Public Employee Press

GHI and Blues implement benefit changes April 1

Beginning April 1, the Empire BlueCross BlueShield and GHI health plan implemented a number of changes that protected vital benefits for members and retirees but resulted in higher co-pays. The changes were included in a Dec. 18 agreement between municipal unions and the city that opened up the way for bargaining on a new economic contract.

Under the agreement between municipal unions and the city, the HIP/HMO plan continues to have no co-pays for office and specialist visits and diagnostic services. Changes in the city’s PICA Drug Program effective April 1 are described on page 8.

Hospital benefit
(Empire BlueCross BlueShield)
Following are changes affecting active workers and retirees:

• The hospital inpatient deductible rose from $200 to $300 per admission with the annual maximum up from $500 to $750.
• The hospital emergency room co-pay increased from $25 to $50. (The co-pay is waived when patients are admitted for hospital stays.)

Medical benefits (GHI)

• Participating medical and mental health-care providers now require a $15 co-payment for each visit, a $5 increase. This group includes family, general, internal medicine, OB/GYN and pediatric physicians; others are listed on GHI’s Web site at www.ghi.com.
• A $20 co-pay (up from $10) now applies to visits to surgeons, surgical specialists and dermatologists.
• The co-pay for GHI participating lab and radiology providers increased from $10 to $15, with a maximum of one co-pay per provider for each date of service.
• The annual deductible for non-participating provider services is up from $175 to $200 per individual. The family deductible remains $500.
• A 25 percent coinsurance now applies to non-mandated in-vitro fertilization services. (see GHI Web site) from participating and non-participating providers. The latter are also subject to the non-participating provider deductible.

Retirees
The changes above also affect retirees who are not yet eligible for Medicare and are enrolled in the BlueCross Blue Shield and GHI CBP plan. The following benefit changes were implemented April 1 in the Senior Care Program that covers Medicare-eligible retirees:

Hospital benefits (Empire BlueCross BlueShield): The inpatient deductible rose to $300 per admission from $200, with an annual maximum of $750 per person, up from $500.

Medical benefits (GHI): After participants satisfy their Medicare Part B deductible ($100), they are responsible for an additional $50 of covered Senior Care services per individual for each calendar year. GHI then pays the Medicare Part B coinsurance (20 percent of the “Medicare allowed charges”) for covered services for that year.

The separate $25 calendar year deductible for private duty nursing, ambulance and durable medical equipment is unchanged.

For more information on hospital benefits, participants should call Empire BlueCross BlueShield at 800-433-90592 or visit www.empireblue.com, its Web site. For questions on medical benefits, call GHI at 212-501-4444 or go to its Web site at www.ghi.com.