A retired New York City employee who enjoys one of the most generous taxpayer-provided health benefits in the United States offered Mayor Eric Adams and the city $5,500 for a $15 copay for a doctor’s visit. I am suing for $10,000.
The Manhattan Supreme Court class action lawsuit was filed on behalf of 183,000 retirees.
The city and Emblem Health/GHI have violated a court order not to charge retirees additional costs for the 20% additional coverage not covered by Medicare, the federal health program for seniors 65 and older. claims to be
The copay, well below the standard $40 to $50 required by private insurance, was imposed in January. Retirees were not previously charged copayments.
Apart from this, Adams posed a challenge. He said the city council must agree to allow retired city employees to switch to private Medicare Advantage plans.
Retirees claim Medicare Advantage is denying or providing less medical care than their current supplemental “senior care” plans.
One of the plaintiffs, Marianne Pizzitra, president of the NYC Public Service Retirees Organization, accused the copays of being “just a clever disguised way for the City and Emblem to pass on costs.”
“It violates contracts, laws, and judge orders, and is outrageous.
The plaintiff seeks $55 million in damages in a lawsuit filed by Pollock Cohen’s Steve Cohen.
But one medical expert said it’s time for New York City retirees to help cut the city’s health care costs.
“New York City taxpayers pay the most expensive version of retiree health insurance to city employees nationwide, in the public sector, let alone the private sector,” said a research director at the Empire Center for Public. says Peter Warren. policy.
“New York City taxpayers are paying for a level of health care that government retirees cannot afford.”
In the private sector, most employers do not provide health care for retirees. Private sector retirees will have to rely on Medicare and pay for additional benefits personally, Warren said.
He said the city has $126 billion in retiree health care liability.
The lawsuit alleges that the $15 copay will cause “irreparable harm” to the retiree.
Medicare pays 80% of the cost of hospital and doctor visits. Under an agreement with the union, the City will recoup the remaining 20% under the Supplemental “Elderly Care” Supplemental Plan.
“Imposing a $15 copay illegally transfers a portion of the 20% provider fee from the provider.
Defendant to retirees.This seemingly small fee is a very heavy burden for the elderly.
Individuals living on a small fixed annuity and needing frequent medical treatment – that’s not allowed under the contract,” Cohen said.
The lawsuit admits that the city has spent “a lot of money.” He spent $9.5 billion on health insurance for active employees, retirees and dependents in fiscal 2021. About a third of the costs, $3.2 billion, were for retirees.
“Naturally, the city was looking for ways to save money on health.
Many years of insurance,” the lawsuit states.
The complaint accuses the city of breach of contract, unjust enrichment, fraudulent solicitation and false advertising.
City Legal Department spokesman Nick Paolucci said of the out-of-pocket lawsuit: No other comments at this time. ”
Emblem Health has no comments yet.
The previous administration under Mayor Bill de Blasio reached an agreement with unions to require retired firefighters, police officers, teachers and other public employees to enroll in the privately-run Medicare Advantage Plus program, and the city Saved $600 million annually.
Retirees will have to contribute $191 a month if they want to keep their current city-funded Senior Care Plus plan instead of enrolling in Medicare Advantage, but the court has so far ruled out retirees. blocking the change based on previous lawsuits filed to prevent the switch.
The city is appealing the ruling.
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