CO-PAYS RISE FOR UFT MEMBERS NOT USING ADVANTAGE CARE OR HIP PREFERRED

We all received the email today from Arthur Pepper, Director of the UFT Welfare Fund, saying many of our co-payments would be rising for healthcare while others stay the same and a few have been eliminated.

Most UFT members use HIP or GHI, which are EmblemHealth. New York City employees are among the few workers remaining in the USA who do not have a deduction from our pay to pay for part of our health insurance except for the Medicare tax. That being said, it would be difficult to conclude that these changes are any kind of step forward unless you use Advantage Care Physicians for all of your medical care. The city and union are really trying to get as many of us as possible into some kind of managed care which severely restricts our choice of doctors unless we want to pay a small fortune.

Nobody who read the 2014 contract should be surprised by any of the increases.  Part of the agreement was that we would save the city money on healthcare to help fund our meager raises of 10% over 7 years and one month. The city must love our union for making this deal which helps them financially. The city surplus was close to $6 billion last year.  There could be a little less black ink this year as Wall Street has had an up-and-down ride lately but nowhere have I seen economists predicting a city recession soon and yet we still keep helping them. One would think they would treat us a bit more professionally in return. These healthcare changes won't necessarily stop here. The contract calls for $1 billion in savings this year and another $1.3 billion for next year and beyond.

It should be noted that an employee can keep virtually free healthcare if he/she stays in the Advantage Care Network but if he/she needs to go outside, costs are going up substantially.  Even HIP, which was traditionally free for doctor visits, will now cost $10 if a UFT members goes out of the new preferred HIP network which my guess will be Advantage Care.

GHI will be increasing co-payments for when UFT members see specialists, for lab tests as well as other services (see below) unless the member stays within Advantage Care in which case the cost will be $0.  Advantage Care facilities will probably end up being overwhelmed by an increase in patients.

Co-pays for emergency room visits are tripling from $50 to $150. According to Pepper, some of us are "over-utilizing hospital emergency rooms."  If Advantage Care isn't available and a UFT member still needs to see a doctor in a hurry, there will be participating Urgent Care facilities with a copay of $50 as opposed to the current GHI $15 copay.

The only real unexpected development here is that the changes were announced before the UFT election this May and prior to Mayor Bill de Blasio's reelection next year. This blog predicted co-pays to increase after everyone was reelected but UFT President Michael Mulgrew is so entrenched that he could care less about worrying how his members will react to changing healthcare rates.

We can just about be certain that the spin from the UFT will be that UFT member healthcare is the best in the country and it just got better. Whether that is true or not, the ICEUFT blog leaves that up to our readers.

The email from Pepper is copied below.


I am writing to inform you about coming changes to the city health care plans negotiated by the city and the Municipal Labor Committee, the umbrella group of municipal labor unions of which the UFT is a member.  These changes affect our in-service members and our retirees who are non-Medicare eligible. As part of our last collective-bargaining agreement, we agreed to achieve health care savings.  By collaboratively working with the city, we have been able to preserve access to quality health care while meeting our savings obligation.

We are proud that public school educators and all other New York City municipal employees have access to health coverage without an annual premium. That will continue. When the changes take effect in the next several months, certain GHI and HIP copays will be adjusted.  Some will increase, but we also made certain to eliminate other copays to make low or no-cost options available for many health care services.

GHI subscribers currently pay $15 when they visit their primary care physician, the most utilized service in the plan. That copay will not change. Members using physicians at the Advantage Care Physician (ACP) offices will have no copay.  There will, however, be copay increases to see specialists and receive various diagnostic tests from other providers in the GHI network.

Members seeking to keep their health care costs down should consider visiting one of the 36 Advantage Care Physician (ACP) centers created by EmblemHealth in New York City and in Nassau and Suffolk counties. Members who receive care, including urgent care, at one of these sites will have no copays for their treatment, including high-tech radiology. Bronx-based members will have access to ACP-affiliated physicians at various Bronx locations to be announced.  We will also be working on extending this coverage north to Westchester, Rockland and other counties.

GHI subscribers will no longer have any copays for preventive health care. All preventive health services — including prescriptions for birth control, immunizations, mammography, prenatal vitamins and colonoscopies — will soon be available to GHI subscribers free of cost. Members will receive more information from EmblemHealth in the next few months.

One of the most expensive forms of care is hospital-based emergency room visits, which should only be used in a genuine emergency. The cost to the health plan for a visit to the ER is several times that of a visit to a doctor’s office. Our data show that some members are over-utilizing hospital emergency rooms. To discourage the use of ERs when a doctor’s visit would suffice, the copay for hospital-based emergency-room visits will increase from $50 to $150.  Please be aware that you can see a doctor at short notice at one of EmblemHealth’s Advantage Care Physician offices with no copay or at a participating Urgent Care facility with a $50 copay.

As part of our Wellness programs, we will also be introducing telemedicine, which will allow members immediate access to an Internet-based physician who can guide their care and even provide a prescription if necessary.  All members in a New York City health plan will also be able to join Weight Watchers at a substantial discount.

HIP subscribers will also see changes to their health plan. HIP is introducing a new plan called HIP Preferred. HIP subscribers can continue to use their HIP doctor with no copay if he or she is in the HIP Preferred network. HIP subscribers will now have a $10 copay if their doctor is not in the HIP Preferred network.

The chart below lists the GHI changes that will take effect in the coming months:

GHI – CBP Benefits	Current Copay	New Copay
PRIMARY CARE PHYSICIAN – PCP (PARTICIPATING GHI DOCTOR)	$15	$15
ADVANTAGE CARE PHYSICIAN – ACP GENERALIST (PCP)	$15	No copay
ADVANTAGE CARE PHYSICIAN – ACP SPECIALIST	$20	No copay
NON-ADVANTAGE CARE PHYSICIAN SURGICAL SPECIALIST	$20	$30
ALL OTHER SPECIALISTS	$20	$30
EMERGENCY ROOM	$50	$150
URGENT CARE FACILITY	$15	$50
MRI/CT (HI-TECH RADIOLOGY)	$15	$50
DIAGNOSTIC LAB (BLOOD, XRAY ETC.)	$15	$20
PHYSICAL THERAPY	$15	$20
ALL PREVENTIVE SERVICES INCLUDING IMMUNIZATIONS, MAMMOGRAPHY, COLONOSCOPY AND PRESCRIPTIONS FOR CONTRACEPTION		No copay

The following chart shows the changes affecting HIP subscribers:

HIP Benefits	Current Copay	New Copay
HIP Preferred Network (new)	No copay	No copay
HIP Non-Preferred Physician	No copay	$10

Here are a few helpful links:

• AdvantageCare Physicians
• EmblemHealth (GHI)

We will be sharing more information in the New York Teacher and on the UFT website in an effort to answer any questions you might have and prepare you for the various changes.

Fraternally,

Arthur Pepper
UFT Welfare Fund Executive Director

UPDATE: Jonathan Halabi has posted the percentage increase for GHI copays:

Emergency Room 300% ↑
Urgent Care  233% ↑
All Specialists 50%↑
Blood Work  33% ↑
MRI 233%↑
Physical Therapy 33% ↑