Benefits for Teachers

Your Health Insurance

As a teacher you are automatically a member of the United Federation of Teachers (UFT), which provides you a number of good health insurance options¹These options are called City basic health plans. See here.. The full UFT brochure on your health-care benefits, which we’ll break down in this section is here.

Your $0-Premium Health-Insurance Options

One affordable option is the NYCE PPO Plan, which has no monthly premium²A premium is the amount you pay monthly for your health insurance plan. and allows you to see doctors outside of your network. You will, however, pay a deductible³A deductible is the amount you pay out-of-pocket for covered health care services before your health insurance plan starts to pay. for out-of-network doctors. There are also two other $0-premium options that are less flexible in terms of which doctors you can see, but have no deductibles. You should review all your options and choose what makes the most sense for you, but here is a brief comparison of the $0-premium plans:

NYCE PPO Plan

• Costs
  • $0 premium; $0 in-network deductible
  • $200/$500 out-of-network deductible for individual/family 
  • General copays are $0 if you use preferred providers (the plan has a list of these doctors); for non-preferred providers, the general copay is $15/$30 for regular/specialist doctors. 
  • ER copay is $150, urgent care is $25.
• Flexibility
  • You can see doctors in and outside your network. 
  • You do not have to select a primary care physician (PCP).
  • You do not need a written referral to see a specialist.

HIP HMO Gold Preferred Plan

• Costs
  • $0 premium; $0 deductible
  • General copays are $0 if you use preferred providers (the plan has a list); for non-preferred providers, the copay is generally $10. 
  • ER copay is $150, urgent care is $50.

• Flexibility
  • You have to stay within network. 
  • You have to select a primary care physician (PCP).
  • You need a written referral to see a specialist.

METROPLUSHEALTH GOLD HMO Plan

• Costs
  • $0 premium; $0 deductible
  • General copays are $0. ER copay is $100, urgent care is $25.

• Flexibility
  • You have to stay within network.
  • You have to select a primary care physician (PCP).
  • You don’t need a written referral to see a specialist, but the plan notes that “all referrals should still be directed by the member’s PCP.”

Each November is Open Enrollment, which is when you can switch⁴Note that when you first become a teacher, your school usually helps you sign up for healthcare as part of the onboarding process, but if for some reason that doesn’t happen, make sure to contact the DOE’s HR department (718-935-4000) within 30 days of your hire to enroll in healthcare. from your current health plan⁵During Open Enrollment, you can also add/drop any riders on your chosen health insurance. (Each plan has optional riders you can purchase for additional types of coverage, as detailed here.) to any other plan. Once you are signed up for a plan, you gain access to its portal, which is where you log in to see all your claims, health benefits, and membership materials. 

Other Health-Care Benefits

Here are other key health-care benefits available to you: 

• The UFT Welfare Fund provides coverage for prescription drugs, dental, and optical.

• Health Care Flexible Spending Account (HCFSA). This account allows you to save money each year (between $260 to $3,400) by using pretax dollars to pay for items not covered by health insurance, like over-the-counter meds and nonprescription reading glasses, and also any deductibles and copays. But be warned: If you set aside money for the year and don’t use it, you’ll lose it⁶Note that there is a grace period with your HCFSA, in case you get to the year’s end and you haven’t used all your funds. If that’s the case, you can use your remaining funds for eligible expenses from Jan. 1 to Mar. 15 of the following year. See here.. 
• You must enroll each year if you want to participate in the following calendar year, by filling out the “FSA Program Enrollment/Change Form” during the Open Enrollment period in November. When you have a relevant expense you seek reimbursement by filling out a “HCFSA program claim form,” and submitting a receipt and an Explanation of Benefits (EOB) form from your insurance company. 
• How do you figure out how much to put in your HCFSA? It’s hard to do this, but you have to estimate your anticipated non-covered medical costs for the following year. One idea is to look at your costs from the prior year, and base your contribution on this figure. 
• Premium Conversion Program. This program deducts the cost of your chosen health plan’s premium directly from your paycheck pretax, meaning your taxable income is reduced. You are automatically enrolled⁷If for some reason you want to change to paying your premium post-tax (i.e., not reduce your taxable income), you would fill out and submit the “MSC Premium Conversion Enrollment/Change Form” during Open Enrollment in November of each school year. That said, we can’t think of a good reason to do this.  if your health plan has a premium.

• Parental leave. Your parental leave⁸To file for your leave, you provide notification in the DOE’s self-service online leave application system (SOLAS) at least 15 days before anticipated birth/adoption. After the birth, you must confirm the birth date in SOLAS within 10 days (except if there are extenuating circumstances). If your baby arrives and you have not already submitted a leave application, you have 10 calendar days afterward to notify the DOE via SOLAS or you may forfeit your right to take the leave. allows for six weeks, fully paid, as long as you have been teaching for at least 12 months before the leave begins. You also need to work for 12 months after you return from leave, or else you have to pay back this benefit⁹Two other things to know. First, the birth parent can also use up to 6 weeks (vaginal birth) or 8 weeks (C section birth) of Cumulative Absence Reserve (CAR) days (i.e., sick days) before commencing paid parental leave; CAR days are accumulated at a rate of 10 per school year, and can be built up and rolled over to a total of 200 days throughout your career. See here for CAR days. Second, you can also take an extended childcare leave of up to four years after taking your parental leave that retains your job and seniority level if you want to return sometime during or at the end of this leave. Pay and medical benefits are not included in this leave, but it does provide job placeholder security.. (Here’s a good FAQ.)

• If both parents are teachers, they can take a combined 12 weeks of fully paid parental leave (i.e., 6 weeks each). These weeks can run concurrently or consecutively (or a combination).
• Special Leave of Absence Coverage (SLOAC¹⁰There’s something called The Family and Medical Leave Act (FMLA) which operates similarly, but is capped at 12 weeks and is intended for leaves related to care of an immediate family member OR serious injury of the employee. If used in the same calendar year, these leaves count against one another (i.e., if you take the full 12 weeks of FMLA, you only get the remaining month of SLOAC).). This program allows you to continue your medical coverage for about four months of unpaid leave. It’s intended to cover you in cases of disability or serious illness. During this period, the city pays any premiums/riders¹¹Each plan has optional riders you can purchase for additional types of coverage, as detailed here. for you.

Health Insurance Into Retirement

If you teach at least 15 years, you are eligible to stay on UFT health insurance into retirement¹²To do this, you must file the “Retired Health Benefits Application” form with your payroll or personnel office prior to retirement (the city recommends 6-8 weeks beforehand) to continue your coverage into retirement, and you must join the UFT Retired Teachers’ Chapter (UFT-RTC) upon retirement.

More info on the UFT-RTC here.. (Do it if you can—you earned it!) This is a great benefit, but there are a few nuances¹³Generally, there is a good retiree healthcare FAQ here, covering things like when you can change your healthcare plan in retirement (including the “once in a lifetime option” that allows you do to it once whenever you want, i.e. outside normal cycles); covering spouses; and how to contact the Health Benefits Program.:

• Payments for any premiums associated with your health-care plan or any riders you opt into are automatically deducted from your pension check, post-tax.

• At age 65, if you’re retired, you must make Medicare your primary health plan¹⁴What this means more technically is that you must join Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) at 65. The UFT Health Benefits Program reimburses you for the cost of Medicare Part B.) Once you’re enrolled in Medicare, you submit the “Notification of Your Medicare Part B Enrollment Application” form to the UFT Health Benefits Program, which is what automatically commences your Medicare Part B reimbursement. You can also waive your city health plan at this time if you’d like to, again via the “Retired Health Benefits Application” form. The only reason to do this would be if you can use a spouse’s better plan for your backup instead., but you can keep your City health plan as a backup. To make sure this goes smoothly, contact Social Security and start your Medicare enrollment process three months before your 65th birthday¹⁵You’re advised to contact Social Security and start your Medicare enrollment process three months before your 65th birthday. Once you’re enrolled, you submit the “Notification of Your Medicare Part B Enrollment Application” form to the Health Benefits Program, which is what automatically commences your Medicare Part B reimbursement. You can also waive your city health plan at this time if you’d like to, again via the “Retired Health Benefits Application” form.. 

The UFT also offers the optional Supplemental Health Insurance Program¹⁶You should opt for pension deductions to pay this premium, since there’s a $30 fee if you do not. You enroll by completing a SHIP enrollment card on the SHIP website. (SHIP). You pay $10/month and receive a lifetime maximum benefit of $100,000 to help pay for typical health-care costs in retirement. (Think ambulances, hearing aids, customized orthopedic shoes, surgical stockings, and private-duty nursing; the full schedule of benefits is here.) One specific example: For hearing aids, SHIP will reimburse out-of-pocket expenses up to $1,500 once every 3 or more years.

Footnotes

• 1
  These options are called City basic health plans. See here.
• 2
  A premium is the amount you pay monthly for your health insurance plan.
• 3
  A deductible is the amount you pay out-of-pocket for covered health care services before your health insurance plan starts to pay.
• 4
  Note that when you first become a teacher, your school usually helps you sign up for healthcare as part of the onboarding process, but if for some reason that doesn’t happen, make sure to contact the DOE’s HR department (718-935-4000) within 30 days of your hire to enroll in healthcare.
• 5
  During Open Enrollment, you can also add/drop any riders on your chosen health insurance. (Each plan has optional riders you can purchase for additional types of coverage, as detailed here.)
• 6
  Note that there is a grace period with your HCFSA, in case you get to the year’s end and you haven’t used all your funds. If that’s the case, you can use your remaining funds for eligible expenses from Jan. 1 to Mar. 15 of the following year. See here.
• 7
  If for some reason you want to change to paying your premium post-tax (i.e., not reduce your taxable income), you would fill out and submit the “MSC Premium Conversion Enrollment/Change Form” during Open Enrollment in November of each school year. That said, we can’t think of a good reason to do this. 
• 8
  To file for your leave, you provide notification in the DOE’s self-service online leave application system (SOLAS) at least 15 days before anticipated birth/adoption. After the birth, you must confirm the birth date in SOLAS within 10 days (except if there are extenuating circumstances). If your baby arrives and you have not already submitted a leave application, you have 10 calendar days afterward to notify the DOE via SOLAS or you may forfeit your right to take the leave.
• 9
  Two other things to know. First, the birth parent can also use up to 6 weeks (vaginal birth) or 8 weeks (C section birth) of Cumulative Absence Reserve (CAR) days (i.e., sick days) before commencing paid parental leave; CAR days are accumulated at a rate of 10 per school year, and can be built up and rolled over to a total of 200 days throughout your career. See here for CAR days. Second, you can also take an extended childcare leave of up to four years after taking your parental leave that retains your job and seniority level if you want to return sometime during or at the end of this leave. Pay and medical benefits are not included in this leave, but it does provide job placeholder security.
• 10
  There’s something called The Family and Medical Leave Act (FMLA) which operates similarly, but is capped at 12 weeks and is intended for leaves related to care of an immediate family member OR serious injury of the employee. If used in the same calendar year, these leaves count against one another (i.e., if you take the full 12 weeks of FMLA, you only get the remaining month of SLOAC).
• 11
  Each plan has optional riders you can purchase for additional types of coverage, as detailed here.
• 12
  To do this, you must file the “Retired Health Benefits Application” form with your payroll or personnel office prior to retirement (the city recommends 6-8 weeks beforehand) to continue your coverage into retirement, and you must join the UFT Retired Teachers’ Chapter (UFT-RTC) upon retirement.
  
  

  More info on the UFT-RTC here.

• 13
  Generally, there is a good retiree healthcare FAQ here, covering things like when you can change your healthcare plan in retirement (including the “once in a lifetime option” that allows you do to it once whenever you want, i.e. outside normal cycles); covering spouses; and how to contact the Health Benefits Program.
• 14
  What this means more technically is that you must join Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) at 65. The UFT Health Benefits Program reimburses you for the cost of Medicare Part B.) Once you’re enrolled in Medicare, you submit the “Notification of Your Medicare Part B Enrollment Application” form to the UFT Health Benefits Program, which is what automatically commences your Medicare Part B reimbursement. You can also waive your city health plan at this time if you’d like to, again via the “Retired Health Benefits Application” form. The only reason to do this would be if you can use a spouse’s better plan for your backup instead.
• 15
  You’re advised to contact Social Security and start your Medicare enrollment process three months before your 65th birthday. Once you’re enrolled, you submit the “Notification of Your Medicare Part B Enrollment Application” form to the Health Benefits Program, which is what automatically commences your Medicare Part B reimbursement. You can also waive your city health plan at this time if you’d like to, again via the “Retired Health Benefits Application” form.
• 16
  You should opt for pension deductions to pay this premium, since there’s a $30 fee if you do not. You enroll by completing a SHIP enrollment card on the SHIP website.