Preview
FILED: NEW YORK COUNTY CLERK 03/25/2024 05:08 PM INDEX NO. 152739/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 03/25/2024
EXHIBIT 1
FILED: NEW YORK COUNTY CLERK 03/25/2024 05:08 PM INDEX NO. 152739/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 03/25/2024
one Office of Labor Relations
of EMPLOYEEBENEFITSPROGRAM
22 CortlandtStreet, 12th Floor, New York, NY 10007
nyc.gov/olr
Renee Campion Georgette Gestely
Commissioner Director, Employee Benefits Program
Daniel Pollak Beth Kushner
First Deputy Commissioner Deputy Director, Administration
Nicole Andrade Sang Hong
General Counsel Deputy Director, Operations
Michael Babette
Director, Financial Management Unit
February 9, 2024
Toby Coles
Dear Mr. Coles,
This letter is in response to your inquiry regarding enrollment into the prescription drug rider
through your health plan.
Our records indicate that, effective January 1, 2024, you became Medicare-eligible and enrolled
into GHI Senior Care with the optional rider during the transfer period.
Since you belong to a union/welfare fund (COBA) that provides prescription drug coverage, you
are ineligible to enroll in the prescription drug portion of the rider and are only eligible to enroll
in for the 365-day hospitalization, per CMS regulations.
Pursuant to the New York City Health Benefits Program Summary Plan Description, any retiree
whose union/welfare fund provides credible prescription coverage is ineligible to enroll in the
prescription drug optional rider through GHI-Senior Care or HIP VIP.
Sincerely,
City Of New York
Employee Health Benefits Program
FILED: NEW YORK COUNTY CLERK 03/25/2024 05:08 PM INDEX NO. 152739/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 03/25/2024
Toby Coles
February 9, 2024
Office of Labor Relations
Health Benefits Program
22 Cortlandt Street - 12th Floor
New York, NY 10007
Dear OLR Representative,
I am retired New York City Correction Officer Toby Coles. SSN XXXXXXXXX, NYC
Department of Correction, Welfare fund Correction Officers Benevolent Association (COBA),
Pension number XXXXXX-X. On November 29, 2023, I electronically submitted a Health
Benefits Program (HBP) Retiree Application/Change Form, on the Office of Labor Relations
(OLR) web page - via the web browser indicated at the top of the application form. As a NYC
retiree transitioning into Medicare, I selected to enroll in the GHI/EBCBS Senior Care Medicare
Supplemental Plan, additionally selecting the optional rider benefits supporting Medicare Part D.
I also uploaded a copy of my Medicare card. My submission of the application and the Medicare
card was received as a successful upload completing the transaction. Be advised, as of January 1,
2024, I am actively enrolled in Medicare Part A and B.
After careful research supporting my Medicare transition, I specifically selected the GHI/EBCBS
Senior Care Medicare Supplemental Plan. I based this decision on my enrolled membership in
Emblem Health GHI/HMO with the optional prescription drug plan. Indeed, while an active
employee with the City of New York under the Department of Corrections, I maintained NYC
health care coverage with the prescription drug plan (PDP). All (31) thirty-one years
uninterrupted. Consequently, my status as a New York City retiree with an historical enrollment
in Emblem Health GHI/HMO with the PDP, confirmed my decision. I selected to enroll in the
GHI/EBCBS Senior Care Medicare Supplemental Plan, which I meet the criteria for. More
importantly this plan satisfies the requirement for Medicare Part D with the Centers for Medicare
and Medicaid Services (CMS).
On December 1, 2023, I received US Postal notifications from the OLR – Health Benefits
Program. The letter explained my responsibilities and obligations for Medicare enrollment.
Further, the letter confirmed that if I were currently enrolled in a health plan with prescription
drug coverage, I would automatically be enrolled in the Medicare Part D plan which would
replace my current drug coverage. The letter identified the same Medicare Part D PDP I selected,
and it further provided the cost sharing details and schedule for the PDP. On December 4, 2023,
via certified mail with the US Postal Service, I wrote a letter to the OLR Health Benefits
Program. My letter informed the OLR Health Benefits Program of my electronically filed
FILED: NEW YORK COUNTY CLERK 03/25/2024 05:08 PM INDEX NO. 152739/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 03/25/2024
application on November 29, 2023. Further, I emphasized that I was resolved in my selection and
decision for GHI/EBCBS Senior Care for my Medicare Part D (PDP). Additionally, enclosed in
my letter was a copy of my Medicare card.
On January 18, 2024, I was notified by Emblem Health that I was now an active member in the
Senior Care (Part A Only) Enhanced – Less Drug. Which is a plan I did not apply for. I
telephoned Emblem Health, the representative explained that I was enrolled in the GHI
Comprehensive Benefits Plan (CBP). I explained to the representative that I selected
GHI/EBCBS Senior Care with the PDP to specifically satisfy my Medicare Part D requirement.
The representative further explained Emblem Health does not determine the plan NYC retirees
receive, adding that the OLR HBP is the decision-making body who informs Emblem Health of
the retiree’s benefit plan. I was offered a telephone number to the OLR. I telephoned the OLR
forthwith.
I telephoned the OLR customer service line on three separate occasions. On two of the
occasions, I spoke with two different rep’s who informed me that my retiree PDP was under
COBA’s union fund, and both calls were abruptly disconnected. On my second call to OLR I
spoke with a female representative, she identified herself as Anita. Anita insisted my prescription
drug plan was covered with COBA, and further stated that I was not allowed to have double
PDPs with the city. She took my phone number and told me a supervisor would return my call,
for my further questions. My call has not been returned as of the date of this letter.
Seemingly, the OLR representatives are not familiar with OLR HBP policy regarding eligible
retirees qualifying for a NYC PDP “in addition to the welfare fund plan”, as it is noted in the
OLR HBP/SPD Section II Retirees.
With due diligence, I methodically and carefully researched my qualifications for Medicare Part
D PDP coverage with the NYC Health Benefit Program, as an eligible NYC retiree. The primary
source of my research is from the written policy in the NYC OLR Health Benefit
Program/Summary Program Description, Section II Retirees. Indeed, I scrutinized the OLR
HBP/SPD booklet at their website. Consequently, that research is further supported by the
Medicare transition notifications I received from OLR Health Benefit Program advising me of
my eligibility for Medicare Part D PDP. Additionally, I perused the Emblem Health website, I
telephoned Emblem Health with critical questions concerning NYC retiree enrollment,
qualification, PDP coverage, and CMS creditability regarding my anticipated transition to
GHI/EBCBS Senior Care. The OLR HBP policy and documented facts, as noted above, cast
doubt – and more importantly contradicts – the assertions of the OLR service representatives.
Conclusively, the extensive research, and the notifications from OLR HBP confirmed my
eligibility. My eligibility permits me to legitimately transition from GHI/HMO with the PDP as
an active NYC employee to Medicare Supplemental Plan GHI/EBCBS Senior Care as a NYC
retiree. Additionally, there are no administrative restraints or prerequisites to satisfy precluding
this transition. Further, I have already electronically filed my application with the OLR HBP. Yet
my application, as an eligible retiree, has not been processed for my selection of the Medicare
Supplemental Plan - GHI/EBCBS Senior Care.
FILED: NEW YORK COUNTY CLERK 03/25/2024 05:08 PM INDEX NO. 152739/2024
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 03/25/2024
In resolve, I request that my submitted November 29, 2023, application for Medicare
Supplemental Plan GHI/EBCBS Senior Care be processed to the complete satisfaction of my
selection. If there is a legitimate reason my application will not be processed as I submitted,
please notify me in writing via US Postal Service, advising me how I am legitimately ineligible
for my selection. The notification should be on NYC OLR letterhead, the month, day and year,
along with the name and title of the employee determining my ineligibility.
If you require evidence of the uploaded application and/or my mailed letter to your office on
December 4, 2023. Please advise. My address, email contact and telephone number noted above
are accurate.
Thank you,
Toby S. Coles
Preview
FILED: NEW YORK COUNTY CLERK 03/25/2024 05:08 PM INDEX NO. 152739/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 03/25/2024 EXHIBIT 1 FILED: NEW YORK COUNTY CLERK 03/25/2024 05:08 PM INDEX NO. 152739/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 03/25/2024 one Office of Labor Relations of EMPLOYEEBENEFITSPROGRAM 22 CortlandtStreet, 12th Floor, New York, NY 10007 nyc.gov/olr Renee Campion Georgette Gestely Commissioner Director, Employee Benefits Program Daniel Pollak Beth Kushner First Deputy Commissioner Deputy Director, Administration Nicole Andrade Sang Hong General Counsel Deputy Director, Operations Michael Babette Director, Financial Management Unit February 9, 2024 Toby Coles Dear Mr. Coles, This letter is in response to your inquiry regarding enrollment into the prescription drug rider through your health plan. Our records indicate that, effective January 1, 2024, you became Medicare-eligible and enrolled into GHI Senior Care with the optional rider during the transfer period. Since you belong to a union/welfare fund (COBA) that provides prescription drug coverage, you are ineligible to enroll in the prescription drug portion of the rider and are only eligible to enroll in for the 365-day hospitalization, per CMS regulations. Pursuant to the New York City Health Benefits Program Summary Plan Description, any retiree whose union/welfare fund provides credible prescription coverage is ineligible to enroll in the prescription drug optional rider through GHI-Senior Care or HIP VIP. Sincerely, City Of New York Employee Health Benefits Program FILED: NEW YORK COUNTY CLERK 03/25/2024 05:08 PM INDEX NO. 152739/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 03/25/2024 Toby Coles February 9, 2024 Office of Labor Relations Health Benefits Program 22 Cortlandt Street - 12th Floor New York, NY 10007 Dear OLR Representative, I am retired New York City Correction Officer Toby Coles. SSN XXXXXXXXX, NYC Department of Correction, Welfare fund Correction Officers Benevolent Association (COBA), Pension number XXXXXX-X. On November 29, 2023, I electronically submitted a Health Benefits Program (HBP) Retiree Application/Change Form, on the Office of Labor Relations (OLR) web page - via the web browser indicated at the top of the application form. As a NYC retiree transitioning into Medicare, I selected to enroll in the GHI/EBCBS Senior Care Medicare Supplemental Plan, additionally selecting the optional rider benefits supporting Medicare Part D. I also uploaded a copy of my Medicare card. My submission of the application and the Medicare card was received as a successful upload completing the transaction. Be advised, as of January 1, 2024, I am actively enrolled in Medicare Part A and B. After careful research supporting my Medicare transition, I specifically selected the GHI/EBCBS Senior Care Medicare Supplemental Plan. I based this decision on my enrolled membership in Emblem Health GHI/HMO with the optional prescription drug plan. Indeed, while an active employee with the City of New York under the Department of Corrections, I maintained NYC health care coverage with the prescription drug plan (PDP). All (31) thirty-one years uninterrupted. Consequently, my status as a New York City retiree with an historical enrollment in Emblem Health GHI/HMO with the PDP, confirmed my decision. I selected to enroll in the GHI/EBCBS Senior Care Medicare Supplemental Plan, which I meet the criteria for. More importantly this plan satisfies the requirement for Medicare Part D with the Centers for Medicare and Medicaid Services (CMS). On December 1, 2023, I received US Postal notifications from the OLR – Health Benefits Program. The letter explained my responsibilities and obligations for Medicare enrollment. Further, the letter confirmed that if I were currently enrolled in a health plan with prescription drug coverage, I would automatically be enrolled in the Medicare Part D plan which would replace my current drug coverage. The letter identified the same Medicare Part D PDP I selected, and it further provided the cost sharing details and schedule for the PDP. On December 4, 2023, via certified mail with the US Postal Service, I wrote a letter to the OLR Health Benefits Program. My letter informed the OLR Health Benefits Program of my electronically filed FILED: NEW YORK COUNTY CLERK 03/25/2024 05:08 PM INDEX NO. 152739/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 03/25/2024 application on November 29, 2023. Further, I emphasized that I was resolved in my selection and decision for GHI/EBCBS Senior Care for my Medicare Part D (PDP). Additionally, enclosed in my letter was a copy of my Medicare card. On January 18, 2024, I was notified by Emblem Health that I was now an active member in the Senior Care (Part A Only) Enhanced – Less Drug. Which is a plan I did not apply for. I telephoned Emblem Health, the representative explained that I was enrolled in the GHI Comprehensive Benefits Plan (CBP). I explained to the representative that I selected GHI/EBCBS Senior Care with the PDP to specifically satisfy my Medicare Part D requirement. The representative further explained Emblem Health does not determine the plan NYC retirees receive, adding that the OLR HBP is the decision-making body who informs Emblem Health of the retiree’s benefit plan. I was offered a telephone number to the OLR. I telephoned the OLR forthwith. I telephoned the OLR customer service line on three separate occasions. On two of the occasions, I spoke with two different rep’s who informed me that my retiree PDP was under COBA’s union fund, and both calls were abruptly disconnected. On my second call to OLR I spoke with a female representative, she identified herself as Anita. Anita insisted my prescription drug plan was covered with COBA, and further stated that I was not allowed to have double PDPs with the city. She took my phone number and told me a supervisor would return my call, for my further questions. My call has not been returned as of the date of this letter. Seemingly, the OLR representatives are not familiar with OLR HBP policy regarding eligible retirees qualifying for a NYC PDP “in addition to the welfare fund plan”, as it is noted in the OLR HBP/SPD Section II Retirees. With due diligence, I methodically and carefully researched my qualifications for Medicare Part D PDP coverage with the NYC Health Benefit Program, as an eligible NYC retiree. The primary source of my research is from the written policy in the NYC OLR Health Benefit Program/Summary Program Description, Section II Retirees. Indeed, I scrutinized the OLR HBP/SPD booklet at their website. Consequently, that research is further supported by the Medicare transition notifications I received from OLR Health Benefit Program advising me of my eligibility for Medicare Part D PDP. Additionally, I perused the Emblem Health website, I telephoned Emblem Health with critical questions concerning NYC retiree enrollment, qualification, PDP coverage, and CMS creditability regarding my anticipated transition to GHI/EBCBS Senior Care. The OLR HBP policy and documented facts, as noted above, cast doubt – and more importantly contradicts – the assertions of the OLR service representatives. Conclusively, the extensive research, and the notifications from OLR HBP confirmed my eligibility. My eligibility permits me to legitimately transition from GHI/HMO with the PDP as an active NYC employee to Medicare Supplemental Plan GHI/EBCBS Senior Care as a NYC retiree. Additionally, there are no administrative restraints or prerequisites to satisfy precluding this transition. Further, I have already electronically filed my application with the OLR HBP. Yet my application, as an eligible retiree, has not been processed for my selection of the Medicare Supplemental Plan - GHI/EBCBS Senior Care. FILED: NEW YORK COUNTY CLERK 03/25/2024 05:08 PM INDEX NO. 152739/2024 NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 03/25/2024 In resolve, I request that my submitted November 29, 2023, application for Medicare Supplemental Plan GHI/EBCBS Senior Care be processed to the complete satisfaction of my selection. If there is a legitimate reason my application will not be processed as I submitted, please notify me in writing via US Postal Service, advising me how I am legitimately ineligible for my selection. The notification should be on NYC OLR letterhead, the month, day and year, along with the name and title of the employee determining my ineligibility. If you require evidence of the uploaded application and/or my mailed letter to your office on December 4, 2023. Please advise. My address, email contact and telephone number noted above are accurate. Thank you, Toby S. Coles