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  • Always check that your provider participates

    Always check that your provider participates

    Always check that your provider participates

    Choose the right care with confidence.

    When it comes to your health, choosing the right provider is one of the most important decisions you can make. The 1199SEIU Benefit Funds offer you an extensive, high-quality network—more than 70,000 credentialed providers across the region. Staying in-network is one of the easiest ways to protect your benefits, ensure you receive the highest level of coverage and avoid out-of-pocket costs.

    Here’s the key:

    Always confirm that your provider is currently participating—before you make an appointment.

    Verify that you are seeing a provider who is currently participating in the Benefit Funds network

    Sometimes a provider’s office will say they “take the 1199 plan.” However, this does not guarantee they are a participating provider with the Benefit Funds. Participation can change, and even members of the same practice might not participate. To be sure you’re covered, take a moment to check their status.

    The easiest way to check their status is to visit the Benefit Funds website

    Our website gives you quick, up-to-date information so you can make informed choices. You can:

    • Search for participating providers in your area
    • Filter by specialty, location, language, gender and more
    • Confirm participation status before scheduling a visit
    • View additional provider details to help you choose care that’s right for you

    A 30-second check can save a lot of stress later.

    Prefer to talk to someone? Call Member Services

    To speak with a Member Services Representative, call (646) 473-9200 (Monday–Friday, during normal business hours). They can confirm whether a provider is participating and answer any questions you may have about coverage or benefits.

    Your benefits work best when you use participating providers­—and we’re here to support you.

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  • CareAllies Is Changing Its Name to Evernorth Health Services

    CareAllies Is Changing Its Name to Evernorth Health Services

    Effective December 19, CareAllies, the Benefit Funds’ hospital and behavioral health services medical management vendor, is changing its name to Evernorth Health Services. Please note that this is a name change only; there will be no changes to existing processes, workflows or contact information. For the most up-to-date information on services that require prior authorization, please continue to visit the Prior Authorization page on the Benefit Funds website.

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  • Major Radiation Therapy Coding Changes Take Effect January 1

    Major Radiation Therapy Coding Changes Take Effect January 1

    Effective January 1, 2026, the American Medical Association will make major updates to radiation oncology coding and reimbursements, including revisions to existing CPT codes, deletions of certain CPT codes and the introduction of new procedure codes. The changes will impact how radiation treatment delivery and image guidance are reported and reimbursed. Visit the EviCore Provider Hub for updates to clinical guidelines.

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  • Benefit Funds Continue to Cover COVID-19 Vaccines

    Benefit Funds Continue to Cover COVID-19 Vaccines

    The Benefit Funds are committed to supporting the health and well-being of our members by continuing to provide coverage for the COVID-19 vaccine with or without a prescription. Visit the Providers’ section of the Benefit Funds website for updates.

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  • Women’s Preventive Services Guidelines Are Updated for 2026

    Women’s Preventive Services Guidelines Are Updated for 2026

    Effective January 1, 2026, the Health Resources and Services Administration (HRSA) will publish its finalized updates to the Women’s Preventive Services Guidelines, which include the following recommendations:

    • Screening and counseling for intimate partner and domestic violence: Providers to include an annual screening for adolescent and adult women, as well as referrals to intervention services when needed.
    • Breast cancer screening for women at average risk: Women begin mammography screening between ages 40 and 50 and are screened at least annually through at least age 74. If supplementary imaging (e.g., magnetic resonance imaging, ultrasound and/or mammography) and pathology evaluations are needed in addition to routine screening, these services are also considered preventive and should be billed with a preventive diagnostic code.
    • Patient navigation services for breast and cervical cancer screening: Providers to include individualized patient navigation services to enhance access to screening and follow-up care, tailored to meet patients’ specific needs.

    For more information, visit the Women’s Preventive Services Guidelines page on the HRSA website.

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  • Help Prevent Prior Authorization Lack of Information Denials

    Help Prevent Prior Authorization Lack of Information Denials

    The Benefit Funds’ Prior Authorization Programs depend on the timely submission of medical documentation to support requests for authorization for medical and prescription services. Non-submission or untimely submission of supporting medical documentation may result in Lack of Information denial of prior authorization cases. For more information, visit the Provider Quick Reference Guide on the Benefit Funds website.

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  • Benefit Funds Recredential Provider Network 

    Benefit Funds Recredential Provider Network 

    The Benefit Funds are recredentialing our provider network and need your help to ensure that members have access to quality in-network healthcare providers. Please update your Council for Affordable Quality Healthcare (CAQH) application and your attestation form. You also must re-attest to the accuracy of the information in your profile, including the address(es) for your practice, by visiting the CAQH Provider Data Portal.

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  • Important Reminders

    Important Reminders

    • Assistant surgery reimbursement: The Benefit Funds reimburse assistant surgery separately only when performed at facilities where there are no residents available and an assistant surgeon is medically necessary. Visit the Benefit Funds website and online Provider Manual regularly for possible updates and changes to this policy.
    • Benefit Funds electronic solutions: Inovalon is the Benefit Funds’ claims clearinghouse for electronic claim submission. Our payor number is 13162. For registration or enrollment, call (800) 548-2890 or complete and submit an intake form and an Inovalon provider representative will contact you. Zelis hosts the Benefit Funds’ electronic payment and electronic remittance advice distribution. There is no cost for you to enroll in the Benefit Funds-sponsored Zelis ePayment center portal. You can also visit Zelis’s proprietary ePayment provider portal or call Zelis at (877) 828-8770 to manage payments.

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  • Message from the Executive Director

    Message from the Executive Director

    Message from the Executive Director

    Dear Retired Members,

    It’s hard to believe that October is already here! Before we know it, the holiday season will be upon us. This time of year can be a wonderful opportunity to celebrate with loved ones and to appreciate all the steps we’ve taken in 2025 on our health journeys. It can also be a great time to set our intentions for what we want to accomplish in the upcoming year.

    Your goal may be to learn something new or re-establish a hobby that you used to enjoy. You may be looking to sharpen your brain power or become more physically active. Or both!

    Our goal here at the Benefit Funds is to support you on whatever path you take on your journey. We offer a variety of in-person and online classes to inspire you, connect you with one another, and improve your mental and physical well-being. Come to one of our chapter meetings to find out all the latest news from the 1199 “Retired…but active” community!

    Please take a moment to look at the three-month class, event and chapter meeting schedules inside. You can also visit the Retiree Events page.

    In 2026, our Health Is the Key podcast will enter its third season—can you believe that? But before we dive into Season 3, I have some exciting news. Chef, author and television personality Adrienne Cheatham will be our November podcast guest. Known for her bold cooking, she is the former Executive Chef of Red Rooster in Harlem. After gaining national prominence as runner-up on Top Chef Season 15, Chef Adrienne created the acclaimed pop-up series “Sunday Best,” followed by her 2022 cookbook of the same name. Adrienne joined our podcast host Elizabeth Moore to talk about her favorite holiday recipes, when you can swap in healthier ingredients and when you should stick with the classics. You can tune in by visiting the Health Is the Key page.

    Enjoy the podcast—and let’s continue this journey together—celebrating our progress every step of the way!

    In good health,

    Donna Rey, EdD

    Estimados miembros jubilados:

    ¡Cuesta creer que ya es octubre! Antes de que nos demos cuenta, ya habrá llegado la temporada navideña. Esta época del año puede ser una oportunidad maravillosa para celebrar con nuestros seres queridos y apreciar todos los pasos que hemos dado en 2025 en nuestro camino hacia la salud. También puede ser un buen momento para decidir lo que queremos lograr en el próximo año.

    Su objetivo puede ser aprender algo nuevo o volver a practicar un pasatiempo que solía disfrutar. Tal vez tenga ganas de agudizar un poco la mente o de hacer más ejercicio. ¡O ambas cosas!

    Nuestro objetivo en los Fondos de Beneficios es brindarle apoyo en el camino que elija. Ofrecemos una variedad de clases presenciales y en línea para darle inspiración, ayudarle a conectarse con otros, y mejorar su bienestar mental y físico. Venga a una de nuestras reuniones de agrupaciones para conocer las últimas noticias de la comunidad “Jubilados…pero activos” de 1199.

    Tómese un momento para ver los horarios de los tres meses de clases, los eventos y las reuniones de la agrupación. También puedes visitar nuestra pagina de eventos para jubilados.

    En 2026, nuestro pódcast Health Is the Key (La salud es clave) comenzará su tercera temporada, ¿puede creerlo? Pero antes de sumergirnos en esta nueva temporada, tengo algunas noticias emocionantes. La chef, autora y personalidad televisiva Adrienne Cheatham será nuestra invitada en el pódcast de noviembre. Conocida por sus platos audaces, es la exchef ejecutiva de Red Rooster en Harlem. Después de ganar prominencia nacional como subcampeona en la temporada 15 de Top Chef, la chef Adrienne creó la aclamada serie emergente “Sunday Best”, seguida de su libro de cocina de 2022 del mismo nombre. Adrienne se unió a la presentadora de nuestro pódcast, Elizabeth Moore, para hablar sobre sus recetas navideñas favoritas, sobre cuándo se puede sustituir ingredientes por otros más saludables y cuándo es mejor quedarse con los clásicos. Puede sintonizarlo en Health Is the Key.

    Disfrute del pódcast y continuemos este viaje juntos, ¡celebrando nuestro progreso en cada paso del camino!

    Con buena salud,

    Donna Rey, doctora en Educación

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    1199SEIU Family of Funds

  • President’s Message

    President’s Message

    President’s Message

    Dear Sisters and Brothers,

    Welcome to Fall! The leaves and weather aren’t the only things changing—this is also a great time for personal reflection, making new habits and recommitting to your goals from earlier in the year. You might notice dramatic changes happening in nature, but don’t forget to take notice of the small, gradual changes as well. Remember: You are making progress every day!

    Your health is your wealth, and the best way to prevent illness or stay on the path to healthy living is with preventive care. Consider this your reminder to schedule those annual exams with your doctor and make sure you are up to date on all your immunizations. It’s normal to feel a little anxiety about getting checked out, but knowing where you stand is the only way to get ahead of the curve on any needed treatments as soon as possible or simply get some peace of mind.

    While keeping on top of your physical health is essential to healthy living, don’t forget that keeping an active mind and staying engaged in your community complete the head-to-toe care package. Your Benefit Fund has the tools and resources to help connect you with 1199ers near and far with online and in-person monthly meetings and classes. Get moving, get social, and explore and build new skill sets with a wide range of activities like Inspirational Chorus, Photography, Line Dancing, Needlework and much, much more. Creating a routine now expands your network of support and helps prevent the feelings of isolation or loneliness that can throw us for a loop during the Winter months. Browse the class and meetings listings to find the perfect fit for your health routine.

    Our 1199 retiree community is full of vibrant personalities and an uplifting energy, and sharing our time and talents with one another only makes us healthier and happier. Together, we’re stronger! As always, if you have questions or concerns, the Funds are just a call away. Reach out to the Retired Members Division at (646) 473-8666.

    In solidarity,

    Mary Stovall-Merrill

    Queridos hermanos y hermanas:

    ¡Les damos la bienvenida al otoño! Las hojas y el clima no son las únicas cosas que cambian, también es un buen momento para la reflexión personal, la creación de nuevos hábitos y volver a comprometerse con sus objetivos de principios de año. Es posible que note cambios dramáticos en la naturaleza, pero no olvide tomar nota de los cambios pequeños y graduales también. Recuerde: ¡todos los días hace progreso!

    La salud es riqueza, y la mejor manera de prevenir enfermedades o mantenerse en el camino hacia una vida saludable es con atención preventiva. Considere esto un recordatorio para programar los exámenes anuales con su médico y asegurarse de estar al día con todas sus vacunas. Es normal sentir un poco de ansiedad por hacerse chequeos, pero saber cómo se encuentra es la única manera de adelantarse a los tratamientos necesarios lo antes posible o solo para tener algo de tranquilidad.

    Si bien mantenerse al tanto de su salud física es esencial para una vida saludable, no olvide que mantener activa la mente y estar involucrado en su comunidad también conforman este paquete de cuidado integral. Su Fondo de Beneficios tiene las herramientas y los recursos para ayudarle a conectarse con otros miembros de 1199 con reuniones y clases mensuales en línea y en persona, ¡sin importar qué tan cerca o lejos estén! Muévase, socialice, y explore y desarrolle nuevas habilidades con una amplia gama de actividades como coro inspirador, fotografía, baile en línea, costura y mucho, mucho más. Crear una rutina amplía su red de apoyo y ayuda a prevenir las sensaciones de aislamiento o soledad que pueden desconcertarnos durante los meses de invierno. Explore los listados de clases y reuniones para encontrar la actividad perfecta para su rutina de salud.

    Nuestra comunidad de jubilados de 1199 está llena de personalidades vibrantes y una energía inspiradora, y compartir nuestro tiempo y talentos entre nosotros solo nos hace más saludables y felices. ¡Juntos somos más fuertes! Como siempre, si tiene preguntas o inquietudes, los Fondos están a una llamada de distancia. Comuníquese con la División de Afiliados Jubilados llamando al (646) 473-8666.

    En solidaridad,

    Mary Stovall-Merrill

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