Frequently asked questions

All employees of the City of New York are eligible, including qualified domestic partners and eligible dependents. Adult children may also be eligible until they turn 30 if they’re unmarried, not insured by employer health coverage and live, work or reside in New York State.

A city worker is someone employed by the City of New York. Some of these include employees of the New York Police Department, Fire Department of New York, Department of Sanitation, Parks Department, the Department of Education, Department of Transportation, and more. It includes administrative, maintenance and uniformed roles.

If you are a NYC worker, you’re eligible for the MetroPlusHealth Gold Plan. You can call 877-475-3795 to speak to a customer service representative to have health insurance explained to you. They will describe how health insurance works with the Gold Plan and help you enroll.

MetroPlusHealth Gold Plan covers primary care visits for injury or illness, specialist visits, preventive care, immunizations, diagnostic tests, diagnostic imaging and facility fees and physician fees for outpatient surgery. Those services cost $0 if you see an in-network provider.

The plan also covers emergency room care, emergency medical transportation, urgent care, facility and physician fees for hospital stays, outpatient and inpatient services for mental health, behavior health or substance abuse, and office visits, childbirth and delivery facility fees.

Emergency room visits cost $100 per visit, while urgent care visits cost $25 per visit.

For recovery services, the Gold Plan covers home health care, rehabilitation services, habilitation services, skilled nursing care, durable medical equipment and hospice services.

MetroPlusHealth’s Gold Plan is for people employed by the City of New York and their families and non-medicare eligible retirees, NYC Health + Hospitals, and MetroPlusHealth employees.

No, typically, employees cannot deduct health insurance premiums from their taxes if their plan is employer-sponsored. That means if you receive health insurance benefits through your employer, your monthly payment toward that is not tax deductible.

However, the basic Gold plan does not have premiums for its members.

What providers take MetroPlusHealth’s Gold Plan?
There are physicians and hospitals in over 34,000 sites across New York City. For help finding an in-network provider, try our Find a Doctor tool.

If you leave your job voluntarily, you will lose your employer-paid health insurance benefits. If you’re laid off, you have options to get health insurance coverage from MetroPlusHealth.

If you retire and you’re 65 or older, and you meet the other requirements, you can sign up for Medicare to receive health insurance benefits.

If you don’t qualify for Medicare, you may be eligible to keep your Gold plan. However, if you leave your job with the City of New York for a new employer, you must choose a different health insurance plan.

You may be able to change your health plan after open enrollment if you qualify for a special enrollment period. A special enrollment period is available for people who have had a recent life event, such as losing other health coverage, moving, getting married, or having a baby. You usually have 60 days from the date of the life event to enroll in a new plan, but you should report your change as soon as possible to ensure there’s no lapse in your health insurance benefits.

You also have the opportunity to change your health insurance plan once a year during Fall Transfer, which is typically throughout the month of November.

The Gold Plan does not cover dental care or routine eye care, and typically, NYC employees get dental and vision coverage through their union benefits.

Many city employees get prescription drug coverage through their union. Those that don’t can purchase a prescription drug rider with the Gold Plan. The Gold Plan also comes with a prescription drug discount program that covers over 100 prescription drugs including certain antidepressants, cholesterol, and blood pressure medications.