Important changes to certain benefits under the Plan will go into effect on August 1, 2023.
Coverage for Medical, Dental, and Prescription Drug Coverage shall be amended as follows:
1 . Effective August 1, 2023, the Fund will remove from eligibility all legally married spouses and Domestic Partners for all benefits.
2. The Fund will change from the current Empire Blue Connection EPO ASO Agreement to the fully insured Empire Blue Connection EPO network benefit with the following changes to current benefits:
Primary Care / Specialist Visit Copay $30.
Annual deductible $1,000 individual/ $2,000 Member & Child.
Emergency Room Copay Visit Copay $300 (waived if admitted).
If you have questions about these changes in benefits, please contact your Plan Administrator at (212) 343 1660.
Frequently Asked Questions May 15, 2023
Why is the Plan making these changes?
The Plan has been running at a deficit due to the volume of medical claims that are paid annually, and the costs associated with certain medical procedures that are covered by the Plan. To continue providing coverage to participants, the Trustees review many factors, such as the number of members enrolled that are contributing to the Plan, the Claim utilization spending, and the projected future cost of providing benefits (medical inflation).
Based on these factors, there are limited options available:
Plan savings by cutting costs through increased cost-sharing and behavior modification. The Summary of Material Modifications included with this FAQ provides all the benefit modifications effective August 1, 2023, the new benefit period options.
When will the changes become effective?
The changes for services will begin on August 1, 2023.
Why is the Plan eliminating Spousal coverage?
The elimination of Spouse coverage is necessary because the Fund does not receive enough funding to support the cost of providing benefits. In prior years the Fund spent money held in reserves, however, the reserves have been depleted. It’s a difficult decision, hopefully, a temporary one, but necessary to stabilize the Plan.
Where will my spouse receive their benefits after August 1, 2023?
If eligible, Medicare as the Primary insurer, through their employer’s insurance, or through the New York State Health Exchange.
Where can I obtain information on health insurance that is available on the marketplace?
In New York, you can log onto: https://nystateofhealth.ny.gov/ to find a health plan that best suits your needs. Bronze plans are the least expensive. Even within “bronze plans” the cost varies considerably. Not only should you check the premium, but you should also examine what co-pays you would be charged as well as what hospitals are in the carrier’s network.
THE BOARD OF TRUSTEES