Find alternative healthcare

Updated September 7, 2021


Our Union has moved mountains to win extraordinary protections and special benefits to assist the workers we represent to get through this emergency. The most important example has been the Union’s success in persuading and compelling a devastated industry to continue to fund healthcare coverage for most of the 40,000 workers we represent (most of whom are laid off) over a period of many additional months.

We have compiled this guide about the many alternative healthcare options that will be available to you should you lose coverage.

We encourage you to review this guide to explore which plan will be best for you and your family should your coverage ultimately comes to an end. If you have any questions, or need assistance, you can contact us at (212) 245-8100 and select option #1.

COBRA

The federal law COBRA gives workers who lose health benefits the right to temporarily continue the same coverage. Under the American Rescue Plan, the Federal Government subsidized COBRA for many laid off workers from April 1, 2021 through September 30, 2021. Starting October 1, 2021, COBRA enrollees will have the option to pay and continue their coverage or apply to a different plan. 

The details below are for individuals participating in the Industry-Wide Benefit Funds ONLY. Individuals who participate in their employer’s healthcare plan should contact their Human Resource Department or healthcare provider to find out details about their coverage, premium, and how to enroll.

Coverage: You can choose between 7 available COBRA plans, each with a different level of coverage and cost. Click here to view the list of plans, and their rates in 2021. 

Eligibility: Typically, if you are laid off and have lost your healthcare coverage, you can purchase COBRA. 

Premium: Premiums will vary based on the level of coverage you elect. Click here to view the list of plans and their rates in 2021.

Enrollment: Contact the Benefit Funds at 212-586-6400 to enroll and discuss payment.

Important note: If you are within three years of becoming eligible for Medicare and plan to continue to use medical and pharmacy benefits at the health centers when you retire, please contact the Funds to discuss your options before enrolling in COBRA.


Medicare

Medicare is a federal health insurance program for individuals who are 65 or older and certain younger individuals with disabilities. There are four parts of Medicare insurance, each covering specific services: Hospital Insurance (Medicare Part A), Medical Insurance (Part B), Medicare Advantage Plan (Part C) and Prescription Drug Coverage (Part D).

You should not need to do anything further to enroll in Medicare Part A (Hospital). However, if you are 65 or older and losing healthcare, you should enroll in Medicare Part B (Medical) as soon as possible – even if you are not retiring. If you do not enroll in Medicare Part B within 8 months of losing your coverage, you will likely have to pay a penalty.

You also have the option to enroll in a Medicare Advantage Plan (Part C). These are plans administered by insurance providers – like MetroPlus or BlueCross BlueShield – that will bundle all of your benefits in a single plan.

Coverage: Your coverage and costs with Medicare vary based on how you decide to assign your Medicare benefits.

If you decide to enroll in original Medicare: You will pay for services as you get them. In general, you will pay a premium for Part B (Medical), an annual deductible for part B, and 20% of the cost of the service. If you add Medicare Part D (Drug costs) you will also pay a premium for that benefit. Please note: If you do not enroll in Part D coverage within 2 months of losing your coverage and then wish to enroll in Part D coverage later, you will likely have to pay a penalty.

If you decide to enroll in a Medicare Advantage Plan (Part C): You can choose from a variety of private insurance providers who will bundle your hospital coverage (Part A), medical benefits (Part B) and may provide additional services including dental, vision, and pharmacy benefits. The coverage and out of pocket costs will vary from provider to provider. If you are a resident of New York City, you can enroll in a Medicare Advantage Plan through MetroPlus.

If you want to continue coverage through the Benefit Funds: You may be eligible to assign your Medicare Part B and Part D benefits to the Industry-Wide Benefit Funds and maintain medical and pharmacy coverage at the health centers. Eligible disabled dependents who have Medicare Part B also have the opportunity to assign their Medicare to maintain health center benefits. This option is only available to individuals who are retiring. If you are over the age of 65 and interested in this option but you are not retiring yet, please be aware that if you enroll in a Medicare Advantage Plan (Part C) with a private insurance company or MetroPlus, you will not be eligible to assign your benefits to the Funds at a later date, unless you are covered by the Funds for 36 consecutive months after returning to work.

Eligibility: In general, in order to be eligible for Medicare, you must be:

  • Age 65 or older
  • A U.S. citizen or a permanent legal resident who has lived in the United States for at least five years
  • Be receiving Social Security benefits (or be eligible to)

Certain younger individuals with disabilities are also eligible. To read the full list of qualifications, visit Medicare’s website here.

If you want to continue coverage through the Benefit Funds: You must meet the following criteria:

  • Be age 65 or older
  • Be a “Hotel Industry Retiree” meaning that you must work for a Contributing Employer until you’re eligible for a Pension benefit that will begin with the calendar month after your last day of Covered Employment
  • Have been part of the Health Benefits Fund Plan for at least 36 consecutive months prior to your retirement.

Important note: You cannot have a break in coverage. If you are thinking about retiring (but are not retired yet) you should enroll in original Medicare Part B coverage now and purchase COBRA to keep this option to continue coverage through the Benefit Funds open. If you do not wish to have the option to continue to use medical and pharmacy benefits at the health centers when you retire, you only need to purchase Medicare Part B when your coverage ends. You do not need to enroll in COBRA.

Important note: If you enroll in a Medicare Advantage Plan (Part C) with a private insurance company or MetroPlus, you will not be eligible to assign your benefits to the Funds at a later date unless you are covered by the Funds for 36 consecutive months after returning to work.

Premium: Your out of pocket premiums and costs will vary based on which Medicare plan you elect.

Enrollment:

If you want to enroll in original Medicare: You can apply online or call Social Security at 1-800-772-1213.

If you want to enroll in a Medicare Advantage Plan (Part C): You should speak with the insurance provider of your choice. 

  • If you are a resident of New York City, you can enroll in a Medicare Advantage Plan through MetroPlus. You can apply by phone by calling 855-809-4073, Monday through Friday from 8 AM to 8 PM, Saturdays from 9 AM to 5 PM, and Sundays from 9 AM to 1 PM.
  • If you want to enroll with BlueCross BlueShield and live in New York State (outside of New York City), you can view your plan options on Empire BlueCross BlueShield’s website.
  • If you want to enroll with BlueCross BlueShield and live in New Jersey, you can view your plan options on Horizon BlueCross BlueShield’s website.

If you wish to enroll in a Medicare Advantage Plan, you will need to enroll within 2 months of losing your coverage, or you will have to wait until the annual Open Enrollment Period to enroll.

In order to be eligible to enroll in a Medicare Advantage Plan with MetroPlus or BlueCross BlueShield, you will need to enroll in Medicare Part B with the Social Security Administration first.

If you want to continue coverage through the Benefit Funds: Call the Benefit Funds at (212)-586-6400.

How does receiving payment for your PTO and continuing your coverage affect your deadlines to enroll in Medicare?

If you have decided to continue your coverage with the Health Benefits Fund for a limited period of time by receiving payment for your paid time off, your 8-month Special Enrollment Period to enroll in original Medicare without paying a penalty will begin AFTER you lose coverage with the Health Benefit Funds.

For example, if you receive payment for your PTO and extend your coverage until February 28, 2021, your 8-month window to enroll in Medicare will begin on March 1, 2021, rather than January 1, 2021.


Enroll in Your Spouse’s Plan

You may be eligible to get healthcare coverage through your spouse’s plan. Your spouse should contact their employer’s Human Resource Department, or whoever administers their health plan, to find out details about what’s covered, the cost, and how to enroll/add you to their plan.

If you need a letter documenting that your coverage with the Industry-Wide Benefit Funds is coming to an end, you can email the Benefit Funds at: HBFservices@hotelfunds.org. Include your first and last name, last permanent union job, and date of birth.

Public Healthcare Programs (New York) 

The following public healthcare programs are available to low-income residents of New York State: Medicaid, Child Health Plus, and the Essential Plan. These three programs are based on your household’s expected, future income and many of the workers we represent may find themselves eligible due to the impact of COVID-19 on the industry.

Medicaid

Medicaid is a federal and state health insurance program for people with limited income and resources.

Coverage: If you are eligible and enroll in Medicaid, you and your family will have access to low-cost or free medical benefits through the Medicaid network, including regular checkups and doctor visits, immunizations, dental and eye care, emergency care, hospital stays, and more.

Medicaid will NOT continue your coverage under the Industry-Wide Benefit Funds and therefore, you will no longer be able to use the Health Centers.

Eligibility: To be eligible for New York State’s Medicaid program, you must:

  • Be a resident of New York State,
  • Be a U.S. citizen, national, or lawful permanent resident (Exception: if you are undocumented, you can access emergency Medicaid services. If you are undocumented and pregnant, you can access all Medicaid services regardless of your immigration status), and
  • Meet strict income requirements:

Medicaid eligibility is based on the number of people living in your household, their age, and your household’s expected future income.

Due to the nature of the current crisis, your income may be subject to unpredictable changes. You will have to estimate your expected income in your application. Unemployment benefits are considered income by Medicaid and should be factored into your estimate. If you are laid off, however, you are likely expecting no income from salary.

The income limits for Medicaid eligibility in New York in 2021 are in the chart below (these income limits may change at any time).

Household Size

Maximum Expected Yearly Income

One

$17,131

Two

$23,169

Three

$29,207

Four

$35,245

Five

$41,284

Six

$47,322

Seven

$53,360

Eight

$59,398

Note: The income limit calculation that is used for Medicaid eligibility is more complex for households that include pregnant women, children, someone who is blind or who has a disability, or someone who is 65 or older. In general, the income limit in those cases will be higher than the amounts shown in the table above.

Premium: $0. There is no monthly premium if you are enrolled in Medicaid. A few services, like prescriptions and emergency room visits, may have a small co-pay depending on your income, but you will never pay more than $200 in co-payments in a single year (between April 1-March 31).

Enrollment: You can apply for Medicaid online or by phone. Click here for further instructions on how to apply.

If you qualify, enrollment in Medicaid is open all year. You must enroll by the 15th of the month before you lose coverage in order to begin coverage the 1st of the following month and guarantee no lapse in healthcare coverage.

If you need a letter documenting that your coverage with the Industry-Wide Benefit Funds is coming to an end, you can email the Benefit Funds at: HBFservices@hotelfunds.org. Include your first and last name, last permanent union job, and date of birth.


Child Health Plus

Child Health Plus is the name used by New York State for the Children’s Health Insurance Program (“CHIP”). CHIP is a federal program that provides low-cost coverage to children under the age of 19. If your household income is too high to qualify for Medicaid, your child could still qualify for Child Health Plus.

Coverage: Your child will have access to a large network of providers who accept Child Health Plus. The program covers services such as checkups and physical exams, prescriptions, lab tests, emergency care, hospital stays and ambulance transportation, and dental and vision care. Unlike Medicaid, the program does not cover long-term care services. Your child will not continue their current coverage under the Industry-Wide Benefit Funds and will not be able to use the Health Centers while covered by Child Health Plus.

Eligibility: To be eligible to apply for New York’s Child Health Plus program, your child must:

  • Be under the age of 19,
  • Be a resident of New York State, and
  • Meet strict income requirements.

In New York, all children are eligible for Child Health Plus if they meet the above criteria, regardless of their immigration status.

The income limits for Child Health Plus are based on your household’s monthly income. Due to the nature of the current crisis, your income may be subject to unpredictable changes. You will have to estimate your expected income in your application. Use this chart to determine if your child will qualify for Child Health Plus and your premium based on your household size and monthly income.

Premium: The monthly premium for Child Health Plus ranges from free to $60 a month per child, depending on your income. Use this chart to determine the premium you would pay based on your household size and monthly income. This chart includes the income limits for Child Health Plus eligibility in New York in 2020. These income limits may change at any time.

Enrollment: You can apply for Child Health Plus online or by phone. Click here for further instructions on how to apply.

If you qualify, enrollment in Child Health Plus is open all year. You must enroll by the 15th of the month before you lose coverage in order to begin coverage the 1st of the following month and guarantee no lapse in healthcare coverage.

If you need a letter documenting that your coverage with the Industry-Wide Benefit Funds is coming to an end, you can email the Benefit Funds at: HBFservices@hotelfunds.org. Include your first and last name, last permanent union job, and date of birth.

The Essential Plan 

The Essential Plan is a state program that is available to uninsured adults in New York who do not meet the income requirements for Medicaid.

Coverage: The Essential Plan covers many of the same services as Medicaid, including health checkups, prescriptions, surgery, emergency/urgent care, and hospital stays. Low income individuals also receive free dental and vision care. If your income does not qualify you for free dental and vision care, you have the option to pay a premium for dental and optical coverage. You can find a full summary of the benefits and cost of the Essential Plan here.

If you enroll in the Essential Plan, you will not be able to continue your current coverage under the Industry-Wide Benefit Funds and you will not be able to use the Health Centers.

Eligibility: To be eligible to apply for the Essential Plan, you must:

  • Be between 19 and 64 years of age,
  • Be a resident of New York State,
  • Be a U.S. citizen, national, or lawful resident. If you immigrated to New York and have a valid visa or deferred action status (even if you immigrated very recently), you can still qualify for the Essential Plan.
  • Meet strict income requirements.

Due to the nature of the current crisis, your income may be subject to unpredictable changes. You will be able to estimate your expected income in your application.

To be eligible for the Essential Plan in 2020, your household income must be too high to qualify for Medicaid, but no higher than the following. Please note: these income limits may change at any time.

Household Size

Expected Weekly Income ($)

Expected Monthly Income ($)

Expected Yearly Income ($)

One

$491

$2,127

$25,520

Two

$663

$2,874

$34,480

Three

$835

$3,620

$43,440

Four

$1,008

$4,367

$52,400

Five

$1,180

$5,114

$61,360

Six

$1,352

$5,860

$70,320

Seven

$1,525

$6,607

$79,280

Eight

$1,697

$7,354

$88,240

Premium: Your monthly premium for the Essential Plan depends on your income and ranges from free to $20. Depending on your income, some services like surgery, prescriptions, dental and vision care may also require co-pays.

Enrollment: You can apply for the Essential Plan online or by phone. Click here for further instructions on how to apply.

If you qualify, enrollment in the Essential Plan is open all year. You must enroll by the 15th of the month before you lose coverage in order to begin coverage the 1st of the following month and guarantee no lapse in healthcare coverage.

If you need a letter documenting that your coverage with the Industry-Wide Benefit Funds is coming to an end, you can email the Benefit Funds at: HBFservices@hotelfunds.org. Include your first and last name, last permanent union job, and date of birth.

NJFamilyCare

Low-income residents of New Jersey have access to the public healthcare program NJFamilyCare. NJFamilyCare is a single program which covers New Jersey residents who are eligible for the federal programs of Medicaid or the Children’s Health Insurance Program (“CHIP”).

If you wish to apply for either of these programs, you will only need to complete one application, which New Jersey will use to determine your eligibility. You can apply for NJFamilyCare online here. If you need help completing your online application, or have any other questions about the application, call 1-800-701-0710.

Coverage: If you are eligible for NJFamilyCare, you and your family will have access to free or very low-cost medical benefits through NJFamilyCare, including but not limited to: regular checkups and doctor visits, immunizations, dental and eye care, emergency care, and hospital stays.

With NJFamilyCare, you will not continue your coverage under the Industry-Wide Benefit Funds and you will not be able to use the Health Centers.

Eligibility: To be eligible for NJFamilyCare, you must:

  • Be a resident of New Jersey;
  • Be a U.S. citizen, national, or lawful permanent resident of at least five years. You can find more information about qualifying for NJFamilyCare based on your immigration status here;
  • You must also meet strict income requirements. If your family is above the household income limit, your children who are under 19 may still be eligible to receive coverage through NJFamilyCare.

Premium: Most people covered by NJFamilyCare do not pay any premiums or copays. Higher-income families whose children are eligible for coverage normally pay monthly premiums ranging from free to $151.50 a month. Many NJFamilyCare premiums have been waived due to the coronavirus pandemic.

Enrollment: You can apply for NJFamilyCare online here. If you need assistance with your application, have questions, or wish to apply by phone, call 1-800-701-0710. You can also apply by mail, or in person at your local Social Security office. Click here for instructions for how to apply.

If you need a letter documenting that your coverage with the Industry-Wide Benefit Funds is coming to an end, you can email the Benefit Funds at: HBFservices@hotelfunds.org. Include your first and last name, last permanent union job, and date of birth.

MetroPlus (For NYC Residents)

MetroPlus is a city-operated, not-for-profit healthcare plan that offers low-cost health insurance to New York City residents. MetroPlus agents are available to speak by phone: 855-809-4073 and at the Queens and Midtown Health Centers starting September 8, 2021, Monday through Friday, 9:00 AM to 5:00 PM.

Coverage: A MetroPlus agent will go over your income, family size, and health needs to help you select the health insurance plan that best fits your needs.

If you are eligible for a subsidized, public health insurance plan (Medicaid, Child Health Plus, or the Essential Plan), a MetroPlus agent will help you enroll.

If you are not eligible for a subsidized, public health insurance plan, MetroPlus offers a number of Marketplace plans. If you choose to enroll in one of these plans, a MetroPlus agent will help you find out if you are eligible for a tax credit. The coverage, deductibles, copays and out of pocket maximums vary widely based on which plan you select. No matter which MetroPlus plan you choose, you will not be able to continue your coverage under the Industry-Wide Benefit Funds or use the Health Centers as part of their health plans.

Eligibility: To be eligible for a MetroPlus plan you must be a New York City resident and be lawfully present in the United States. There are no income limits for their Qualified Health Plans.

Immigration: MetroPlus can only enroll New York City residents with a legal immigration status. Undocumented New York City residents can enroll in NYC Care, a healthcare access program for New Yorkers regardless of their ability to pay or immigration status.

Premium: MetroPlus premiums vary based on the plan you choose, your income, family size, and eligibility for tax credits. Find a description of the MetroPlus plans available here

Enrollment: You can apply in person, you can also apply by phone by calling 855-809-4073, Monday through Friday from 8 AM to 8 PM, Saturdays from 9 AM to 5 PM, and Sundays from 9 AM to 1 PM. 

During your phone call, the MetroPlus agent will ask you for the name, address, and Social Security number of each U.S. citizen who will be covered by the plan, or for the Alien Registration Number (the 7-9 digit number found on a green card or work permit) for all non-citizens who will be covered.

If you need a letter documenting that your coverage with the Industry-Wide Benefit Funds is coming to an end, you can email the Benefit Funds at: HBFservices@hotelfunds.org. Include your first and last name, last permanent union job, and date of birth.

BlueCross BlueShield (For Residents of New Jersey and New York)

BlueCross BlueShield is a health insurance provider that offers a variety of plans in New York and New Jersey. 

Coverage: A BlueCross BlueShield agent will go over your income, family size, and health needs to help you select the health insurance plan that best fits your needs.

If you are eligible for a subsidized, public health insurance plan, a BlueCross BlueShield agent will help you enroll. They will also help you find out if you are eligible for a tax credit.

If you are not eligible, Empire BlueCross BlueShield offers a number of Marketplace plans in New York and Horizon BlueCross BlueShield offers plans in New Jersey. The coverage, deductibles, copays and out of pocket maximums vary widely based on which plan you select. No matter which plan you choose, you will not be able to continue your coverage under the Industry-Wide Benefit Funds or use the Health Centers as part of their health plans.

Eligibility: Empire BlueCross BlueShield only enrolls residents of New York State. Horizon BlueCross BlueShield only enrolls residents of New Jersey.

Premium: Premiums vary based on the plan you choose, your income, family size, and eligibility for tax credits.

New York (outside of NYC): Find a description of the Empire BlueCross BlueShield plans available on the New York State Marketplace here.

New Jersey: Find a description of the Horizon BlueCross BlueShield plans available here.

Enrollment: The Union and the Benefit Funds have arranged for representatives from Empire BlueCross BlueShield and Horizon BlueCross BlueShield to speak with HTC-represented workers over the phone.

New York (outside of NYC): Call Empire BlueCross BlueShield to ask questions and enroll at 888-809-8009 followed by pressing option 4. This line is available Monday through Friday from 9:00 AM to 5:00 PM and Saturdays from 9:00 AM to 1:00 PM. When calling please mention the “Hotel Trades Council.”

New Jersey: Call Empire BlueCross BlueShield to ask questions and enroll at 888-809-8009 followed by pressing option 4. This devoted line is available Monday through Friday from 9:00 AM to 5:00 PM and Saturdays from 9:00 AM to 1:00 PM. When calling please mention the “Hotel Trades Council” and state that you are a New Jersey resident. You will then be transferred to Horizon BlueCross BlueShield.

If you need a letter documenting that your coverage with the Industry-Wide Benefit Funds is coming to an end, you can email the Benefit Funds at: HBFservices@hotelfunds.org. Include your first and last name, last permanent union job, and date of birth.

Qualified Health Plans (Also Known as “Obamacare”)

In 2010, President Obama pushed for significant healthcare reforms in the Affordable Care Act (also known as “Obamacare”). The law expanded access to affordable healthcare for millions of uninsured Americans and expanded Medicaid. Because of this law, today you can find and sign up for a Qualified Health Plan, a healthcare plan that has been certified by the Health Insurance Marketplace and meets all of the requirements of the Affordable Care Act, easily.

Coverage: Qualified Health Plans are provided by insurance companies and your level of coverage will vary widely based on the plan you choose. If you enroll in a Qualified Health Plan, you will have access to doctors who accept your new plan’s network. You will not be able to continue your coverage under the Industry-Wide Benefit Funds or use the Health Centers.

Eligibility: Once you lose your health coverage, you are eligible for a Special Enrollment Period of 60 days after losing coverage. To be eligible to purchase a Qualified Health Plan you must be a resident of the state in which you are purchasing a plan. There are no income requirements.

Immigration: In New York, there are no immigration requirements to sign up for a Qualified Health plan. In New Jersey, you must be a U.S. citizen, national, or lawfully present immigrant. You can learn more about New Jersey’s immigration requirements here.

Premiums: Premiums for Qualified Health plans vary widely, depending on your family size, where you live, and the level of coverage you elect.

Explore your plan options (NY):

  • MetroPlus offers a variety of Qualified Health Plans to NYC residents. You can find a list of their plans here.
  • Empire BlueCross BlueShield has Qualified Health Plans for residents of New York (outside of NYC). You can view a list of their plans here.
  • To view a full list of the plans available in your area and monthly premiums visit the New York State of Health website, here.

Explore your plan options (NJ):

  • To review a full list of your plan options, visit GetCoveredNJ. You can search for plans by your ZIP code, household information, and what level of healthcare coverage you wish to receive. 

Enrollment:

New York Residents:

  • NYC residents can apply with the help of an agent from MetroPlus. You can apply by phone with MetroPlus at 855-809-4073.
  • NY residents outside of NYC: You can call Empire BlueCross BlueShield to ask questions and enroll in one of their plans at 888-809-8009 followed by pressing option 4. This line is available Monday through Friday from 9:00 AM to 5:00 PM and Saturdays from 9:00 AM to 1:00 PM. When calling please mention the “Hotel Trades Council.”
  • You can apply online on New York State’s official healthcare marketplace, NY State of Health, here. When applying, you will only need to complete one application, which will determine if you are eligible for Medicaid, Child Health Plus, or the Essential Plan, or if you are eligible to receive financial assistance to purchase a Qualified Health Plan.

New Jersey Residents:

  • To review a full list of your plan options, visit GetCoveredNJ. You can search for plans by your ZIP code, household information, and what level of healthcare coverage you wish to receive. To sign up online, visit healthcare.gov. Your application will also be used to check your eligibility for a public subsidy.
  • You can call Horizon BlueCross BlueShield to ask questions and enroll in one of their plans, at 888-809-8009 followed by pressing option 4. This line is available Monday through Friday from 9:00 AM to 5:00 PM and Saturdays from 9:00 AM to 1:00 PM. When calling please mention the “Hotel Trades Council” and state that you are a New Jersey resident.

If you need a letter documenting that your coverage with the Industry-Wide Benefit Funds is coming to an end, you can email the Benefit Funds at: HBFservices@hotelfunds.org. Include your first and last name, last permanent union job, and date of birth.