UNIONS SIGN EMHP AGREEMENT
(Article appeared in September 2012 newsletter)
On July 31, 2012, all eleven County Unions signed an agreement with the County that extends our health insurance through December 31, 2020. I would like to thank County Executive Steve Bellone and Director of Labor Relations Paul Margiotta for working with Labor to reach an agreement that provides significant savings for the County while preserving adequate benefits.
Some highlights of the Agreement are:
- Anyone employed by the County on December 31, 2012 will not contribute to the premium or group cost of health insurance. However, effective January 1, 2013, any active member in an HMO Plan will pay the difference between the cost of the HMO and the cost of the Employee Medical Health Plan of Suffolk County (EMHP).
- All retired employees will have the same benefit level and cost as active employees. Participants covered by Medicare will have county insurance as secondary coverage.
- Any participant receiving a New York State Disability Pension will not make any health insurance contribution.
- EMHP will cover emergency treatment costs above the reasonable and customary rate for out of network providers when they are utilized on an emergency basis and there is no participating provider available to provide the emergency treatment. This benefit will be limited to $100,000 cost per claim.
- Coordination of benefits will be reinstated for all participants hired prior to January 1, 2013.
- The Health Insurance Buy-Back Grievance is granted.
- Upon application to the EMHP co-chairs, a participant with minor child(ren) with a physical or mental disability may be exempt from the out of network deductible and may receive 100% reasonable and customary reimbursement for care of the child(ren).
- Reasonable and customary will no longer be calculated as a percentage of Medicare. The parties will agree upon a new third party provider.
- Dependent grandchildren will be covered as they were in 2011. However, the child must live with the covered employee and the employee must be the legal guardian of the child.
- The Unions will provide $17 million in recurring savings starting in 2013.
- All employees hired on or after January 1, 2013 will contribute 15% of the premium or group cost of health insurance they select, single or family.
The signed agreement will be presented to the Suffolk County Legislature for approval.
EMHP Labor Management Committee Meeting Agenda Item # VIII.B.3
What do you do if you need medical care outside of the U.S.A.?
When you need healthcare outside the U.S., Puerto Rico and U.S. Virgin islands
- Always carry your EMHP Empire BlueCross Blue Shield (EBCBS) identification card.
- Check with EBCBS before leaving because your health care benefits may be different outside the U.S., Puerto Rico and U.S. Virgin Islands.
- In case of emergency, go directly to the nearest hospital or doctor. Call the BlueCard Worldwide Service Center if hospitalized, at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177.
- If you need to locate a doctor or hospital, or need medical assistance services, call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, in conjunction with a medical professional, will arrange a physician appointment or hospitalization, if necessary.
- Call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or collect at 1-804-673-1177 when you need inpatient care. In most cases, you should not need to pay upfront for inpatient care at participating BlueCard Worldwide hospitals except for the out-of-pocket expenses (non-covered services, deductible, co-payment and co-insurance) you normally pay. When cashless access is arranged, the hospital will submit your claim on your behalf.
- Call EBCBS at 1-800-939-7515 for pre-certification or prior authorization, if necessary.
Claims filing and payment information
- For inpatient care at a BlueCard Worldwide hospitalthat was arranged through the BlueCard Worldwide Service Center, 1-800-810-BLUE (2583), you only pay the provider the usual out-of-pocket expenses (non-covered services, deductible, co-payment and co-insurance) when cashless is arranged. The provider files the claim for you.
- For all outpatient and professional medical care, you pay the provider and submit a claim. You may also have to pay the hospital 9and submit a claim) for inpatient care obtained from a non-BlueCard Worldwide hospital or when inpatient care was not arranged through the BlueCard Worldwide Service Center.
- To submit a claim, complete an International Claim Form and send it to the BlueCard Worldwide Service Center. The claim form must be completed and accompanied by itemized bills otherwise your claim will be returned to you and payment will be delayed.
Neither the Blue Cross and Blue Shield Association nor any of its independent Licensees shall be liable for any loses, damages, or uncovered charges as a result of using the BlueCard Worldwide Service Center or receiving care from any provider listed on the Blue Cross and Blue Shield Association site.
See the "Links" page for the EMHP, Empire Blue Cross Blue Shield and Flexbene websites.