New York City employees and retirees — coupled with advocacy group Hands Off NY Care — filed a lawsuit in response to the city’s expected transition to a self-funded health plan, according to an Oct. 29 court document.
The new plan, NYCE PPO, would go into effect Jan. 1, 2026. It would be an “administrative services only” model, meaning the city would take on all risk and cover claims itself. UMR, under UnitedHealthcare, and EmblemHealth would act as contractors but only for administrative responsibilities.
“Rather than functioning as traditional insurers, UMR and EmblemHealth would assume none of the legal or financial obligations of a state-regulated insurance carrier and would instead rely entirely on the city’s fiscal capacity to fund and pay medical claims. Thus, no ‘insurance’ is provided under the new plan,” the filing said. “It would not be bound by key statutory and regulatory requirements that protect employees, retirees and their dependents.”
Some of these protections include oversight by state regulators and network adequacy. The lawsuit argued the city is violating its own code by implementing the new plan.
The petitioners requested injunctive relief to prevent the city from migrating to the NYCE PPO.
