed implementation to 4/1/22. Then on March 3, 2022, a NYS supreme court judge ruled that NYC could not charge the $191.57 premium. The City immediately appealed (still pending) and decided not to implement its original plan on 4/1/22.

Then in breaking news on 7/18/22, Anthem/Empire (part of “The Alliance” administering the program) withdrew from the MA+ plan, in effect killing it. What this means is that everything is on hold — in effect status quo ante. (More on this below and in PSC President James Davis’ letter to retirees.).

—————————————–

The web page is organized into six parts:

UPDATES | WHAT RETIREES NEED TO KNOW TO MAKE A DECISION | HOW THIS HAPPENED | PSC RESPONSE | ADVOCATING FOR MEMBERS HEALTHCARE | KEY LINKS | TIMELINE
.

UPDATES

JULY 25, 2022 LETTER FROM JAMES DAVIS – MEDICARE ADVANTAGE PLUS PROVIDER WITHDRAWS FROM CONTRACT. Click here for President Davis’ letter to PSC retirees.

JULY 18, 2022 UPDATE — THE ANTHEM/EMPIRE MEDICARE ADVANTAGE PLAN IS DEAD. Anthem/Empire (part of “The Alliance” administering the now dead MA+ plan) announced that they are withdrawing their MA+ program for NYC municipal retirees. In a letter to member unions, the chair of the Municipal Labor Committee, Harry Nespoli, stated that both NYC and the MLC are “exploring options to provide a substitute Medicare Advantage program.” But this cannot happen quickly and seamlessly, if at all. For most PSC and municipal retirees, this means that for the forseeable future they stay on traditional Medicare with premium-free suppemental insurance from NYC (Senior Care). As President James Davis noted in his letter to retirees, “Many of you know that the PSC was one of five MLC unions that opposed the MA+ contract with Anthem/Empire, and we continue to advocate for alternatives to MA+.” Click here for an article from NY Focus (“Health Insurers Just Killed The Medicare Plan City Retirees Railed Against“) with more details.

JUNE 2022 UPDATE: While we expect no developments in the legal case until the fall, many retirees have continued to write and call the mayor’s office and their local city councilmembers with their concerns (as we have heard from council staff).

Anyone who would like some TALKING PONTS to use in explaining this issue to elected officials, colleagues, or even friends and neighbors can click HERE for a backgrounder prepared by the PSC retirees chapter.

“REJECT THE CRUELTY OF MEDICARE ADVANTAGE, NYC:”
Click here to read this powerful and moving op/ed in the June 16 NY Daily News on how the author and his dying wife had to spend her last six months fighting the denial of end-of-life treatments “because our excellent union-negotiated, employer-provided retiree health care coverage had been downgraded from traditional public Medicare to a for-profit Medicare Advantage plan.”


HHS INSPECTOR GENERAL REPORT FINDS THAT MEDICARE ADVANTAGE PLANS OFTER DENY NEEDED CARE:
Articles in the New York Times (April 28) and the New York Daily News (April 29) reported that a study by the Inspector General of the Health and Human Services Administration found “widespread and persistent problems related to inappropriate denials of services and payment.” These same services are covered by traditional Medicare. The Daily News revealed that “Despite the HHS study, Adams spokesman Jonah Allon said late Thursday that the [mayoral] administration ‘continues to believe that the Medicare Advantage Plan is in the best interests of retirees and the city.’”

APPELLATE COURT WILL NOT EXPEDITE CITY’S APPEAL OF JUDGE FRANK’S DECSION. NYC requested that the Appellate Court expedite its appeal of Judge Lyle E. Frank’s order of March 3rd, putting the case on its June calendar so that it could be initially heard between now and the end of June. On Tuesday, April 12th, the court denied the request, putting the case on its September calendar, meanng the appeal would not be heard until September or later in the fall. As a result, MA+ program in all probability will not be implemented for many months and maybe not at all this year, Those on NYC Senior Care will continue on that program premium-free for the foreseeable future.

LETTER TO THE MAYOR AND YOUR CITY COUNCIL MEMBER. The NYC Organization of Public Service Retirees, the organization that brought you the lawsuit, has organized a campaign that has already sent thousands of letters to the Mayor and the City Council urging them:

  • Not to abandon traditional Medicare for NYC retirees.
  • Not to lock us into a Medicare Advantage program.
  • Not to appeal Judge Lyle E. Frank’s March 3rd decision.

You can sign a petition to Mayor Adams and send a letter to your City Council member at: https://nycretirees.org/petition

JUDGE RULES THAT NYC CANNOT CHARGE A PREMIUM FOR NYC SENIOR CARE. On Thursday morning, March 3, Judge Lyle E. Frank “ORDERED:”

The respondent is permanently enjoined from passing along any costs of the New York City retirees’ current plan to the retiree or to any of their dependents, except where such plan rises above the H.I.P.-H.M.O. threshold, as provided by New York City Administrative Code Section 12-126. [The HIP cap is $776 a month. The NYC Senior Care cost of $191.57 per month is well below the cap.]

The court has lifted its preliminary injunction, meaning that the City’s plan could have gone into effect on April 1. Subsequently, the City announced that it will NOT implement the plan on that date. If the judge’s decision holds, the City cannot charge retirees a premium (as it had planned) if retirees choose to opt out in order to stay in their current NYC healthcare plan (which for most is Emblem/GHI NYC Senior Care). Yet the new implementation date is in question as is the status of the City’s plan. Also, it’s not clear whether, in the future, NYC has to offer options to MA+. We are seeking clarification as the facts on the ground seem to be a moving target.

You can read the judge’s decision here.

Here is an excellent article covering the judge’s decision and its implications for PSC and municipal retirees.

(The lawsuit was brought by NYC Organization of Public Service Retirees. Many PSC members have made donations to the NYC Organization of Public Service Retirees to help defray the cost of the lawsuit. For information on donating, click HERE)

As we untangle the legal issues and learn more, we will provide updates on this page.

COMPTROLLER DOES NOT REGISTER MA+ PLAN, SENDING IT BACK TO THE ADMINISTRATION. On Monday, February 28, the NYC Office of Labor Relations (OLR) submitted its contract with the Medicare Advantage vendor to the office of the Comptroller, Brad Lander, for review and registration. As early as Tuesday, March 8, Lander suggested that the Adams administration consider walkng back the plan in light of Judge Frank’s decision. On Wednesday, March 30, Lander announced that “Due to the legal and budgetary uncertainties that remain while litigation over the City’s contract with Anthem Insurance Companies continues, the Comptroller’s office does not have sufficient information to register the proposed Medicare Advantage Plan contract at this time.”

Lander’s full statement can be read here.

[The PSC met with Lander and his key deputies on Friday, March 4, pointing to serious deficiencies in the contract and expressing opposition to the move of retiree healthcare to MA+. Lander and his staff were provided with a PSC White Paper that dissected flaws in the contract]

OPT-OUTS. The Alliance (the MA+ vendor) has told many who call its 1-833-325-1190 number that it is not presently processing opt-outs. But some members have reported successfully opting-out by phone and then receiving an email confirmation, Others have opted out electronically or by mail. See below for links to the electronic and PDF forms. However, once it sets a new implementation date, the City under the judge’s order must give retirees, if they so choose, at least three months to opt out of the MA+ plan in order to keep their current coverage.

LETTER FROM PSC PRESIDENT JAMES DAVIS with important updated information in light of Judge Frank’s ruling. The letter, sent on March 8, can be read here.

VIDEO OF 4/4 CHAPTER MEETING. Both parts of the meeting were recorded — Part 1 on threats to American democracy and part 2 on healthcare updates (which begins at the one hour thirty two minutes mark of the video).

VIDEO OF 3/7 CHAPTER MEETING. Both parts of the meeting were recorded as separate videos — Part 1 on climate legislation and part 2 on retiree healthcare.

VIDEO OF 2/7 CHAPTER MEETING ON HEALTHCARE: You can view the full meeting here.

64,489 OPT OUT. In an article posted online on 3/28/22, the NY Daily News reported that as of 3/20/22 64,489 have opted out of the MA+ plan.

2/6/22: MAYOR ENDORSES MOVE TO MEDICARE ADVANTAGE: In a press release from the Mayor’s ofice on Sunday, February 6, Eric Adams stated “I am announcing my support for” the Medicare Advantage Plus Plan.

(“Valentine’s Day, Tell the Mayor Don’t Break Our Hearts!.” Scroll down here for report on spirited 2/14 noon rally at City Hall.)

TWO EARLIER UPDATES ON THE LAWSUIT:

1. BUT THE LAWSUIT CONTINUES – 2/7/22 in the court of judge Lyle E. Frank. In a status conference on Monday, February 7 on the suit brought by the NYC Organization of Public Service Retirees, Judge Frank continued his preliminary injunction and agreed later this month to hear arguments pro and con on the City’s right to make these changes in retiree healthcare. He’ll probably make a decision in March. Click here to read a brief questioning the legality of the plan. (Many PSC members have made donations to the NYC Organization of Public Service Retirees to help defray the cost of the lawsuit. For information on donating, click HERE)

2. JUDGE DELAYS RETIREE HEALTHCARE SWITCH TO APRIL – 12/14/21.: The City planned to have its Medicare Advantage Plus plan in place on January 1, 2022. In a court order, made public at 5 pm on Tuesday, December 14, Justice Lyle E. Frank in effect said NOT SO FAST. He extended his injunction, pushing back implementation of the Medicare Advantage Plus plan to April 1, 2022 and the opt-out date to March 31, 2022.

The order was in response to the lawsuit brought by NYC Organization of Public Service Retirees.

Frank wrote that his “preliminary injunction will remain in effect until” the City and the Medicare Advantage vendor, The Alliance, satisfy “the following conditions:”

  1. “The effective date of the Medicare Advantage Plus Plan (the “Advantage Plan”) shall be April 1, 2022, with the opt-out period to end March 31, 2022. However, there will be a continuing opt-out period until June 30, 2022, even while the Advantage Plan is in effect;”
  2. “Respondents shall send to all retirees a letter containing a list of the corrections and additions made to the previously sent Enrollment Guide as discussed between the parties, on or before January 7, 2022. The letter must contain information on how a retiree can obtain a corrected Enrollment Guide free of charge, and the specific web addresses where the corrected Enrollment Plan may be seen; and”
  3. “Respondents must ensure that there only be one set of deductibles in the calendar year 2022 for all retirees.”

In addition, in order to clarify which medical providers accept the MA+ plan, the judge ordered the City to report bi-weekly on “how many medical providers have been contacted personally regarding the plan…[and] how many medical providers in such areas have yet to be personally contacted about the plan, and how and when those additional medical providers will be contacted.”

THE CITY’S “THE DOG ATE MY HOMEWORK” DEFENSE: Judge Frank clearly rejected the City’s contention before his court that it could not send out a new enrollment guide to correct many errors in the original because of “a global paper supply shortage.” He ordered that the City and vendor correct the enrollment guide and provided a three-month window for retirees to evaluate the corrected material and make a choice to opt-in or out.
In sum, then, the judge’s order:

  • Keeps the premium-free MA+ plan in place, but delays implementation at the earliest until 4/1/22
  • Sets 3/31/22 as the opt-out deadline, but also ordered an opt-out option until 6/30/22 for those enrolled in the MA+ plan who decide they want to leave it.
  • Guarantees that retirees will pay only one annual deductible in the “calendar year 2022.”
  • Instructs the City to notify all municipal retirees of errors in the original MA+ material, telling them how to obtain a corrected enrollment guide.
  • Monitors bi-weekly the City’s (and vendor’s) personal outreach to medical providers, ostensibly (1) confirming whether or not these providers will accept the plan and (2) producing an accurate list of participating providers.

Bottom Line: If the judge’s order stands, retirees will continue with City coverage premium-free until March 31. For over 90% of municipal retirees this means traditional Medicare with NYC Senior Care (Emblem) as their secondary insurance.

Click here to read the judge’s order.

Here is a link to an article on the judge’s decision.

EMBLEM’S COPAYS FOR NYC SENIOR CARE. The somewhat good news from the judge’s chambers was tempered by a “Dear City of New York Retiree” letter from Emblem Health announcing previous negotiated copays that took effect on January 1 for those currently on the GHI/Empire Blue Cross Blue Shield Senior Care plan. The vast majority of PSC and NYC retirees have Senior Care as their supplementary insurance to traditional Medicare.

Emblem listed a host of services and procedures for which there will be a $15 copay. It then informed recipients that “this is not a full list of services with a copay.”

The NYC Office of Labor Relations (OLR) and the Municipal Labor Committee (MLC) negotiated the copays PRIOR to their agreement to move most NYC retirees from traditional Medicare to the privatized Medicare Advantage plan. The copays were scheduled to go into effect much earlier, but implementation was delayed until 1/1/22. We alerted members at our December chapter meeting of the impending copays. Advance notice, however, doesn’t make them more palatable. Judge Lyle E. Frank’s March 3rd order (if sustained after appeal) means that the plan will remain premium free. The co-pays, however, are unaffacted by his decision and as of1/1/22 are in place.

Emblem’s “Dear City of New York Retiree” letter concludes with the hollow sentence “We’re committed to supporting you.”

The support we need is not Emblem’s, but that of multiple retiree and union voices pressing the new mayoral administration and the courts to reverse the copays and the move to privatized Medicare. A daunting task, but one we must pursue.

WHAT YOU NEED TO KNOW TO MAKE A DECISION

(The following section is preserved for the historical record. It is presently moot with the withdrawal of Anthem/Empire from the initial iteration of the NYC MA+ plan. But if NYC persists and chooses a new vendor to move municipal retirees from traditional Medicare to Medicare Advantage, this section should serve as a reminder of the hoops our retirees had to jump through and the anxiety that ensued.)

TO GET YOUR QUESTIONS ANSWERED TAKE THESE STEPS IN ORDER

  1. Check NYC OLR FAQs;
  2. If still no answers, call the Alliance toll free number at 1-833-325-1190, Monday to Friday, 8 am to 9 pm;
  3. If still no answers, check the PSC/CUNY Welfare Fund FAQS;
  4. And if still no answers, only then send an email to [email protected] (this is the email your questions should be routed to, not the retiree chapter email address).

CHECKLIST FOR CHOOSING YOUR 2022 HEALTHCARE PLAN

We have created the first iteration of a checklist for the enrollment process HERE. We will update it as we receive more information and get unanswered questions answered.

CHAPTER MEETINGS AND INFORMATION SESSIONS ON RETIREE HEALTHCARE (VIDEOS)

FAQS FROM QUESTIONS ASKED AT CHAPTER AND INFORMATION MEETINGS

ENROLLMENT GUIDES

In response to a Temporary Restraining order, the New York City Office of Labor Relations (OLR) changed the opt out and enrollment dates to the end of March. Leon E. Frank, the judge who issued a Temporary Restraining Order, determined that the original enrollment guides were inaccurate or incomplete in several areas and Instructed the City to notify all municipal retirees of errors in the original MA+ material, telling them how to obtain a corrected enrollment guide.

Below are links to the original (and uncorrected) guides:

There is now a single online enrollment guide. The link to the new guide is below:

OPT OUT FORMS

[The Alliance (the MA+ vendor) has told many who call its 1-833-325-1190 number that it is not presently processing opt-outs. But some members have reported successfully opting-out by phone and then receiving an email confirmation, Others have opted out electronically or by mail. However, under the judge’s order, if upheld, the City must give retirees at least three months to opt out of the MA+ plan to keep their current coverage once it sets a new implementation date.]

By default, you will be enrolled in the Alliance Medicare Advantage plan. If you want to stay on traditional Medicare, you will have to complete an opt out form: If your spouse is on your coverage, BOTH of you will need to submit an opt out form.

We recommend using the electronic form if you choose to opt-out. Once you submit the form electronically (as opposed to snail-mailing, emailing or faxing a completed PDF form), you should within minutes receive an email confirmation for your records. If you do it via PDF, you will have to wait for a confirmation through the U.S. mail.

If you wish to cease your City of New York retiree health coverage altogether, complete the NYC Health Benefits Application/Change Form available on the Health Benefits Program website at: https://www1.nyc.gov/site/olr/health/retiree/health-retiree-forms-and-downloads.page. Please be advised, you will NOT be eligible for the reimbursement by the City of the Medicare Part B premium if you cease New York retiree health coverage. You may, however, reenroll in City retiree health benefits during the next Transfer Period.

OPT-OUT CONFIRMATIONS

[The Alliance (the MA+ vendor) has told many who call its 1-833-325-1190 number that it is not presently processing opt-outs. But some members have reported successfully opting-out by phone and then receiving an email confirmation, Others have opted out electronically or by mail. Links to the electronic and PDF forms are above. Under the judge’s order, if upheld, the City must give retirees at least three months to opt out of the MA+ plan to keep their current coverage once it sets a new implementation date.]

1) Submitting the opt-out form online should result in an email confirmation. When an opt-out submission includes an email address, the confirmation should be emailed to that address promptly. Be sure to check your SPAM folder, as sometimes confirmations end up there. [In the wake of the March 3 court decision and with the City announcing that transition to the new plan is on hold, we cannot yet confirm that confirmations are being sent in a timely way.] To opt out on the electronic form, go to https://nyc-ma-plus.empireblue.com/optout/.
2) Some folks have gotten verbal confirmation of receipt of their mailed opt-out forms by calling the Alliance’s informational phone number at 833-325-1190.
3) Emblem, in late January, began mailing opt-out confirmations through the U.S. postal service. Note that the confirmations come from Emblem, not the city.

OPT OUT PAYMENTS

[As of a 3/3/22 court decision, the City cannot charge a premium if you opt out and continue your present covergage. However, the City wii undoubtedly appeal. The information below only applies if the City wins on appeal.] If you opt out and end up paying a monthly premium (e.g. $191 plus for NY Senior Care), payments will be deducted from your monthly pension check. The process is relatively straightforward for those in TRS. The premium will be deducted from you monthly pension benefit. If you are in TIAA, the process is not as straightforward, but there are options for payment through an annuity or direct billing, including autmatic debit from your bank account. Click here for details.

For context and background to this issue, those in TIAA should read the article (pp. 6-8) by Bonnie Nelson in the October retiree newsletter — “TIAA, CUNY AND THE MOVE TO MEDICARE ADVANTAGE.” The October issue of Turning the Page is available here.

VENDOR RELEASES PRE-AUTHORIZATION LIST

This disturbingly long list of pre-authorizations required for the MA+ plan, was recently released by its Alliance sponsors. But in case you have not, HERE is the link distributed by the NYC Office of Labor Relations:

Included in this link is the following statement: “Below is a general list of services to help you know when prior authorization is required or when to ask your provider to request it. Please note, this is not a complete list [emphasis added] and is provided as a guide to help you get the most out of your plan. Detailed prior authorization information is available for your providers.”

Below this statement is a list of 87 medical services and types of medical equipment. Chapter members are encouraged to examine this list carefully. In response to questions related to prior authorizations, the Alliance statement says that “You aren’t responsible for asking for it [authorization] when you see a provider that accepts NYC Medicare Advantage Plus.” And “If you see an out-of-network provider, you can ask them to request it for you.” If authorization is denied, you always have right to appeal the decision. Among other MA plans, an average of about 40 percent of appeals are upheld and the requested service(s) delivered.

In contrast, prior authorization is rare among those enrolled in Traditional Medicare.

NY RETIREE HEALTH RATE CHARTS EFFECTIVE JANUARY 1, 2022

If you opt out of the Alliance Medicare Advantage plan in order to continue with your current NYC health care plan, you will have to pay a monthly premium (except for HIP VIP and Aetna NY/NJ/PA which are premium free). Click here to see the rates on the NYC Office of Labor Relations (OLR) website. Note that you will NOT be paying for prescription drug coverage since that is already covered by the PSC CUNY Welfare Fund.

NYC OFFICE OF LABOR RELATIONS ON RETIREE HEALTHCARE BENEFITS

MEDICARE PART B AND IRMAA REIMBURSEMENTS

You will only be eligible for Medicare Part B (and if you qualify, IRMAA) reimbursements from NYC if you are in the Alliance Medicare Advantage plan or if you opt out and continue on your present NYC health plan. (If you are not familiar with the NYC Medicare Part B and IRMAA reimbursement policy, you can read about it in this primer that we have prepared on the subject.)

If You Have Submitted an Application But Have Not Received Your IRMAA Reimbursement. The Office of Labor Relations (OLR) has informed us that if you have not yet received your IRMAA reimbursement check for 2020, you should email OLR at [email protected]. Please do not submit duplicate applications; this will just increase the delays.

PSC JULY MAILING TO RETIREES

Letter from James Davis to Retirees on Healthcare Options

CORRECT MAILING ADDRESS

Take action now to be sure that the NYC Employee Benefits Program has your correct mailing address, particularly if you did not receive a Medicare “Notice of Change” letter from NYC last summer. The form to submit to the NYC Employee Benefits Program is here. Have you ben receiving mailings from the PSC and the Welfare Fund. If not, make sure both the PSC and the Welfare Fund have your correct address by entering your name and correct mailing address and mailing it to the PSC-CUNY Welfare Fund at 61 Broadway, 15th floor, New York, NY 10006.

365 DAY HOSPITAL RIDER.

This is automatically included in the Alliance Medicare Advantage Plan. However, if you opt out and pay the premium to continue in GHI/Empire Senior Care and presently have the rider, it will be grandfathered in for next year at a cost of $2.83 a month. To find out if you presently have the rider, call the Emblem Customer Service number at 212-501-4444. If you do not have the rider, and you are opting out to continue in GHI/Empire Senior Care, there was sign up period during the the November 2021 transfer period. We are checking with OLR to see if there will be another opportunity to sign up for the rider now that the opt out period has been extended to March 31. The form to add the rider is still available on the NYC HBP website, although we do not know if OLR is still accepting it now that the November transfer period has come and gone. Instructions are on page 2: https://www1.nyc.gov/assets/olr/downloads/pdf/health/health-benefits-app…

NAVIGATING RETIREE HEALTHCARE INSURANCE

NavigatingRetireeHealthcare.jpegThere is an excellent article in the October Clarion by Deborah Bell on “Navigating Retiree Healthcare Insurance.” All members should receive a hard copy in the mail. Read it online here.

YOUR CHOICE IS NOT WRITTEN IN STONE

Whatever your choice — Medicare Advantage or staying with a traditional Medicare plan — your choice is not irrevocable. Every fall (October or November) there will be a transfer period so retirees can change plans, from MA+ to Senior Care or from Senior Care to MA+, for the following year. Retirees currently enrolled in another supplemental plan who enroll in MA+ for 2022 will be able to switch back to the old plan only next year, for 2023. In addition, you may use your “Once in A Lifetime” option (you must be retired one year to use this option) at any time to change your health plan.

WILL YOUR DOCTORS AND MEDICAL PROVIDERS ACCEPT THE NYC MEDICARE ADVANTAGE PLUS PLAN?

Retirees are getting conflicting answers from their providers. Here is an information sheet that the Empire/Alliance shares with doctors and medical providers.

HOW THIS HAPPENED: THE MLC VOTE AND THE PSC RESPONSE

This is how we reported in real time to the MLC vote and PSC response.

On Wednesday, July 14, the Municipal Labor Committee (MLC) voted to approve a contract with the NYC Office of Labor Relations (OLR) to move city retirees, including CUNY retirees, from traditional Medicare with supplemental city insurance to a privatized Medicare Advantage plan. The transition would take effect on January 1, 2022. The PSC cast a “NO” vote. [implementation, as aresult of a court order, has been pushed back to April 1, 2022.]

The Medicare Advantage vendor is Alliance, a partnership of Empire BlueCross BlueShield and Emblem Health.

Members can choose to go into the Medicare Advantage plan or stay with traditional Medicare but would have to pay for their own suplementary insurance. Retirees 65 years and older will automatically be enrolled in the new Medicare Advantage Plus program effective January 1, 2022 [Now April 1, 2022], unless they affirmatively opt out. The retiree chapter, to put it charitably, is most unhappy that the City and MLC chose that the default for Medicare eligible retirees would be automatic enrollment in the Medicare Advantage plan.

You can choose to remain on your current NYC plan by opting out of the NYC Medicare Advantage Plus plan during the opt-out period (which by court order has been extended indefinitely), but you will have to pay a premium to stay on most of the current NYC plans. For retirees who opt out and wish to stay on the GHI/Empire BlueCross BlueShield Senior Care Supplementary plan, you will pay $191.57 a month per person and the plan will have co-pays (plus an additional $2.83 a month if you purchase the 365 day hospital rider). Premiums for other plans are on the OLR website here.

The City will continue to reimburse for Medicare Part B and IRMAA ONLY IF:

  • One signs up for the Alliance Medicare Advantage plan;
  • OR, one chooses to enroll in and pay premiums for one of the City’s health plans, including the current senior care (with a premium of $191.57 per month per person).

On Tuesday, July 27, the PSC set up the first of meeting with the vendor, Alliance, where members had the opportunity to ask questions. Here is a video of that meeting. A follow-up information meeting took place on August 30. Here is a video of that meeting. Subsequently, the Retirees Chapter held information sessions, videos of which you can find here.

THE PSC RESPONSE

retireehealthcare03.jpgPSC RESPONSE. For several months, the PSC raised serious concerns about the closed nature of the process, urging more transparency from the MLC and calling on it to seek savings through alternative means, such as working with other unions to contain skyrocketing hospital costs.

At its April 15th meeting, by unanimous vote, the PSC Delegate Assembly supported a call for a moratorium on negotiations about the change to a Medicare Advantage plan until PSC members have the information necessary to assess the matter.

The union urged the MLC to ensure sufficient time for members to review any proposal before representatives vote on it and promised to schedule an online forum for PSC members when information was made available about any Medicare Advantage plan the MLC is considering for approval. That forum, with close to 800 people attending, took place on Tuesday, July 13. (A video of the forum is available here.)

Before the forum, PSC President James Davis stated:

“The MLC’s vote on approval is being held just six days after the proposal was made available to leaders of the MLC unions, an inadequate review period. The PSC would like to hear in advance of Wednesday’s vote from interested members of our bargaining unit – current or future retirees – about the proposed Medicare Advantage Plan, a group plan developed by Emblem/GHI/Anthem. We have been asking many questions of the MLC, and we’re sure you will have your own. Information provided by the MLC is available here: Intro, Strategic plan, Comparison.”

Meanwhile, the PSC put out a press release on Monday, July 12 entitled PSC Call for Postponement of Upcoming Municipal Labor Committee Vote on Changes to Retiree Health Insurance. Click here to read it.

The press release quotes PSC President James Davis making the case to postpone the MLC vote:

“Our members are deeply troubled by the MLC’s rush to vote on this proposal. Five days is not enough time to consult on such a consequential decision. Although the MLC agreed to work with the City on healthcare savings measures in 2015 and 2018, this vote to seek savings through the retiree medical plan comes at a time when the City can well afford to pursue alternatives. This austerity measure opens the door to further cost-cutting and diminished benefits in future contracts.”

“We are concerned by the closed nature of the negotiations. Municipal retirees should have a chance to review the agreement and engage with their representatives to the MLC before a vote. MLC unions have not been provided with a copy of the contract with the proposed vendor.”

The PSC’s motion to postpone was defeated.

Subsequently, three healthcare unions (Committee of Interns and Residents, Doctors’ Council and New York State Nurses Association) voted “no” on the Medicare Advantage motion together with the PSC and a fifth union, the Sergreants Benevolent Association. The vote was weighted by union memberdship, but even without a weighted ballot, it would have carried by a large margin.

ADVOCATING FOR MEMBERS’ HEALTHCARE:

Together, with thousands of other municipal retirees, we pushed back. Our chapter was one of the first to shine sunlight on OLR/MLC negotiations that sought to re-engineer our health benefits by moving municipal retirees from traditional Medicare to privatized Medicare Advantage. Here is a shout out to the municipal retiree organizations and their allies who pushed back against the City’s plan and brought us to this moment — the Cross Union Retiree Organizing Committee (CROC), the Council of Municipal Retiree Organizations (COMRO), the DC-37 Retirees, Physicians for a National Health Plan (PNHP) and of course the NYC Organization of Public Service Retirees which brought the lawsuit and now has 15,000 members on its Facebook page. Below is a partial list of PSC events and city-wide moments in the pushback.

RETIREE CHAPTER NEWSLETTERS BEGINNING IN APRIL 2021 and every month since have provided reporting and analysis on the proposed move to MA+ — and the pushback by retirees.. The April 2021 issue first sounded the alarm about what is happening.

TWO CHAPTER MEETINGS ON THIS ISSUE: The chapter devoted two meetings to the MLC proposal to move retiree healthcare to Medical Advantage and our response. Both meetings were recorded. Click below to see the Videos:

THE APRIL 5TH MEEETING: 320 retirees attended. We invited two key people to discuss this and answer questions: PSC President Barbara Bowen, who is on the MLC Steering Committee, and Donna Costa, Executive Director of the PSC/CUNY Welfare Fund and a member of an MLC committee assessing the two Medicare Advantage finalists for an RFP issued by the city. Len Rodberg, Professor Emeritus from Queens College, a prominent advocate for single-payer healthcare and a PSC retiree, presented a brief history of Medicare Advantage as a privatized, for profit version of Medicare (which of course raises lots of questions.) Click HERE for a PDF of the PowerPoint slides Prof. Rodberg used in his presentation.
There is a full recording of the Zoom meeting. Click HERE for the link.

At the beginning of the meeting, a statement of urgent concern, unanimously endorsed by the Retiree Chapter Executive Committee, was read. It is available here.

At the conclusion of the April 5 chaper meeting meeting, the body passed the following resolution (93.5% to 6.5%):

As a matter of urgent concern, the Retiree Chapter of the Professional Staff Congress requests that the PSC seek a moratorium on any agreement between NYC and the Municipal Labor Committee to move retiree healthcare coverage from Medicare/Senior Care to Medicare Advantage.

Municipal retirees affected by the proposed changes to retiree coverage have not been provided adequate and timely information nor have they had opportunities to discuss and debate the controversies around Medicare Advantage plans, the personal effects of such a change and its policy implications.

DA RESOLUTION ON A MORATORIUMTHE MAY 3RD MEETING: The second half of this meeting, from 2 – 3:30 pm, focused on updates on the NYC/MLC negotiations on retirement health insurance and the organized response to these moves. There was a discussion of possible actions. The meeting was recorded. Click here for a video.

SPRING 2021 — COMRO PETITION. PSC retirees worked with the Council of Municipal Retiree Organizations (COMRO) on mobilizing municipal retirees in response to the move to Medicare Advantage. COMRO has an online petition addressed to the mayor and the MLC entitled “Preserve Medicare Part B for NYC Retirees.” The petition generated over 28,000 signatures. To view the petition and add your name, click here.

FORUM: THURSDAY, JUNE 17. City to Retirees: Private Health Care ─ Take It or Leave It! More than 650 people attended this webinar. The NY Metro Chapter of Physicians for a National Health Program (PNHP) presented a program examining the proposed move of municipal retirees from traditional Medicare to a private, for profit, Medicare Advantage Plan. The forum reached out to municipal retirees, but it also took the story to a much wider audience. There was analysis by health care professionals and economists and a report on pushback by NYC retirees. PSC retirees played a prominent role in the program.

There was also a roadmap presented of future actions and pushback against NYC/MLC proposed healthcare moves. Here is a link to a video of the forum:

https://vimeo.com/565806450

FORUM: THURSDAY, JUNE 24. How Do We Stop the Move of Municipal Retirees to Medicare Advantage? More than 600 attendees participated in a meeting on Thursday, June 24 via Zoom. Panelists representing a cross-section of NYC retirees and unions discussed actions we can take in opposition to the proposed move of municipal retirees from traditional Medicare to a private, for-profit, Medicare Advantage Plan. There was a robust question and answer period with lots of suggestions about how we can push back. The webinar was hosted by the NY StateWide Senior Action Council. Once again, PSC retirees played an important role in the program.

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JUNE 30 MARCH AND RALLY On the hottest day of the year, PSC retirees and future retirees joined retirees and future retirees from across the municipal workforce for a rally at Bowling Green and march to City Hall. Several hundred marched, including a few with canes and walkers — “summer soldiers” in blistering heat demanding that the MLC and OLR call for a moratorium in negotiations, make their deliberations transparent and listen to the voices of the 250,000 municipal retirees affected. There were stops at unions along the march route (UFT and PSC) and the NYC Office of Labor Relations Two PSC retirees were among the speakers — Eileen Moran and Nancy Romer. Here is a short video of the march and rally.

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JULY 12, 2021 – PSC CALLS FOR MLC TO POSTPONE ITS VOTE ON MOVE TO MA+, The PSC put out a press release on Monday, July 12 entitled PSC Call for Postponement of Upcoming Municipal Labor Committee Vote on Changes to Retiree Health Insurance. Click here to read it.

The press release quotes PSC President James Davis making the case to postpone the MLC vote:

“Our members are deeply troubled by the MLC’s rush to vote on this proposal. Five days is not enough time to consult on such a consequential decision. Although the MLC agreed to work with the City on healthcare savings measures in 2015 and 2018, this vote to seek savings through the retiree medical plan comes at a time when the City can well afford to pursue alternatives. This austerity measure opens the door to further cost-cutting and diminished benefits in future contracts.”

“We are concerned by the closed nature of the negotiations. Municipal retirees should have a chance to review the agreement and engage with their representatives to the MLC before a vote. MLC unions have not been provided with a copy of the contract with the proposed vendor.”

The PSC’s motion to postpone was defeated.

PSC VOTES “NO” ON MOVE TO MA+. At the July 14, 2021 meeting of the MLC, the PSC and three healthcare unions (Committee of Interns and Residents, Doctors’ Council and New York State Nurses Association) voted “no” on the Medicare Advantage motion together with a fifth union, the Sergreants Benevolent Association. The vote was weighted by union memberdship, but even without a weighted ballot, it would have carried by a large margin,

SEPTEMBER 24 DIE-IN: This was a street theater event on Friday, September 24th at City Hall to protest the NYC move of retiree healthcare from traditional Medicare to a privatized, for profit Medicare Advantage Plan. Click here for a shorrt video of the event.

OCTOBER 2021: THREE LAWSUITS.

Three lawsuits in the courts sought injunctive relief to stop implementation of the NYC retiree healthcare changes. Two of the suits were by losing bidders for the Medicare Advantage contract – UnitedHealthCare and Aetna. A third, filed by the NYC ORGANIZATION OF PUBLIC SERVICE RETIREES, represents municipal retirees. Over 12,000 city retirees have joined its Facebook page, including PSC retirees. All three lawsuits, while not combined, were before the same judge, Lyle E. Frank on Wednesday, October 20. The next day, he issued a Temporary Restraining Order (TRO) extending the enrollment deadline for the retiree healthcare plans beyond October 31. He wrote, “the “Court feels that the method of implementation of this plan at present has been irrational, and thus arbitrary and capricious.” But the “Court has upheld the process used to pick the Alliance, so the entire process will not need to begin anew.” In effect, he ruled against Aetna and UnitedHealthCare, keeping the Alliance NYC Mediare Plus plan in place.

The NYC Organization of Public Service Retirees has created a website at http://www.nycretirees.org/, where you can sign up for an email newsletter. The web page has information on how to make a monetary contribution to the lawsuit, which many PSC retirees have done.

[Subsequently, the lawsuit by the NYC Organization of Public Service Retirees resulted in a decision on March 3 by judge Lyle Frank stipulating that NYC could not charge a premium for NYC Healthcare, but that the MA+ plan could be implemented on April. The City, however filed a notice of appeal and indefinitely delayed implementation of MA+. Scroll to the top of this page for details. ]

OCTOBER 28 CITY COUNCIL HEARING ON CHANGES TO MUNICIPAL WORKERS RETIREE HEALTH PLANS,

The City Council Committee on Civil Service and Labor, held a hearing on Thursday, October 28th. Several PSC retirees submitted teistimony, as did James Davis, President of the PSC. Bill Friedheim, chair of the retirees chapter testified in person.

The meeting was most notable for the aggressive cross examination of the commissioner and deputy commissioner of tlhe Office of Labor Relations by council members, particularly Councilwoman Helen Rosenthal.

A video of the hearing is avallable here. (At the top of the web page, look for “meeting video” and click the link.)

OLR HEARING ON THE MEDICARE ADVANTAGE CONTRACT, NOVEMBER 10.

The NYC Office of Labor Relations (OLR) hosted a hearing on the contract before submitting it to the NYC Comptroller. The hearing was absolute bedlam, to the point where speakers could not register to testify and could only be heard by out-shouting others trying to talk. More than 250 attended, but only a handful got to testify. The hearing was organized as a telephone conference call where anyone could press *6 to unmute, which meant that multiple attendees tried to talk at the same time. An account in the online city journal, New York Focus, captured the absurdity of what the Office of Labor Relations (OLR) publicized as a hearing. OLR did not create even a bare bones structure for registering, for testifying and for conducting the hearing in an orderly manner. Even so, many retirees tried to testify; not one supported the Medicare Advantage plan. Click here to read the NY Focus piece. James Davis, President of the PSC, submitted testimony based on a close reading of the document which raised serious questions about lack of accountability in the contract for the vendor. He urged “elected officials of the City to reject the contract because it is significantly flawed.” Click here to read his testimony.

“DECEMBER 24, 2022: CITY RETIREES URGE ADAMS TO SCRAP SWITCH TO MEDICARE ADVANTAGE”

NEW YORK, N.Y.—Sporting sparkly party hats and lifting empty plastic champagne glasses, about 50 retired city workers gathered on the stone steps of Brooklyn Borough Hall Dec. 21 to wish mayor-elect Eric Adams a happy new year — and urging him to cancel the city’s plan to switch their health care from traditional Medicare to a private Medicare Advantage plan.

“We’re wishing Eric Adams Happy New Year, and also telling him our wishes: To have a happy healthy new year, we need our traditional Medicare back,”….

–From an article in the Labor Press describing a 12/21 action at Brooklyn Borough Hall sponsored by the Cross Union Retiree Organizing Committee (CROC). Read the full Labor Press article here.

DoNotBreakOurHearts.jpgVALENTINE’S DAY RALLY TELLS THE MAYOR “Don’t break our Hearts! Don’t privatize our Medicare and give us an inferior plan! Don’t make us jump through hoops with 87 prior authorizations to get necessary medical procedures and tests! Don’t make us pay a penalty of almost $200 to keep our public Medicare! Show your love to your fellow city retirees!”

These were the themes that resonated on a bitterly cold day as PSC retirees joined fellow municipal retirees for a spirited rally on Monday, February 14 across from City Hall. Sponsored by the Cross-union Retirees Organizing Committee and nine other groups. .

Here is a clip of coverage on WPIX-TV.

An article in the NY Daily News with the headline “More than 45K NYC retirees opt out of city’s new Medicare plan over ‘bait and switch’ concerns” had extensive reporting on the Valentine’s Day rally.

KEY LINKS

TIMELINE

Here is a list of both PSC and city-wide key events on the proposed NYC changes in healthcare benefits for municipal retirees — and the pushback against them.

Go back to the retirees main page


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Union Week December 5-9, 2022