What is the new NYCE PPO?
The NYC Employees PPO Plan (NYCE PPO) is a new premium-free health plan offered jointly by EmblemHealth and UnitedHealthcare. It would include health coverage for doctors, hospitals and other medical facilities — all under one health plan and one member ID card. The current in-network copays — the flat fee we pay for visits with contracted doctors — would remain the same, while the network of providers would expand. This plan would be available to all city employees, pre-Medicare-eligible retirees and their eligible dependents enrolled through the NYC Health Benefits Program. Coverage would begin on Jan. 1, 2026. This plan, if approved, would replace the current GHI CBP plan for in-service members and pre-Medicare retirees. No other city health plans would be affected.
Is EmblemHealth different from GHI CBP?
EmblemHealth is the insurance company that administers the medical portion of the current GHI CBP plan. Your medical health insurance card now says EmblemHealth at the top and it would continue to say EmblemHealth under the NYCE PPO. The continuing participation of EmblemHealth is a big benefit of this new plan.
Anthem (formerly BlueCross BlueShield) administers the hospital portion of the GHI CBP plan. Therefore, members have two ID cards for the GHI CBP plan: an EmblemHealth card for medical coverage and an Anthem card for hospital coverage. The new plan streamlines medical and hospital coverage into one network with one ID card (see below).
Is there anything in the GHI CBP plan that isn’t included in the new plan?
No. All the benefits and services that we have in our current plan would be offered in the NYCE PPO, plus more features and enhancements.
Would we still have access in this plan to our same EmblemHealth providers in the Downstate 13 counties (DS13), which are made up of New York City, Long Island and Dutchess, Orange, Putnam, Rockland, Ulster and Westchester counties?
Yes, providers who are currently contracted with EmblemHealth in these locations would also be covered under the NYCE PPO.
Are copays changing?
No, they are not. Each year we have to fight to stop insurance companies from increasing our copays. Under the proposed plan, our copays would stay the same as they are now, and more services would have no copays. NYC Health + Hospitals would join ACPNY as an in-network preferred provider which would expand the options across the city for medical services with no copays. This plan would help to protect our current rates for the next five years.
What about hospital coverage?
The NYCE PPO would allow you to visit all major hospital networks in the nation. In the NY Downstate 13, this includes but is not limited to NYU Langone, Northwell Health, New York-Presbyterian, Mount Sinai, Montefiore, Memorial Sloan Kettering (MSK), Hospital for Special Surgery (HSS) and NYC Health and Hospitals (H+H).
Would the new plan place hospitals in different tiers with different benefit levels and out-of-pocket costs?
There is no tiering of hospitals in the NYCE PPO. Members will incur the same out-of-pocket costs at all hospitals, with the exception of NYC Health + Hospitals, MSK and HSS, which will remain preferred providers with low-cost or $0 copays for services.
The new plan, like the current GHI CBP plan, allows for the option of tiering in the future to penalize hospitals that price gouge or act in bad faith.
What mental and behavioral health services would the new plan provide?
Mental and behavioral health services will now be provided by United Healthcare. Through the new plan, members would continue to have in-person and virtual access to a nationwide network of quality behavioral health providers offering evidence-based treatment options. The proposed plan would include:
- 39,000 mental and behavioral health providers in New York State, which represents a 325% increase from the 12,000 providers in the GHI CBP plan.
- 87% of which would be accepting new patients.
- 418,000 mental and behavioral health providers nationwide, which represents a 685% increase from the 61,000 providers in the GHI CBP plan.
- 84% of which would be accepting new patients.
- 85.5% of which practice both in person and virtually.
- Access to 22 specialty mental and behavioral health provider organizations, up from the seven offered in the GHI CBP plan. These organizations, which would provide virtual services to members, would be accessed through EmblemHealth concierge services under the NYCE PPO. Examples include:
- Charlie Health for teens and adults who need mental health, substance use disorder or eating disorder-specific car
- Hazelden Betty Ford for virtual/digital therapy for substance use disorders
- InStride Health for virtual/digital therapy for pediatric anxiety and obsessive-compulsive disorders (OCD)
- Talkspace for virtual/digital therapy via texting, video or chat with licensed therapists
What other types of specialty health care programs would be offered in the new plan?
A suite of programs and resources would be offered on topics including wellness, disease management, maternity care, convenient virtual care and more. Details on these programs will be available if the plan is approved.
Would I need to get referrals from my doctor to see specialists?
No, the NYCE PPO would not require referrals.
What protections are in place to ensure the expanded network remains in place?
- The provider network in the DS13 would not drop below 74,000.
- At least 90% of all services inside the DS13 must be in-network.
- At least 95% of all services outside the DS13 must be in-network.
- EmblemHealth/UHC would commit to bring highly utilized out-of-network providers into the network.
Can this health plan be altered without MLC approval?
No. Any changes to the proposed health plan would need to be approved by both the city and the Municipal Labor Committee before they could take effect.
I have heard that the new city plan is a self-funded insurance plan. What does that mean?
In a self-funded plan, the employer (in our case, the City of New York) pays the medical bills directly when claims come in. "Self-funded" does not mean that individual members are paying their own medical bills. The "self" is the city in our case.
The insurance company is still there, but now they're acting as the administrator — processing claims, running the network of doctors and hospitals, and providing customer service.
This has no effect on us and the health care we receive. You will still use your health insurance card, go to doctors and hospitals, and pay the copays and deductibles like you're used to.
Moving to a self-insured plan from the current plan — which is technically a “minimum premium” plan — allows more flexibility in our case, with larger provider networks and fewer denials, since it's not about what makes an insurance company money, but about meeting negotiated standards.
Does "self-funded" mean that the plan is not subject to Department of Financial Services oversight?
First, it’s important to note that our GHI CBP plan was never a “fully funded” plan -- it is a minimum premium plan. With NYCE PPO, we would be moving from a minimum premium plan to a self-funded plan.
Second, NYCE PPO would be thoroughly protected by law. It is accurate that the New York City Department of Financial Services (DFS) does not have direct oversight of self-funded plans (as they are not an “insured” product). However, as a New York public employee self-funded health plan, NYCE PPO must follow state consumer protection laws, including grievance and appeals processes. This plan maintains internal grievance and appeal rights, as well as the ability to further appeal externally. Additionally, plan members may file complaints directly with DFS even before completing the internal appeals process.
More importantly, our plan isn’t just run by insurance companies or managers, it’s collectively bargained and jointly monitored by the Municipal Labor Committee and the city. That means unions, not just an insurance commissioner at the state level, sit at the oversight table. Decisions are made with us in the room.
It’s critical that any plan has these protections. Moving to a self-funded plan, in our case, makes these protections stronger, faster and more in our control.
What is the benefit of a self-funded plan?
Self-funded benefit plans are very common with large employers, including many large unions across the country. A primary benefit of a self-funded plan is the flexibility in plan design.
Remember: all changes to any plan design are still subject to collective bargaining. Unions have a seat at the table to both advocate for improvements and fight back against any attempts to diminish benefits in the future.
I have heard the city is saving money with this new health plan. How is it possible to save money and still provide quality health care?
We leveraged the massive buying power of the entire Municipal Labor Committee to tell insurance companies to offer us high-quality health care at lower prices. They were willing to do this because getting our business is a massive win; the MLC represents 750,000 city workers, pre-Medicare city retirees and their dependents in the GHI CBP plan alone.
Let's say a contract with the MLC is worth $10 billion. We told insurance companies that they could get our business for $9 billion or not get our business at all. Of course, they chose to get $9 billion. This is what enabled us to maintain and improve our benefits while reining in costs for the city. The insurance companies didn’t want to walk away from 750,000 customers so we were able to reach a deal that met our needs.