Paul Sanchez
The 1199 Health Insurance Plan is a commercial insurance plan that offers comprehensive health coverage to its members. It is accepted by renowned cardiologists like David Kavesteen and Anthony Spera of Heart and Health Medical. The plan provides access to a wide range of medical and mental health services, including COVID-19-related care, with little to no out-of-pocket costs. Members can also take advantage of additional benefits such as full prescription coverage, eye exams, and life insurance. With access to over 30,000 Benefit Fund providers in New York City, Westchester, and Long Island, the 1199 Health Insurance Plan is recognized as one of the best healthcare plans available.
| Characteristics | Values |
|---|---|
| Provider | 1199SEIU |
| Coverage | Health and life insurance |
| Providers | Teladoc, EmblemHealth, Aetna DMO |
| Coverage type | Comprehensive, including talk therapy, inpatient and outpatient treatment, prescription drugs, eye exams, basic dental care |
| Co-payments | Modest co-pays and premiums for some members, no co-payments for prescription drugs for others |
| Eligibility | Six benefit funds with their own eligibility requirements |
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What You'll Learn
The 1199SEIU Benefit Fund network includes over 30,000 providers
The 1199SEIU Benefit Funds are some of the largest self-administered labour-management funds in the nation, providing health coverage for more than 400,000 union members, retirees and their families. The 1199SEIU Benefit Fund network includes over 30,000 providers throughout New York City, Westchester and Long Island.
The Benefit Funds contract directly and indirectly with hospitals, ancillary providers and practitioners throughout New York City and the Greater New York metropolitan area, including Long Island, the Hudson Valley, Western and Northern New York State and New Jersey. The Benefit Funds also partner with other networks in certain regions of New York and New Jersey, and throughout the country, to supplement their network and help ensure members have access to services.
The 1199SEIU Benefit Fund covers telehealth services for its patients, including visits via phone, video and other virtual means for all eligible medical and mental health services, including COVID-19-related services. The Fund also covers phone visits with 1199SEIU providers for all medical and mental health services, including COVID-19-related services. In addition, the Fund offers comprehensive support through talk therapy, inpatient and outpatient treatment programs and coordinated care.
Practitioners interested in joining the Benefit Funds network must first complete and submit the Provider Recruitment Form, which serves as a request to participate in the network. The request is then subject to the Benefit Funds' network adequacy review to service members in the practitioner's geographic area, among other considerations. The Benefit Funds do not credential provider types or practitioners that are not licensed by New York State, where it is required.
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Members can access mental health services via phone
1199SEIU members can access a range of mental health services via phone. These services include support for behavioral and mental health issues, alcohol or substance abuse, and emotional well-being. Members can also access talk therapy, either in person or online, with a network provider.
To find a provider, members can visit the "Find a Provider" page on the 1199SEIU website, where they can search for clinics, therapists, psychologists, psychiatrists, and social workers. Members can also access phone and virtual visits with any 1199SEIU provider, which are covered by their benefits.
In addition to the "Find a Provider" page, members can also access the following resources for mental health support:
- NYC WELL: (888) 692-9355 or (800) 985-5990. NYC WELL provides brief support, talk therapy, and crisis counseling in multiple languages for anyone experiencing distress or other mental health issues.
- NAMI-NYC: (212) 684-3264. This confidential community health helpline is staffed by trained professionals and is available Monday through Friday, from 10:00 am to 6:00 pm.
- New York State Office of Mental Health Emotional Support Helpline: (844) 863-9314. This helpline offers free and confidential support from trained volunteers, including mental health professionals.
Members can also access the Member Assistance Program, which provides counseling, outpatient treatment, and inpatient hospital stays for behavioral health problems, alcohol or substance abuse, and other issues. The program also provides coordination of care for hospitalization and emergency hospitalization.
Additionally, 1199SEIU members can access Teladoc, a telehealth and video conferencing service, to access mental health providers online for themselves or their dependent children age 13 and older.
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The plan covers prescription drugs with no co-payments
1199SEIU members and retirees who are eligible for health and other benefits are covered through one of six benefit funds. These funds provide health coverage with little to no out-of-pocket costs, with some members paying modest co-pays and premiums for high-quality care.
Members can access more than 30,000 Benefit Fund providers throughout New York City, Westchester, and Long Island, and can also access providers by telephone to avoid transportation and waiting rooms. Comprehensive support is provided through talk therapy, inpatient and outpatient treatment programs, and coordinated care.
The specific covered services and benefits may vary depending on the member's Benefit Fund, which can be found on their Health Benefits ID card. It is within the discretion of each Benefit Fund's Plan Administrator to determine whether a particular service is covered, and some services may require prior approval.
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Members can choose from two plans: EmblemHealth or Aetna DMO
1199SEIU members have access to unparalleled health coverage with little to no out-of-pocket costs, while others pay modest co-pays and premiums for high-quality care. Members can choose from two plans: EmblemHealth or Aetna DMO.
EmblemHealth offers a range of health insurance options and provides access to its Neighbourhood Care specialists and sales representatives to help explore plan options. They also offer free health and wellness classes. The company is currently inviting doulas to join their provider networks. In 2025, EmblemHealth will make a change to the network that services individual and family plan members living in Rockland County, NY. Members who live in this county will now have access to providers in the Millennium network only.
Aetna DMO is a dental insurance plan that offers a choice of dentists, health discounts, and digital tools. The specific costs and features depend on the chosen plan. Aetna DMO plans provide limited out-of-network benefits, and members must select and have their care coordinated by a primary care dentist (PCD) to receive maximum benefits. The DMO plan doesn't have any deductibles or annual maximums, and members pay based on a percentage of the charges (coinsurance) or a flat dollar amount (copay).
Both plans provide basic care, including cleanings, exams, and restorative services. Members with the Aetna DMO plan also have access to exclusive offers from CVS Health and discounts on various health-related products and services.
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The plan includes a life insurance benefit
The 1199 insurance plan is backed by the 1199SEIU Benefit Funds, which provide benefits to healthcare workers. These funds are self-administered and independent of private insurance companies, allowing them to prioritise comprehensive benefits at lower costs for members. The plan includes a life insurance benefit, which is based on an individual's Wage Class and salary.
Full-time employees typically receive the most comprehensive benefits, including life insurance, with little to no-cost medical visits, prescription coverage, and dental and vision care. Part-time employees may receive reduced benefits with higher out-of-pocket costs. The 1199 plan offers stability in coverage, preventing sudden cost increases, and members can appeal denied claims through a structured review process.
The life insurance benefit provides financial support and security for beneficiaries in the event of the insured individual's death. It can help cover expenses such as funeral costs, mortgage payments, or education fees. The benefit amount is determined by the individual's Wage Class and salary, with higher wages potentially resulting in a larger benefit.
To understand their specific coverage, individuals can contact Member Services or refer to the Summary Plan Description for their Benefit Fund. The 1199SEIU Benefit Funds are governed by a board of trustees, ensuring that decisions reflect both workers' and employers' interests. By contributing to the 1199 plan, employers offer their employees comprehensive benefits at lower costs compared to commercial plans.
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Frequently asked questions
The 1199 Health Insurance Plan is a healthcare plan offered by 1199SEIU, which provides access to more than 30,000 Benefit Fund providers throughout New York City, Westchester, and Long Island.
The plan covers medical and mental health services, including COVID-19-related services, with full prescription coverage for preferred drugs. It also includes basic care such as cleanings, exams, and restorative services, as well as eye exams and vision correction every two years.
Yes, there are two plans to choose from: EmblemHealth and Aetna DMO.
Yes, the plan includes a life insurance benefit based on Wage Class. Additionally, members can access Teladoc, which allows them to speak to a doctor over the phone or via video call.
You can check with your preferred doctors or healthcare providers directly to see if they accept this insurance plan. Some doctors who accept the 1199 Health Insurance Plan include David Kavesteen, MD FACC, and Anthony Spera, MD FACC, both cardiologists at Heart and Health Medical.
