City Health Care Plan
On September 30, the Municipal Labor Committee (MLC), a coalition of over a hundred unions, voted to approve the City’s updated health plan. The NYC Employees PPO Plan passed with almost 90% support from MLC members.
As we previously shared, this plan will cover in-service members, pre-Medicare retirees and their dependents.
According to the City, the NYCE PPO Plan will take effect January 1, 2026, and the open enrollment and transfer period will begin November 1, 2025. (We will provide more information about next steps in the coming days.)
Nothing is more important to us than the health and well-being of you and your family. From the moment this plan was first raised a couple of years ago, our goal has been to ensure our union is among the best-informed to strategically advocate on your behalf. The NYCE PPO Plan locks in a five-year agreement to provide you with high-quality, premium-free health care with expanded access and mental health services.
Last week, CSA Welfare Fund’s director Susan Barone delivered a virtual presentation to highlight the improvements from our current plan and address members’ questions.
The zoom webinar can be accessed by clicking here (Password: if2$bJuQ)
This webinar is only the start of how we will support and protect you. We will continue to address your questions in the coming weeks and months, so please continue to share with sbarone@csawf.org.
We will also provide comprehensive details in emails, on our website, in webinars, and in the CSA news, so that you rest easy knowing any steps you’ll need to take by January. We’ll monitor the rollout of the update plan, flag any concerns, and hold the City accountable to provide the health care you deserve and have earned.
Medicare Retirees - Prescription Manager (DOE-Based)
Beginning January 1, 2026, Emblem Health has decided to update the prescription benefit manager (PBM) for all DOE-based retirees from Express Scripts to Prime Therapeutics. Before then, you will receive a new ID card and important communications directly from Prime.
Please review all mailings carefully, as they may include steps you’ll need to take—such as selecting a new in-network pharmacy if your current one is not included, reviewing updates to the drug formulary, or confirming information if you use home delivery services. The process of transferring your current medications will be automatic, and you do not need your doctor to call in new prescriptions. If any medication you take is affected by formulary changes, Prime will notify you, and temporary transition supplies may be available while you and your doctor determine alternatives. You will be notified if the pharmacy you currently use is not in-network.
Medicare Retirees will remain on Medicare with the current Emblem/GHI Supplemental plan with no change to medical coverage.
For questions about the plan email Susan Barone, CSA Welfare Fund Administrator at sbarone@csawf.org
IRMAA Reimbursement Payment for 2025 for DOE Retirees
For those who submitted your IRMAA reimbursement forms in a timely manner, (the Office of Labor Relations considers timely – before July 1, 2025) the first round of payments should have landed in the same bank account you receive your pension, this past Friday October 11th. Note that OLR will continue making payments over the next several weeks. Also note, if you submitted one document with your partner or spouse included, some members received reimbursement for one person. The second reimbursement should also appear within six weeks. It is not too late to submit your IRMAA reimbursement form for 2025 as OLR allows a three-year look back.
Doctoral Research Study – Participants Needed
Assistant Principal Johnnie Bradford III’s research focuses on the lived experiences of retired Black male educational leaders in New York State. His study aims to honor the voices, examine the organizational structures that shaped careers, and document the personal beliefs and behaviors that sustained you through challenges and triumphs.
AP Bradford is deeply aware that our progress rests on the shoulders of trailblazers like the many retirees in our CSA family who paved the way, and that your commitment and sacrifices established pathways of access, resilience, and excellence that in-service members now walk upon. With humility, this study recognizes the importance of staying connected to elders, drawing upon their wisdom, and ensuring that the legacies of leadership continue to thrive.
What to expect: A One on One Interview via Zoom that should last approximately 60-90 minutes. If you are interested, please contact Johnnie at bradfj2@sage.edu or call 917-435-8057
Turning 65 Webinar
Susan Barone and Mark Brodsky will be hosting a Turning 65 Webinar for all members turning 65 who will be transitioning to Medicare in 2026. Members are welcome to join the zoom with dependents who are covered by the NYC Health Plan and would like to learn how to apply for Medicare, coordinate benefits with the NYC Health Plan and apply for Medicare Part B Reimbursement.
When: Jan 22, 2026 at 4:00 PM
Register in advance for this webinar:
https://us06web.zoom.us/webinar/register/WN_DANjCjZDTEWkBq2_K7ueSA
After registering, you will receive a confirmation email containing information about joining the webinar.
National Principals Month
AFSA, NAESP, and NASSP have designated October as National Principals Month to honor the hard work and dedication of our nation’s principals. CSA salutes our principals, not only during this commemorative period but the whole year round, and thanks them for their immense contributions to the success of students across New York City. We strongly encourage you to invite elected officials to your schools to highlight the day-to-day realities of the job and celebrate throughout the month on social media.
Informational Update Vol 16 #9
1. Acupuncture – On January 1, 2017, the CSA Welfare Fund first covered acupuncture (only 18 visits) through its supplemental medical benefits. In 2019, the coverage was expanded to 36 per year. Medicare offered no coverage for this service until 2021 when it covered 12 visits in a 90-day period for chronic lower back pain
Medicare will cover the 12 visits in a 90-day period for chronic lower back pain providing:
· The pain lasts 12 weeks or longer
· The pain is not related to spreading cancer, inflammatory or infectious disease
· The pain is not associated with pregnancy or surgery.
Medicare also covers an extra 8 sessions if your doctor indicates that your chronic back pain shows improvement. If the doctor indicates there is no improvement or your condition is getting worse, then Medicare will not cover the additional sessions.
Medicare covers no more than 20 treatments yearly. These treatments may only be used for chronic lower back pain.
Once you have used your allotted 20 treatments (12 + 8), or if you are not eligible for Medicare reimbursement—either because you do not meet its requirements or are not Medicare-eligible—you may turn to the CSA Retiree Welfare Fund and the CSA Retiree Chapter for additional coverage.
v CSA Retiree Welfare Fund – You are allowed a maximum of 36 visits a year. The maximum allowable charge for reimbursement is $100 per visit, although the acupuncturist may charge more than the $100. After an annual $100 deductible you will be reimbursed 80% of the cost.
The provider must be legally certified to practice acupuncture under the provider’s state license. If the provider is not state licensed or lives in a state that does not have a state license, then he or she must have a certificate from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).
To file a claim, submit the bill, proof of payment, and on the first claim, the provider’s state license or certification.
v CSA Retiree Chapter – You will get an additional 20%
reimbursement of whatever the Fund reimburses you. You do not have to apply for it as the process is a seamless operation. The reimbursement should come about 2 weeks after the Fund reimbursement.
2. 2026 Medicare Handbook –The 2026 Medicare is now available for your use. It contains valuable information about Medicare’s benefits and costs. You can obtain either a hard copy or an electronic one. The advantage of the electronic copy is that the information is most up to date.
If you want to order a hard copy, you need to have a Medicare account. If you don’t have an account, go to www.Medicare.gov and follow the prompts. Once you have an account, login and click on the link, Get my Medicare Summary Notices electronically. You will then see a box labeled, “Medicare & You” handbook. Click on the link, “paper” in the box and Medicare will eventually mail you the handbook.
3. Question of the Month
Q. I am eligible for 2024 IRMAA but have not yet applied. Am I too late to do so?
A. No, you can still apply. Just make sure to check the 2024 box and sign the application. You can mail the application along with the proper documents to the Office of Labor relations. The address is:
NYC Office of Labor Relations
Health Benefits Program
22 Cortlandt Street, 12th Floor
New York, NY 10007
You can also submit the application electronically. Instructions on how to do it on OLR’s website, https://www.nyc.gov/olr.
Norm Sherman
Florida CSA Retiree Chapter Liaison & Outreach Coordinator
nshermzie@aol.com