Find Alternative Healthcare

September 25, 2020 2:49 PM

During this catastrophe, the federal government utterly failed the people they are supposed to serve and the toll has been more horrific even than most American wars.

Our Union, however, 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 in the upcoming months.

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.

Receive Payment for Your Paid Time Off to Extend Healthcare

Before this pandemic, under the long-standing rules of the Industry-Wide Benefit Plan, covered employees were eligible for healthcare if they worked enough hours (functions in the case of banquet servers) or as part of a severance package. Laid off workers, generally were not eligible and payment of accrued time off did not extend their eligibility.

However, to meet this emergency, on August 25th, HTC President Rich Maroko convened a special meeting of the trustees of the Funds and convinced the trustees to amend the plan so that payment of paid time off would extend healthcare coverage. The trustees also approved a temporary plan that allows the workers we represent to maintain partial healthcare coverage.

Now, employees at all IWA and Division A shops can receive payment for paid time off to extend healthcare coverage and eligible Club employees can access such coverage by requesting sufficient hours of vacation time. You can choose to maintain either full coverage (Tier 1) or partial coverage (Tier 2), depending on how much unused paid time off you have and for which you wish to receive payment.

Full coverage (Tier 1)

Coverage: You will have continued access to all of your normal services including medical at the Health Centers, out of area medical (only if you currently have out of area coverage), hospitalization, prescription drugs, vision, dental, and the Member’s Health Assistance Program (“MHAP”).

Eligibility: If you are a full-time employee, you must take 35 hours of paid time off to maintain coverage for one additional week (seven days). This applies regardless of your classification or regular schedule.

If you are a regular part-time employee, who normally works at least 14 hours per week, you must match the number of hours you are regularly scheduled to work in a week to maintain coverage for one additional week. So for example, if you normally work 21 hours in a week, you will need to receive payment for 21 hours of paid time off to maintain one week of coverage. Please note that eligible Club employees can access such coverage by requesting sufficient hours of vacation time.

Premium: None

Enrollment: You must notify your Human Resource Manager in writing (by text or email) of how many hours of paid time off (vacation time for Club employees) for which you want to receive payment.

You will automatically be enrolled in Tier 1 coverage. To enroll in Tier 2 (or partial coverage), you MUST apply for Tier 2 coverage on the Benefit Fund’s website. Click here to be redirected to the Funds’ site.

You must apply to receive payment for your paid time off with your employer’s Human Resources Manager by the deadlines below.

  • If you are first losing coverage on October 1, you must notify your HR Manager by Monday, September 28th at 4:00 PM.
  • If you are first losing coverage on November 1, you must notify your HR Manager by Monday, October 26th.
  • If you are first losing coverage on December 1, you must notify your HR Manager by Monday, November 23rd.
  • If you are first losing coverage on January 1, you must notify your HR Manager by Friday, December 18th.

Please note that this coverage is only available so as to continue coverage. In other words, you must request paid time off to continue coverage before you first lose coverage, or this option will not be available to you. For example, if you are first losing coverage on October 1, you must notify your HR Manager by September 28; you cannot make the request at a later date.

How this will affect your unemployment benefits: The New York State Department of Labor has confirmed that if an employee cashes out all of their benefit days at once, in a single lump sum, it will not affect your unemployment benefits. However, if you take your paid time off in increments, the Department of Labor cannot guarantee that it will not affect your unemployment benefits.

So for instance, if you elect to take four weeks of paid vacation and continue your healthcare coverage, you should elect to be paid all four weeks in a single lump sum (vs. being paid one week at a time) in order to ensure that it does not affect your eligibility for unemployment benefits.

Contact us if you need assistance: If you have questions or need assistance reaching your manager, you can contact us at (212) 245-8100 and select option #1. Leave us a message with your full name, hotel, phone number, and a short description of your question/issue. A Union representative will call you back as soon as possible.

Partial coverage (Tier 2)

Coverage: You will ONLY have access to medical at the Health Centers, prescription drugs, and the Member’s Health Assistance Program (“MHAP”). Tier 2 coverage DOES NOT include hospital, outside physician referrals, out-of-area medical (EPO), vision, or dental coverage.

Eligibility: If you receive payment for 56 hours of paid time off in a month, you will be granted one month (i.e. 30 days) of coverage the following month. Please note that eligible Club employees can access such coverage by requesting 56 hours of vacation time.

Premium: None

Enrollment: You must notify your Human Resource Manager in writing (by text or email) of how many hours of vacation or other paid time off for which you want to receive payment.  

You will automatically be enrolled in Tier 1 coverage. To enroll in Tier 2 (or partial coverage), you MUST apply for Tier 2 coverage on the Benefit Fund’s website. Click here to be redirected to the Funds’ site.

You must apply to receive payment for your paid time off with your employer’s Human Resources Manager by the deadlines below.

  • If you are first losing coverage on October 1, you must notify your HR Manager by Monday, September 28th at 4:00 PM.
  • If you are first losing coverage on November 1, you must notify your HR Manager by Monday, October 26th.
  • If you are first losing coverage on December 1, you must notify your HR Manager by Monday, November 23rd.
  • If you are first losing coverage on January 1, you must notify your HR Manager by Friday, December 18th.

Please note that this coverage is only available so as to continue coverage. In other words, you must request paid time off to continue coverage before you first lose coverage, or this option will not be available to you. For example, if you are first losing coverage on October 1, you must notify your HR Manager by September 28; you cannot make the request at a later date.

How this will affect your unemployment benefits: The New York State Department of Labor has confirmed that if an employee cashes out all of their benefit days at once, in a single lump sum, it will not affect your unemployment benefits. However, if you take your paid time off in increments, the Department of Labor cannot guarantee that it will not affect your unemployment benefits.

So for instance, if you elect to take four weeks of paid vacation and continue your healthcare coverage, you should elect to be paid all four weeks in a single lump sum (vs. being paid one week at a time) in order to ensure that it does not affect your eligibility for unemployment benefits.

Contact us if you need assistance: If you have questions or need assistance reaching your manager, you can contact us at (212) 245-8100 and select option #1 Leave us a message with your full name, hotel, phone number, and a short description of your question/issue. A Union representative will call you back as soon as possible.


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.

COBRA

The federal law COBRA gives workers who lose health benefits the right to temporarily continue the same coverage. Qualifying individuals make their own payments to the same group plan they had before. 

The details below are for individuals participating in the Industry Wide Benefit Fund 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.

If you live outside of Manhattan, Brooklyn, the Bronx, or Queens and you want to maintain EPO coverage, you must select one of the plans that include hospitalization and health center coverage (COBRA3, COBRA4, COBRA5).

Eligibility: If you are laid off and have lost your healthcare coverage, you can purchase COBRA. Due to the pandemic, the government has extended the deadline, allowing enrollment as late as 60 days after the end of the coronavirus national emergency.

Premium: COBRA premiums that include healthcare coverage range from $300 to $1,920 per month, depending on your family size and plan. This chart shows monthly rates for individual and family coverage for each of the 7 plans.

Enrollment: Representatives from the Funds can help you review your options and enroll in the COBRA plan of your choice by phone. Call the Benefit Funds at (212)-586-6400, Monday - Friday, 9 AM - 5 PM.


Medicare

Coverage: Medicare is a federal health insurance program for individuals who are 65 or older and certain younger individuals with disabilities. If eligible, you can assign your Medicare Part B and Part D benefits to the Industry Wide Benefit Funds and maintain medical and pharmacy coverage through the Funds. Hospitalization services (Medicare Part A) are paid by Medicare and all related deductibles and co-insurances are the responsibility of the Retiree, Retiree’s spouse or other covered dependent. Eligible disabled dependents who have Medicare Part B also have the opportunity to assign their Medicare to maintain health center benefits.

Eligibility: You can use Medicare Part B to continue your current coverage if:

  • You are 65 or older
  • You are 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
  • You have been part of the Health Benefits Fund Plan for at least 36 consecutive months prior to your retirement.

Premium:  $0

Enrollment: To assign your Medicare benefit to the Industry Wide Benefit Funds and continue your coverage, call the Benefit Funds at (212)-586-6400.


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 2020 are in the chart below (these income limits may change in 2021).

Household Size

Maximum Expected Monthly Income

Maximum Expected Yearly Income

One

$1,468

$17,609

Two

$1,983

$23,792

Three

$2,498

$29,974

Four

$3,013

$36,156

Five

$3,529

$42,339

Six

$4,044

$48,521

Seven

$4,559

$61,046

Eight

$5,074

$67,945

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. NYC residents can also apply in-person at the Benefit Funds office located at 305 West 44th Street, and at the Brooklyn, Queens, and Harlem Health Centers beginning October 4. Click here for further instructions on how to apply.


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.

Enrollment: You can apply for Child Health Plus online or by phone. NYC residents can also apply in-person at the Benefit Funds office located at 305 West 44th Street, and at the Brooklyn, Queens, and Harlem Health Centers beginning October 4. Click here for further instructions on how to apply.

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 in 2021.

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. NYC residents can also apply in-person at the Benefit Funds office located at 305 West 44th Street, and at the Brooklyn, Queens, and Harlem Health Centers beginning October 4. Click here for further instructions on how to apply.

Public Healthcare Programs (New Jersey)

Low-income residents of New Jersey have access to the public healthcare program NJFamilyCare. NJFamilyCare is a single program, but 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 for both programs.

Medicaid (NJFamilyCare)

Medicaid is a federal and state health insurance program for people with limited income and resources. In New Jersey, the state’s NJFamilyCare program covers residents who are eligible for Medicaid.

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

With Medicaid, 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 New Jersey’s Medicaid plan, you must:

  • Be a resident of New Jersey;
  • Have lost your health insurance coverage in the past 60 days (this will qualify you for a Special Enrollment Period);
  • Be a U.S. citizen, national, or lawful permanent resident of at least five years. You can find more information about qualifying for Medicaid (and CHIP) based on your immigration status here;
  • Meet strict income requirements.

Medicaid income eligibility is based on your income from your most recent federal tax return. Please note: If you or anyone else in your household is receiving unemployment insurance, your regular unemployment benefits are considered to be income for Medicaid purposes. The extra $600 a week supplemental unemployment benefits that were provided under the CARES Act and federal stimulus checks will not be considered income.

In 2020, these are the income limits for Medicaid eligibility in New Jersey. Please note: these income limits may change in 2021:

Household Size

Maximum Monthly Income

One

$1,468

Two

$1,983

Three

$2,498

Four

$3,013

Five

$3,529

Six

$4,044

Seven

$4,560

Eight

$5,076

Premium:  No premiums or co-payments.

Enrollment: You can apply for Medicaid on the NJFamilyCare website. You can also apply on by phone, by mail, or in-person at your local Social Security Office. Click here for instructions for how to apply.

Children’s Health Insurance Program (NJFamilyCare) 

The Children’s Health Insurance Program (“CHIP”) is a federal program that provides low-cost healthcare to children under the age of 19. In New Jersey, NJFamilyCare covers residents who are eligible for CHIP. If your income is too high to qualify for Medicaid, your child could still qualify for Child Health Plus.

Coverage: If your child enrolls in the Children’s Health Insurance Program, your child will gain access to a large network of providers who accept the Children’s Health Insurance Program. The program covers many of the same services as Medicaid, such as checkups and physical exams, prescriptions, lab tests, emergency care, hospital stays and ambulance transportation, and dental and vision care.

With CHIP, your child will not continue their current coverage under the Industry Wide Benefit Funds and will not be able to access services at the Health Centers.

Eligibility: To be eligible to apply for New Jersey’s Children’s Health Insurance Program, your child must:

  • Be under the age of 19;
  • Be a resident of New Jersey;
  • Be a U.S. citizen, national, or have been lawfully admitted to the U.S.;
  • Have lost their health insurance coverage in the last 60 days (this will qualify them for a Special Enrollment Period), and;
  • Meet strict income requirements.

The income limits for the Children’s Health Insurance Program are higher than the income limits for Medicaid. These income limits are based on your income on your most recent federal tax return.

In 2020, these are the maximum income limits for the Children’s Health Insurance Program in New Jersey. Please note: these income limits may change in 2021.

Household Size

Monthly Income ($)

One

$3,775

Two

$5,101

Three

$6,426

Four

$7,751

Five

$9,077

Six

$10,402

Seven

$11,728

Eight

$13,054

Premium: Normally, monthly premiums range from free to $151.50 a month, based on your income. All NJFamilyCare premiums have been waived due to the Coronavirus pandemic. For the time being, you will NOT pay a monthly premium if your child enrolls in CHIP.

Enrollment: You can apply for CHIP on the NJFamilyCare website. You can also apply on by phone, by mail, or in-person at your local Social Security Office. Click here for instructions for how to apply.

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 private 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.

Enrollment: 

New York Residents:

  • To view a full list of the plans available in your area and monthly premiums visit the New York State of Health website, here. You can filter your plan options by the number of people who will be covered and level of coverage you would like.
  • You can also sign up through New York State. Go to New York State’s official healthcare marketplace, NY State of Health, here. 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.
  • NYC Residents only: You can apply by phone with MetroPlus. MetroPlus has provided a devoted line for the workers we represent, reachable at 855-809-4073. You can also apply with a representative from MetroPlus (for NYC residents only) in-person at the Benefit Funds office located at 305 West 44th Street, and at the Brooklyn, Queens, and Harlem Health Centers. These representatives will be available for walk-in meetings from 9:00 AM to 5:00 PM beginning October 4, and will answer all questions with no obligation on your part.
  • For those that do not reside in New York City: You can call Empire Blue Cross Blue Shield 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.”

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 Medicaid or Children’s Health Insurance Program eligibility.
  • You can call Horizon Blue Cross Blue Shield to ask questions and enroll, reachable 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.