Find alternative healthcare

September 25, 2020 2:49 PM

During this catastrophe, the federal government utterly failed the people it is 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.

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 continue your current healthcare coverage, or receive partial (Tier 2) coverage, depending on how much unused paid time off you have and for which you wish to receive payment.

Continue Your Coverage

Coverage: You can maintain your current coverage by receiving payment for your unused paid time off. 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”).

Keep in mind, as has been reported, unless the city’s hotel industry recovers by the end of the year and a large number of members are recalled, it is very likely that the Benefit Funds will have to reduce staffing and temporarily close the Harlem and Brooklyn health centers in January.

Eligibility: If you are a full-time employee, you must take 35 hours of paid time off to continue your 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 continue 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 continued 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 continued coverage.

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 January 1st, you must notify your HR Manager by Friday, December 18th.
  • If you are first losing coverage on February 1st, 2021, you must notify your HR Manager by Wednesday, January 20th.

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 January 1st, you must notify your HR Manager by December 18th; 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.

Keep in mind, as has been reported, unless the city’s hotel industry recovers by the end of the year and a large number of members are recalled, it is very likely that the Benefit Funds will have to reduce staffing and temporarily close the Harlem and Brooklyn health centers in January.

IMPORTANT NOTE: If you elect Tier 2 coverage and you intend to enroll in COBRA thereafter, your COBRA enrollment will be retroactively applied beginning on the date that you lost your full, employer-sponsored healthcare, and you will still have to pay for COBRA for each month you had Tier 2 Coverage on top of future COBRA payments. Furthermore, losing Tier 2 coverage will NOT qualify you for a special enrollment period to enroll in a Qualified Health Plan. This means if you intend to enroll in a Qualified Health Plan, you must do so within the first 60 days of losing your full, employer-sponsored healthcare even if you are enrolled in Tier 2 coverage. If you fail to do so, you may not be able to enroll in a Qualified Health Plan until the open enrollment period in November 2021.

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 partial 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 continued full 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 January 1st, you must notify your HR Manager by Friday, December 18th.
  • If you are first losing coverage on February 1st, 2021, you must notify your HR Manager by Wednesday, January 20th.

In other words, you must request paid time off to receive partial 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.


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 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.

Keep in mind, as has been reported, unless the city’s hotel industry recovers by the end of the year and a large number of members are recalled, it is very likely that the Benefit Funds will have to reduce staffing and temporarily close the Harlem and Brooklyn health centers in January.

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.

Please keep in mind, if you decide to receive payment for your paid time off and enroll in limited Tier 2 coverage and then, you enroll in COBRA, you must enroll in COBRA retroactive to the date that you lost your full, employer-sponsored healthcare and pay for COBRA for those months you had Tier 2 coverage.

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 in 2020.

If you participate in the Industry-Wide Benefit Funds, you receive money each calendar year on a Health Reimbursement Arrangement (HRA) Card. Under the IWA and Division A contracts, eligible employees receive $200/year for individuals and $400/year for families. Any funds on your HRA Card can be used to help pay for COBRA.

And if you are receiving severance in the form of weekly bridge payments and you have not exhausted your severance bank, your bridge payments will increase by $443 a week on January 1st, 2021 to help cover the cost of COBRA.

If you need to access savings in your 401(k) account, the CARES Act allows for qualifying individuals to take an early withdrawal from this retirement account without the normal 10% penalty that you pay if you make a withdrawal from your 401(k) before the age of 59 and 1/2. You can read more in the Retirement Q&A.

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.

Keep in mind, as has been reported, unless the city’s hotel industry recovers by the end of the year and a large number of members are recalled, it is very likely that the Benefit Funds will have to reduce staffing and temporarily close the Harlem and Brooklyn health centers in January.

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.


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.

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 at any time).

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 Midtown, Brooklyn, Queens, and Harlem Health Centers beginning October 4. 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.


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. NYC residents can also apply in person at the Benefit Funds office located at 305 West 44th Street, and at the Midtown, Brooklyn, Queens, and Harlem Health Centers beginning October 4. 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.

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. NYC residents can also apply in person at the Benefit Funds office located at 305 West 44th Street, and at the Midtown, Brooklyn, Queens, and Harlem Health Centers beginning October 4. 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.

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.

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 meet with Union workers in the Union’s Gertrude Lane Auditorium (at 305 West 44th Street) and at the Midtown, Harlem, Brooklyn, and Queens Health Centers from 9 AM – 5 PM, Monday through Friday.

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: The Union and the Benefit Funds have arranged for representatives from MetroPlus to be available for walk-in meetings, in person at the Union’s Gertrude Lane Auditorium (305 West 44th Street) and at the Midtown, Brooklyn, Queens, and Harlem Health Centers. MetroPlus agents are available to meet in person 9:00 AM to 5:00 PM, Monday through Friday.

You can also apply by phone by calling 855-809-4073 from 9:00 AM – 5:00 PM, Monday through Friday and 9:00 AM – 1:00 PM on Saturdays.

Deadline to Apply: If you are eligible for a subsidized, public health insurance plan (Medicaid, Child Health Plus, or the Essential Plan), you must enroll by the 15th of the month before you lose coverage, in order to guarantee no lapse in healthcare coverage. So for example, if you are losing coverage on January 1st, you must enroll by December 15th in order to begin coverage on January 1st.

If you are enrolling in a Qualified Health Plan, you are able to get retroactive coverage to the beginning of the month you enroll.

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. Our Union has arranged for a designated phone line for HTC-represented workers to speak with BlueCross BlueShield Agents and receive assistance enrolling in a health plan.

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 on a designated phone line.

New York (outside of NYC): 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.”

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.

Deadline to Apply: If you are eligible for a subsidized, public health insurance plan, you must enroll by the 15th of the month before you lose coverage, in order to guarantee no lapse in healthcare coverage. So for example, if you are losing coverage on January 1st, you must enroll by December 15th in order to begin coverage on January 1st.

If you are enrolling in a Qualified Health Plan, you are able to get retroactive coverage to the beginning of the month you enroll.

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 in person at the Benefit Funds office (located at 305 West 44th Street) and at the Midtown, Brooklyn, Queens, and Harlem Health Centers from 9:00 AM to 5:00 PM, Monday through Friday. 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 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.”
  • 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 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.