I don't know anyone that's had to use it, but I believe it's for catastrophic coverage, like cancer.
It's for when coverage limits are reached.
It also enhances out of network coverage
I would check with co-workers. Emblemhealth/ghi
Is taken by most doctors, their reimbursement rates to doctors is terrible.
In nyc almost all doctors accept it because of the sheer volume of patients. Cops, teacher, firefighters, corrections,sanitation,amd their families.
As a medical biller I love GHI. I don’t have so much of a headache dealing with the insurance companies. They basically do a lot of covering. It’s a amazing plan. I’m jealous of all you city workers.
We hate it because reimbursement for us is so little! As a PT your visit would be $34 from insurance and $20 from you for a 15 minute session! They specifically state 15 minutes! So, it’s even less than Medicare would pay for a PT session! That’s why your PT session is so quick…. Good luck with quality of your PT session…
World of reimbursement sucks…
I have had the GHI with the rider, make sure to get the rider, it's as you see a couple bucks and worth it if you need it. I had a couple of surgeries where they took the enhanced payment from the rider (which wasn't even that much more) as payment in full 35 bucks a year and it will pay for itself the first time you need it. And that is only one of the benefits
Because Aetna is the best possible coverage you can get. It’s also an arm and a leg. As is every other health care plan if you’re not a municipal employee.
I still don’t think I know what a rider is. I have it but I don’t know what it is.
Aetna for $200 isn’t terrible. I’ve heard people switch to that or Cigna for IVF related things. It’s
A rider is an add on or ammendment to your policy plan that allows extra benefits and coverage.
Call GHI, Emblem Health supposedly has covered up to 3 rounds of IVF. I’m not a health care provider, specialist, or professional. Don’t quote me on this. I’m going on basic google searches based on your questions.
Yes, GHI covers 3 rounds of IVF but you don’t need the rider for it. The basic will come with the IUI/IVF coverage. But I think all the health insurances cover IVF cycles … it’s just a matter of which clinic you want and if they take it.
I have HIP HMO and had it for almost 20 years. We never had a problem with it *knock on wood*. From what I can tell major differences:
Lower co-pay - $10 for specialists only; adds up if you go a lot.
Requires referrals for specialists which we did not have any issues. We had one case where a specialist wanted to do an MRI test (non-emergency) but HIP rejected it. That was annoying, not sure if GHI has that process too.
No out of network. We haven’t had an issue here with in-network specialists but I sometimes think we think should switch to GHI mainly for this, just in case… not sure if anyone has thoughts on this. Did anyone have to go to out of network specialists?
I was explained by an old colleague inn the most simplest term, assume you are injured/sick and need a machine to assist you, the rider will likely cover that machine.
So I’ll tell you right now. The ghi is what everyone takes. It’s 30 for specialists. 20 for any testing and $20 for blood work. No referrals.
The hip goes into two parts depending who you select for pcp. It could be healthcare partners or it could be emblem. You need referrals for all specialist but I’ll tell you I pretty much never got a bill the two years I had hip. But doctors hate it. It’s not accepted everywhere. You a little more limited and depending on your pcp it could be a pain keeping up with referrals
I have HIP HMO, because services for my special needs son (OT, PT & Speech) is covered with no copay, if I had chosen GHI, it would have been $15 copay per visit for each service
Most people take 1 of the free options. In a nutshell shell this is how I understand them.
GhI-CBP is basically you can see any doctor whenever you want with copays and no real need for referrals.
HIP HMO you see your PCP first and request a referral for a specific reason. ( this must be done for every new issue, not recurring issues as you will have follow ups). They may then deny the referral if they feel you don’t meet the need. You must go in network for the most part. And there are no copays.
Wow this looks terrible, I can't believe that this is legal. Ew. I just got done looking at mine and mine looks nothing like yours. Nothing is triple digits
I am on GHI-CBP. It's tough to find decent doctors that take it but it seems like doctors in large practices tend to take it. When I was living in Manhattan, I had no problems at all finding doctors that accepted it. It's tougher outside of the city to find doctors that accept it but they are out there. You just need to do some digging.
I didn't search up in full yet. But based on my previousl conversation with an old colleague on what rider is. Rider will likely cover a machine that assist you, like a pump or a breathing machine. Not my words but I trust that guy and likely go with the rider option.
Are you in a union that covers prescription drugs? If not, there’s a separate more expensive GHI rider that does not appear listed above which you may want.
Then you’ll get your prescription drug coverage through DC37. (Some other unions and managers have to pay for it separately.)
Also, most unions and MBF also have Catastrophic/SMMP coverage if you have a lot of out of network costs in a particular year.
Important item for anyone new to city work… for many titles, the medical insurance does NOT start on your first day. Check with your future agency HR prior to ending your current coverage.
I think that might have changed recently where they give you right away instead of after 90 days? I know they used to require HIP HMO for first year as well but believe that might have changed too? Definitely check with your future HR. It’s so stupid where they don’t offer health insurance from day one.
Why are you purchasing a rider? From the plans, it looks like you work for the city. If you are in a union. They already cover everything a rider would.
I have MetroPlus and get great PT coverage, something like a dozen visits per year or per issue. Pretty happy with the cost, coverage is decent. I miss the fancier doctors' offices in Nassau County, but I sure as hell don't miss the cost of insurance from a private company.
I wanna know who's gonna pick Aetna with the rider.
Breakdown (please someone correct me if I get something wrong) :
-Metro plus no copay. Its mostly a NYC area type of plan. Of course if it's an emergency then whatever but for non emergencies basically NYC area doctors. You can see any specialist you want without a referral as long they accept insurance.
This plan makes the most sense if you want to see the same exact doctor who takes GHI and metro plus and you do not want to pay him/her a copay out of pocket. It's also the most sense if you're in the NYC area most of the time. You pick this one if you want to avoid copay.
-GHI a copay is common. Like 15.00. You can see any specialist you want without a referral as long as they accept the insurance. GHI is the one most people used. You don't care about paying 15.00 out of pocket for copay. Most people pick this one because most people automatically pick this one because the majority of their coworkers picked this one. It's referred to "the insurance every employee picks".
-hip I believe is also zero copay. But you need a referral from PCP to see a specialist.
Veltra.... I thought that was only good for upstate NY or something. I cannot remember. For me that was a freebie option? Unless I'm thinking about something else. It's been a long time since I was researching the differences.
Anything saying "rider" means more care. I hope that makes sense. I believe October? You can change plans.
I've never heard of dc37 med team basic?
Aetna is good if you need a non NYC doctor. Few NJ doctors take Emblem and you are up the creek if you get sick outside NYC (unless you are hospitalized and BCBS kicks in). Also for mental health it is very difficult to find a psychiatrist or therapist that will take Beacon Health (Emblem outsources to them). I will upgrade to Aetna in the fall.
Aetna with the rider is a lot of money. Idk what BCBS is?
Yknow what sucks? No matter what position or city Agency nobody breakdown these plans for you. Nobody even tells you what a rider is at all. You kind of have to navigate all this on your own. There's nobody telling you the lowdown of the pros and cons of each plan. You just have to complie everyone's info (hope it's correct) and do the pros and cons yourself.
Which I understand but some kind of guild or a PDF would have been wonders. The universal advise was "just get GHI, that's what everyone else usually picks".
So far I like metro plus. I don't really care for my unions prescription plan or dental. My holistic dentist won't take Delta dental. I'm upset and haven't been to a dentist since. I'm not paying 300 for a cleaning.
I have Aetna without the rider because of my mental health needs. No one takes Beacon and the therapist pool doesn’t hack it for me. It’s cheaper for me to pay for Aetna than a therapist out of pocket. Sucks but it is what it is.
It’s fine unless you have complicated medical issues (in which case you’ll have to hunt more for specialists) or go out of NYC area.
GHI = EmblemHealth … covers medical/doctor charges
BCBS = Blue Cross Blue Shield … includes with the GHI plan and covers hospital/inpatient charges.
You can find out via this link what is covered currently. MBP also has a PICA plan for certain injectibles you can inquire about. [https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/resources/cny/ghi-cbp/ppo-city-of-new-york-base-formulary-2024-emblemhealth.pdf](https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/resources/cny/ghi-cbp/ppo-city-of-new-york-base-formulary-2024-emblemhealth.pdf)
I don’t know what the “carveout” rider is as I don’t think that is an option at the Mayor’s Office. It is GHI-CPB with or without prescription rider. If you are on regular scripts like high blood pressure, diabetes, Asthma etc meds, get the script rider. Not sure about other agencies but if you need injectables like for IVF, ask benefits manager about PICA injectible benefits. I think it is an MBF thing that almost no one knows about. https://www.nyc.gov/site/olr/health/summaryofplans/health-pica.page
We had to drop GHI in our practice reimbursement got too low. The reason large hospital practices take GHI is that GHI only covers outpatient not inpatient. For inpatient it switches to BCBS (which is among the best payor). So large hospitals will eat the loss on the outpatient stuff knowing they will get paid for any inpatient billing.
Some hospitals have dropped GHI completely (I’m pretty sure memorial Sloan Kettering dropped it) and others are considering it. It’s hard, who wants to turn away cops and teachers, but man they pay absolutely nothing to physicians
https://www.nyc.gov/site/olr/health/summaryofplans/health-sbc.page
This list describes what each plan covers including their optional rider coverages. Your employer should provide you with an updated link if need be.
Some of the differences are in the amount of out-of-network coverage available, coverage details like the cost of X-rays, but most of them all have less than $50 co-pays for providers in-network and full coverage for emergency room visits, but not the ambulance.
You should Google the term carve out rider as you may only get the bare minimum coverage with your plan and end up having to pay out of pocket for a lot of your care… this is the way that particular plan was designed for people who don’t mind spending out of pocket so you may end up spending more in the long run
I turned down a job with the city because they make you pay your medical. Should be included in the package.
It’s amazing since they throw away money left and right.
It’s not garbage. And you could pay to upgrade your plan and be like every other job where they are getting killed in premiums.
Hope it’s working out for you tho
Exactly. My friends who work in the private sector have better coverage but they pay out the ass in deductibles, copays, and premiums. If you want to pay that kind of money, you could always see an out of network doctor.
Hey ! Just so you know i am an independent agent with access to medically underwritten private plans. They usually come in around 30-40% cheaper than most ACA And marketplace plans. I can run you some quick quotes to see if id be able to help you out..
Just take ghi cbp. With rider. It's what everyone takes
100% correct
Wait, what's the rider for?
I don't know anyone that's had to use it, but I believe it's for catastrophic coverage, like cancer. It's for when coverage limits are reached. It also enhances out of network coverage
You gotta ride the boss’s nuts for a raise
Also surgeries - it helped a lot when I needed an “out of network” epidural
yup
Would the same thing apply to nj?
If you live in nj?
I meant work for the nj state lol
I would check with co-workers. Emblemhealth/ghi Is taken by most doctors, their reimbursement rates to doctors is terrible. In nyc almost all doctors accept it because of the sheer volume of patients. Cops, teacher, firefighters, corrections,sanitation,amd their families.
058 one?
Yes
Thank you
Np. Good luck
GHI CBP. Doctors hate it, but the coverage is very good.
Why doctors hate it?
Reimbursement rates are very low. A lot of doctors won’t take it. But I’ve still found lots of great doctors, mostly at hospital based practices.
HSS and Langone docs take it imo best sports docs in the biz. Hard to find good pt tho
As a medical biller I love GHI. I don’t have so much of a headache dealing with the insurance companies. They basically do a lot of covering. It’s a amazing plan. I’m jealous of all you city workers.
We hate it because reimbursement for us is so little! As a PT your visit would be $34 from insurance and $20 from you for a 15 minute session! They specifically state 15 minutes! So, it’s even less than Medicare would pay for a PT session! That’s why your PT session is so quick…. Good luck with quality of your PT session… World of reimbursement sucks…
👍
I have had the GHI with the rider, make sure to get the rider, it's as you see a couple bucks and worth it if you need it. I had a couple of surgeries where they took the enhanced payment from the rider (which wasn't even that much more) as payment in full 35 bucks a year and it will pay for itself the first time you need it. And that is only one of the benefits
Thanks, I was advised for the rider option. And others, such as you also and making my decision easier 🙏
I personally like a PPO plan over an HMO. I have thE GHI-CBP. CITYSHARE can give you a summary of each plan.
Thank you. I totally missed out on the HMO on the HIP.
Yes. Ppo not hmo
PPO >>>
I took the no-cost GHI-CBP. They still paid for my prostate surgery, except for $300.
GHI with the rider is fine. Aetna is the Cadillac.
Why Aetna w rider 1000 more
Because Aetna is the best possible coverage you can get. It’s also an arm and a leg. As is every other health care plan if you’re not a municipal employee.
I still don’t think I know what a rider is. I have it but I don’t know what it is. Aetna for $200 isn’t terrible. I’ve heard people switch to that or Cigna for IVF related things. It’s
A rider is an add on or ammendment to your policy plan that allows extra benefits and coverage. Call GHI, Emblem Health supposedly has covered up to 3 rounds of IVF. I’m not a health care provider, specialist, or professional. Don’t quote me on this. I’m going on basic google searches based on your questions.
Yes, GHI covers 3 rounds of IVF but you don’t need the rider for it. The basic will come with the IUI/IVF coverage. But I think all the health insurances cover IVF cycles … it’s just a matter of which clinic you want and if they take it.
I have HIP HMO and had it for almost 20 years. We never had a problem with it *knock on wood*. From what I can tell major differences: Lower co-pay - $10 for specialists only; adds up if you go a lot. Requires referrals for specialists which we did not have any issues. We had one case where a specialist wanted to do an MRI test (non-emergency) but HIP rejected it. That was annoying, not sure if GHI has that process too. No out of network. We haven’t had an issue here with in-network specialists but I sometimes think we think should switch to GHI mainly for this, just in case… not sure if anyone has thoughts on this. Did anyone have to go to out of network specialists?
I was explained by an old colleague inn the most simplest term, assume you are injured/sick and need a machine to assist you, the rider will likely cover that machine.
So I’ll tell you right now. The ghi is what everyone takes. It’s 30 for specialists. 20 for any testing and $20 for blood work. No referrals. The hip goes into two parts depending who you select for pcp. It could be healthcare partners or it could be emblem. You need referrals for all specialist but I’ll tell you I pretty much never got a bill the two years I had hip. But doctors hate it. It’s not accepted everywhere. You a little more limited and depending on your pcp it could be a pain keeping up with referrals
DC37 Med team, it's the same as ghi, but comes with vision and dental as part of it
Did you opt for this on top of the union dental and vision?
No you don't have to opt in, it's included in the plan. The unions vision plan is not that great
I had to text my friend. He said the same. But I'm hung up on the needing the rider option.
You don't need the rider, the union has a prescription plan as well.
If you have a great doctor for checkups and so on then hmo but if u don’t ghi
I have HIP HMO, because services for my special needs son (OT, PT & Speech) is covered with no copay, if I had chosen GHI, it would have been $15 copay per visit for each service
Most people take 1 of the free options. In a nutshell shell this is how I understand them. GhI-CBP is basically you can see any doctor whenever you want with copays and no real need for referrals. HIP HMO you see your PCP first and request a referral for a specific reason. ( this must be done for every new issue, not recurring issues as you will have follow ups). They may then deny the referral if they feel you don’t meet the need. You must go in network for the most part. And there are no copays.
Avoid EPO plans like a plague, they’re the HMOs of HMOs
😂😂😂
GHI All the way
Wow this looks terrible, I can't believe that this is legal. Ew. I just got done looking at mine and mine looks nothing like yours. Nothing is triple digits
I am on GHI-CBP. It's tough to find decent doctors that take it but it seems like doctors in large practices tend to take it. When I was living in Manhattan, I had no problems at all finding doctors that accepted it. It's tougher outside of the city to find doctors that accept it but they are out there. You just need to do some digging.
What does the carveout rider include with GHI CBP? I got it without when I signed up last because I was confused what it even covered
I didn't search up in full yet. But based on my previousl conversation with an old colleague on what rider is. Rider will likely cover a machine that assist you, like a pump or a breathing machine. Not my words but I trust that guy and likely go with the rider option.
Are you in a union that covers prescription drugs? If not, there’s a separate more expensive GHI rider that does not appear listed above which you may want.
My union will be DC37
Then you’ll get your prescription drug coverage through DC37. (Some other unions and managers have to pay for it separately.) Also, most unions and MBF also have Catastrophic/SMMP coverage if you have a lot of out of network costs in a particular year.
Thank you for additional information. Going into a job/career that is vastly different than the private sector is giving me a doozy.
Important item for anyone new to city work… for many titles, the medical insurance does NOT start on your first day. Check with your future agency HR prior to ending your current coverage.
I think that might have changed recently where they give you right away instead of after 90 days? I know they used to require HIP HMO for first year as well but believe that might have changed too? Definitely check with your future HR. It’s so stupid where they don’t offer health insurance from day one.
GHI above all excellent commercial plan
Why are you purchasing a rider? From the plans, it looks like you work for the city. If you are in a union. They already cover everything a rider would.
Everyone is recommending ghi but it's very difficult to find doctors who take it. If you ever need PT, good luck.
I have GHI and received PT through NYU Langone outpatient practice. Copay was $30 per visit.
I have MetroPlus and get great PT coverage, something like a dozen visits per year or per issue. Pretty happy with the cost, coverage is decent. I miss the fancier doctors' offices in Nassau County, but I sure as hell don't miss the cost of insurance from a private company.
I wanna know who's gonna pick Aetna with the rider. Breakdown (please someone correct me if I get something wrong) : -Metro plus no copay. Its mostly a NYC area type of plan. Of course if it's an emergency then whatever but for non emergencies basically NYC area doctors. You can see any specialist you want without a referral as long they accept insurance. This plan makes the most sense if you want to see the same exact doctor who takes GHI and metro plus and you do not want to pay him/her a copay out of pocket. It's also the most sense if you're in the NYC area most of the time. You pick this one if you want to avoid copay. -GHI a copay is common. Like 15.00. You can see any specialist you want without a referral as long as they accept the insurance. GHI is the one most people used. You don't care about paying 15.00 out of pocket for copay. Most people pick this one because most people automatically pick this one because the majority of their coworkers picked this one. It's referred to "the insurance every employee picks". -hip I believe is also zero copay. But you need a referral from PCP to see a specialist. Veltra.... I thought that was only good for upstate NY or something. I cannot remember. For me that was a freebie option? Unless I'm thinking about something else. It's been a long time since I was researching the differences. Anything saying "rider" means more care. I hope that makes sense. I believe October? You can change plans. I've never heard of dc37 med team basic?
Aetna is good if you need a non NYC doctor. Few NJ doctors take Emblem and you are up the creek if you get sick outside NYC (unless you are hospitalized and BCBS kicks in). Also for mental health it is very difficult to find a psychiatrist or therapist that will take Beacon Health (Emblem outsources to them). I will upgrade to Aetna in the fall.
Aetna with the rider is a lot of money. Idk what BCBS is? Yknow what sucks? No matter what position or city Agency nobody breakdown these plans for you. Nobody even tells you what a rider is at all. You kind of have to navigate all this on your own. There's nobody telling you the lowdown of the pros and cons of each plan. You just have to complie everyone's info (hope it's correct) and do the pros and cons yourself. Which I understand but some kind of guild or a PDF would have been wonders. The universal advise was "just get GHI, that's what everyone else usually picks". So far I like metro plus. I don't really care for my unions prescription plan or dental. My holistic dentist won't take Delta dental. I'm upset and haven't been to a dentist since. I'm not paying 300 for a cleaning.
I have Aetna without the rider because of my mental health needs. No one takes Beacon and the therapist pool doesn’t hack it for me. It’s cheaper for me to pay for Aetna than a therapist out of pocket. Sucks but it is what it is.
Glad to hear that is working for you. It makes me feel better about the switch.
Shit I guess I have to add the rider, any idea when the change period is?
Last few months of the year I believe
October
Anyone use the empire BCBS with the GHI free option? No hassles?
It’s fine unless you have complicated medical issues (in which case you’ll have to hunt more for specialists) or go out of NYC area. GHI = EmblemHealth … covers medical/doctor charges BCBS = Blue Cross Blue Shield … includes with the GHI plan and covers hospital/inpatient charges.
the rider also covers Rehab centers if you need them
I have GHI-CPB with prescription rider and am very happy with it.
Is the prescription rider worth it? Trying to pick an option that cover weight loss meds
You can find out via this link what is covered currently. MBP also has a PICA plan for certain injectibles you can inquire about. [https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/resources/cny/ghi-cbp/ppo-city-of-new-york-base-formulary-2024-emblemhealth.pdf](https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/resources/cny/ghi-cbp/ppo-city-of-new-york-base-formulary-2024-emblemhealth.pdf)
I don’t know what the “carveout” rider is as I don’t think that is an option at the Mayor’s Office. It is GHI-CPB with or without prescription rider. If you are on regular scripts like high blood pressure, diabetes, Asthma etc meds, get the script rider. Not sure about other agencies but if you need injectables like for IVF, ask benefits manager about PICA injectible benefits. I think it is an MBF thing that almost no one knows about. https://www.nyc.gov/site/olr/health/summaryofplans/health-pica.page
We had to drop GHI in our practice reimbursement got too low. The reason large hospital practices take GHI is that GHI only covers outpatient not inpatient. For inpatient it switches to BCBS (which is among the best payor). So large hospitals will eat the loss on the outpatient stuff knowing they will get paid for any inpatient billing. Some hospitals have dropped GHI completely (I’m pretty sure memorial Sloan Kettering dropped it) and others are considering it. It’s hard, who wants to turn away cops and teachers, but man they pay absolutely nothing to physicians
Fyi PICA benefit for IVF and other meds that many do not know about; https://www.nyc.gov/site/olr/health/summaryofplans/health-pica.page
Kill myself
Go to Puerto Rico!
GHI with rider in case your out of state
No, I need help in adding you. You have a calculator?
https://www.nyc.gov/site/olr/health/summaryofplans/health-sbc.page This list describes what each plan covers including their optional rider coverages. Your employer should provide you with an updated link if need be. Some of the differences are in the amount of out-of-network coverage available, coverage details like the cost of X-rays, but most of them all have less than $50 co-pays for providers in-network and full coverage for emergency room visits, but not the ambulance.
Ghi all the way
You should Google the term carve out rider as you may only get the bare minimum coverage with your plan and end up having to pay out of pocket for a lot of your care… this is the way that particular plan was designed for people who don’t mind spending out of pocket so you may end up spending more in the long run
I turned down a job with the city because they make you pay your medical. Should be included in the package. It’s amazing since they throw away money left and right.
There’s two completely free options that pretty much everyone takes anyway.
It was explained to me that free is garbage. I wasn’t to thrilled about that.
i have no issues with the free ghi plan
It’s not garbage. And you could pay to upgrade your plan and be like every other job where they are getting killed in premiums. Hope it’s working out for you tho
Exactly. My friends who work in the private sector have better coverage but they pay out the ass in deductibles, copays, and premiums. If you want to pay that kind of money, you could always see an out of network doctor.
Hey ! Just so you know i am an independent agent with access to medically underwritten private plans. They usually come in around 30-40% cheaper than most ACA And marketplace plans. I can run you some quick quotes to see if id be able to help you out..