Health Plan Options for Newly Hired Employees on or after October 1, 2022

CUNY/City of New York employees, hired on or after October 1, 2022, and their eligible dependents, will only be eligible to enroll in the EmblemHealth HIP HMO Preferred Plan, and must remain in the HIP HMO Preferred Plan for the first year (365 days) of employment. 

After 365 days of employment, the employee will have the option of either remaining in the HIP HMO Preferred Plan or selecting a different health plan within 30 days before the end of the 365-day period if a new health plan is selected, the new plan will be effective on the 366^th day.

Only after the 365^th day can the employee participate in any Annual Fall Transfer Period. (See Annual Fall Transfer Period selection below for details.)

An employee who needs to request an exemption from the required enrollment in the HIP HMO Preferred Plan can do so by submitting a HIP HMO Opt-Out Request Form to EmblemHealth directly. An employee, or eligible dependent, must meet certain criteria in order to submit the request and it must be approved by EmblemHealth before the exemption is granted, The HIP HMO Opt-Out Request Form and HIP HMO service area are available on the EmblemHealth website. 

October 1, 2022 HIP Enrollment Requirements:

1) Any employee who is a new hire on or after October 1, 2022.

2) 365 days begin with the effective date of hire (not the benefits coverage effective date)

Note: Rehires and agency/participating employer transfers who were originally hired prior to October 1, 2022 are not subject to this requirement.

      A.) Options for Newly-Hired Employees who are electing City Health Coverage: 

1. HIP HMO Preferred Basic Plan, or
2. HIP HMO (Rider Other) Private Duty Nursing & Appliances (for those employees in a union where prescription drug coverage is offered to their members), or
3. HIP HMO Full-Optional Rider (for those employees in a union where prescription drug coverage is not offered)

      B.) Options for Newly-Hired Employees who are not electing City Health Coverage: 

1. Elect the Health Benefits Buy-Out Waiver Program and receive an incentive payment ($500-Individuals Coverage, $1,000-Family Coverage), or
2. Elect Waiver (the City doesn't allow double coverage if the employee is covered under another City employee's health coverage.)

II) HIP HMO Opt-Out: Click here for HIP HMO Opt-out request Form

Employees can Opt-Out of the HIP Enrollment requirement of they meet either of the below:

• If the new employee resides outside of the HIP HMO service area (HIP's service area includes the five boroughs New York City, as well as Nassau, Rockland, and Westchester counties, New Jersey and Connecticut) and cannot access primary care with one of the HMO providers. Visit the Health Benefits website at nyc.gov/hbp in order to access the hyperlink to Emblem's website for a list of countries in the HIP HMO Service Area. The employee must provide their name and address on the back of the HIP HMO Opt-Out Request Form. 

• If the new employee is being treated by a non-network provider for a life-threatening or disabling disease or condition and is receiving ongoing treatment for a catastrophic or terminal illness or has a condition that requires complex case management (such as ventilator dependence or trauma). The employees or eligible dependent must provide the treating Physician's name, address and phone number on the back of the HIP HMO Opt-out Request Form.

An employee who needs to request an exemption from the required enrollment in the HIP HMO Preferred Plan must submit the HIP HMO Opt-Out Request Form to EmblemHealth directly. Once the employee completes and submits the HIP HMO Opt-Out Request Form, EmblemHealth will notify the employee of the notice from EmblemHealth, along with other necessary documentation, to the Health Benefits Program when they are applying for City health benefits.

For the NYCAPS system, health benefits representatives can select "EXP" to override the HIP requirement if the employee submits the approved OPt-Out notice from EmblemHealth.

Furthermore, employees can request the HIP HMO Opt-Out Request Form during the 365-day period if they are moving out of a HIP HMO service area, but they must do so within 30 days of that event.