On May 5, MEA members met with OLR representatives regarding MBF Benefits. Video recording is available until June 30.
MEA Statement: Health care is one of the most sacred and indispensable necessities required to sustain our lives. Therefore, the quality of health care insurance and the performance of the insurer are of the utmost importance.
MEA testimony at New York City Council, Civil Service and Labor Committee Hearing on “Health Insurance Coverage for Municipal Employees, Municipal Retirees, and Their Dependents” via Administrative Code 12-126. LINK here.
MEA met with the Comptroller Office and City Council regarding Administrative Code 12-126.
MBF: 212-306-7290 or submit your questions via this FORM
FSA: 212-306-7290 or submit your questions via this FORM
In order to receive the MBF subsidy benefits, you must be enrolled in the City’s Health Benefits program.
Retirees who wish to participate in HIP VIP instead of the Aetna Medicare Advantage PPO Plan may do so by contacting Aetna at 1-855-648-0389 or by visiting Aetna CONY.AetnaMedicare.com and indicating that they wish to “opt out” of Aetna Medicare Advantage PPO Plan. No opt-out form will be required.
Retirees can call the Aetna NYC Retiree dedicated call center at 1-855-648-0389 (TTY: 711), Monday to Friday, 8 a.m. to 9 p.m. between May 1, 2023, and June 30, 2023 in order to opt-out of the Aetna Medicare Advantage PPO Plan and be enrolled in HIP VIP.
1. The ASO website is very difficult to log on. Have the issues been resolved?
MBF: We contacted ASO dental administrator and they advised us that there are no outstanding website
issues that they are aware of at this time. Please provide us with contact information for those MBF
members who are having difficulty logging into the ASO website and we will assist them.
2. Why is approval for a crown and root canal taking so long with ASO?
MBF: We also contacted ASO dental administrator on the processing time for these services. We were
advised that these claims are processed within 10 days unless they require additional information from
either the member or provider. Please provide us with contact information for those MBF members who
are having these issues and we will assist them.
3. New dental insurance ASO partially covers root canal and crowns. Can SMMP be used to reimburse out of pocket expenses?
MBF: No, dental claims are not eligible to be submitted to ASO. Dental has coinsurance that is
the responsibility of the member.
SMMP (Superimposed Major Medical Plan)
4. Can SMMP be used for cataract surgery expenses?
MBF: Yes, SMMP can be used for cataract surgery expenses. However, SMMP is the payor of last resort. Any out-of-pocket expenses not covered by the member’s primary health carrier can be submitted to SMMP for reimbursement, as long as the member met the applicable SMMP deductible and submitted
the appropriate documentation. Please note that vision correcting lens are not covered by SMMP.
5. Can the MBF streamline the process of submission of documentation for SMMP? It is a burdensome paperwork process especially proof of payment for med/pharmacy over $50/$75 or is it $50/$100? Can the process be available as online function?
MBF: Proof of payment is required for any copay over $50 and any prescription charge over $100. It is also required on all out of network charges. Members can submit SMMP claims online through the ASO website. If ASO requests additional information for a particular submitted claim, the member can log into their account and upload the requested documentation directly related to the claim.
6. If MBF members waive their City health coverage with the Aetna Medicare Advantage Plan, will they still be covered by the Superimposed Major Medical Plan (SMMP)? Would we be able to submit out-of-pocket expenses after Medicare payments and the $500 deductible to the Superimposed Major Medical Plan? Will there be any restrictions?
MBF: Yes, the MBF member is still eligible for the SMMP program even if the member waives City
health coverage. As for the out-of-pocket expenses, please refer to the below link for the SMMP booklet:
7. Why is SMMP for prescription drug reimbursement not available to retirees who are enrolled in Traditional Medicare or a Medicare Advantage Plan?
MBF: Please refer to pg. E11 under the Section MEDICARE PART D CATASTROPHIC-LEVEL
COINSURANCE at the above link.
MEA compiled a quick reference about SMMP, LINK here.
MBF (Management Benefits Fund)
8. Is there a possibility that managers and retirees will lose MBF benefits or is there a proposal on the table to expand existing benefits?
MBF: There are no changes to MBF benefits.
9. The current benefits are indexed to 2012 prices. Will the benefits be adjusted for inflation? For example: The Disability Benefit was $60, 000 per year in 2012 but adjusted for inflation should now be: $78, 879.06.
MBF: The LTD benefit is 66 2/3% of pre-disability salary. As for the maximum amount under LTD,
MBF will review this benefit.
10. MBF reimbursement procedures/rejections are not clear – how/what is the next step to request additional assistance? These are listed benefits of MBF (such as gym membership) and yet they are being declined. Why are many FSA & fitness claims nitpicked & turned down unnecessarily?
MBF: The Health and Fitness reimbursement requires members to submit claims for a consecutive 6-
month period and must provide proof of payments for those 6 months. The payment receipt must indicate the participant’s/eligible spouse’s or domestic partner’s name. As for the FSA program, it is governed under IRC 125 and the FSA Program must substantiate the claims based on the IRS rules and regulations.
11. How will MBF benefits work in conjunction with the Aetna Advantage Plan in areas where there is overlap such as health club/fitness benefits, hearing aids?
MBF: MBF members can utilize the benefits from the health plan and MBF for fitness activity and
hearing aids. However, please keep in mind that SMMP is the payor of last resort.
12. Will there be a reduction in any MBF benefits if a retiree goes with the Aetna plan?
MBF: There are no changes to the MBF benefits.
VDT (Visual Display Terminal)
13. Why are City managers at the Department of Education, CUNY and the Unified Court System excluded from the VDT coverage?
MBF: This is not an MBF benefit. This is a Citywide benefit subject to collective bargaining.
14. For current employees, upon retirement, will our insurance default from Medicaid managed care to the Aetna Medicare Advantage PPO/ESA?
MBF: Please refer to the Health Benefits website at nyc.gov/hbp for the current information.
Retired managers have raised the issue of Management Benefits Fund coverage with the proposed Aetna plan. The OLR site contained the paragraph in italics until recently regarding the MBF:
The current dental, vision and SMMP benefit programs offered through the Fund will not change due to the start of the new NYC Medicare Advantage Plus Plan.
Retiree Prescription Drug Optional Rider
· When the new NYC Medicare Advantage Plus Plan starts, the Fund will pay directly to the health carrier the entire cost of the optional prescription drug rider on behalf those MBF members who enroll.
The Fund will continue to pay a $50 per person per month subsidy benefit ($100 maximum) directly to the health carrier on behalf of Fund members and their spouses/domestic partners who are covered under the GHI Senior Care Program and elect to purchase the optional prescription drug rider.
HMO /HIP VIP coverage remains the same:
The Fund will pay the premium cost of any drug option of qualified Medicare HMO Plans offered by the City of New York Employee Health Benefits Program, where such a cost would otherwise be paid by the member through pension deductions. The member, however, will be liable for any co-payments (if applicable). Please Note: The Fund Retiree Medicare HMO Drug Benefits are only available to Medicare-eligible members and/or their Medicare-eligible spouses/domestic partners. Charges for a drug option for a non-Medicare-eligible person will not be assumed by the Fund and are the responsibility of the member.
15. Why was that paragraph deleted? Is it the intention of the MBF to pay the full cost for the drug rider for the retiree and any dependent when the Aetna drug plan is effective 1/1/24? Or will it remain at $50 per member per month?
MBF: The Aetna MA plan will be the standard City health plan for retirees effective September 1, 2023,
replacing GHI Senior Care. Therefore, the MBF will continue to subsidize the standard City health plan
with $50 per member per month, as long as the MBF member is enrolled in the standard City health plan.
16. Please address the impact Aetna Medicare Advantage will have upon the retirees’ major medical coverage.
MBF: There are no changes to the SMMP program.
17. What happens if the retiree chooses to stay in traditional Medicare? If a person waives their City retiree health care coverage, will the retiree and their dependent remain eligible for ALL existing benefits?
MBF: Yes, the member will continue to be eligible for MBF benefits, even if the MBF member waives
City health benefits. In addition, please refer to the answer to Question #15.
18. What will happen to Part B reimbursement, IRMAA, Plan D Prescription Drug Coverage? Will all MBF benefits still be available to the retiree in this case? Please be specific.
MBF: Medicare Part B and IRMAA are not MBF benefits. Please refer to the Health Benefits website.
Please refer to the above answers regarding the MBF benefits, which address this question.
19. How will MBF be impacted by the forced Medicare Advantage switch from traditional Medicare?
MBF: Please refer to the above answers regarding the MBF benefits, which address this question.
20. How will non-Medicare eligible dependents be impacted?
MBF: There are no changes.
21. What happens to Medicare eligible dependents of current employees?
MBF: Please refer to the Health Benefits website.
22. What do retirees do if their longtime medical providers including hospitals do not accept the Aetna Medicare Advantage PPO?
MBF: Please refer to the Health Benefits website.
RECORDING of the MBF Info Session – open this LINK and enter passcode: 9t$c%.41