Provider Wellness FAQ

What is Provider Wellness?
Provider Wellness is an initiative funded by the NYS Department of Health and the United Federation of Teachers (UFT), and designed and operated in the five boroughs of New York City by the UFT whose purpose is to improve the health and wellbeing of NYC-based family child care providers.

What does Provider Wellness cost?
Provider Wellness is 100% cost-free for its participants. If you’re eligible to participate, you can receive whichever benefits apply to you at no cost.

Who provides the services/benefits in Provider Wellness?
The benefits are provided by Emblem Health (Dental/Vision), WellSpark Health (Lifestyle Coaching & Wellbeing Resources), the UFT Member Assistant Program (Mental Health Services), the UFT (Premium Reimbursement program).

What languages (besides English) does Provider Wellness support?
On the administrative side, our main Provider Wellness information line is managed by individuals fluent in both English and Spanish. In addition, we utilize a live interpretation service that allows us to provide assistance and support (including assistance enrolling in Provider Wellness or signing up for any specific benefits) in more than 150 languages.

On the programmatic side, the support is as follows:

• Dental/Vision Care: In addition to helping you enroll, the extensive network of providers includes one or more who are conversant in English, Spanish, Mandarin, Russian, and French. Other languages may be supported but these were the ones we researched.
• Premium Reimbursement: As this is simply a paper-work benefit, our administrative staff can assist providers in more than 150 languages in assembling and submitting the correct paperwork to receive these reimbursements.
• Mental Health Services: Without interpretation, these services are primarily available exclusively in English at this time. If you are comfortable with an interpreter in the conversation, we can support more than 150 languages. We are also planning to bring on a Spanish-speaking counselor in the near future.
• Lifestyle Coaching & Wellbeing Resources: Coaching is available now in English, Spanish, Russian, and Mandarin and can be expanded to include Haitian Creole and French if sufficient demand materializes.

Who is eligible for Provider Wellness?
Any NYC-based family child care provider – whether Family Day Care, Group Family Day Care or Legally Exempt (informal) – with at least one HRA/ACS child under care is eligible.

What about my assistants? Are they eligible?
No. Assistants are not eligible for Provider Wellness at this time.

What about members of my family/household? Are they eligible?
The benefits in Provider Wellness are only available to the provider themselves. The only exception is that if you go onto the NY State of Health Marketplace (health insurance exchange), you may purchase a health insurance plan that covers your whole family and the premiums that you pay for that plan will be eligible for reimbursement through the Provider Wellness Marketplace Premium Reimbursement benefit, subject to the limitations of that benefit (see below for more information).

Do I have to be a member of the UFT Family Child Care Provider chapter of the union in order to participate in Provider Wellness?
No, but Provider Wellness only exists thanks to the tireless advocacy of the union on behalf of family child care providers like you. If you find you’re getting at least $21/month worth of benefits from Provider Wellness – and we’re fairly certain you’ll get much more than that – we would urge you to help support us in our work supporting you by joining. Learn more about the benefits and how to join.

Will I have to provide financial documents in order for Provider Wellness to determine what level of benefits I qualify for?
No. Provider Wellness is open to all NYC-based family child care providers with at least one HRA/ACS child in care, regardless of income. The only place your income comes into play is that it may impact what health insurance you already have (e.g. Medicaid, Essential Plan, Qualified Health Plan from the marketplace) independent of Provider Wellness and that will impact which of our two Dental Care options make most sense for you. That said, we will not be asking for or reviewing your financial documents to determine which Dental Care plan to enroll you in (should you choose to enroll in the Dental Care plan at all). Instead, we simply ask you to share with us what type of insurance you currently have so we can provide you with the correct dental coverage.

Will participating in Provider Wellness affect my taxes/income, Medicaid, or any other form of public assistance I receive?
No. This will not affect those in any way. The benefits you receive through Provider Wellness are not considered income and therefore will not affect your taxes, eligibility for Medicaid, or eligibility any other income-based form of public assistance.

Will participating in Provider Wellness affect my existing insurance?
No. Any insurance-related benefits from Provider Wellness are considered secondary insurances. Your existing insurance (if any) will pay first and then the Provider Wellness coverage will take over after that. Your existing insurance provider (if any) does not need to know about (and likely will not know about) your Provider Wellness benefits.

Who are these services for?
Anyone with little or no existing dental coverage.

What services are covered?
Everything you would expect out of a dental plan, including:

- Preventive & Diagnostic Services – Examinations, cleanings, x-rays, & tests and labs
- Basic Services – Simple Extractions, fillings, endodontics, anesthesia
- Major Services – Prosthetics, restorations, and oral surgery up to an annual maximum of $2,000 in services.

For full details, check out the Tier I Benefits Summary

Which services are not covered?
The following services are not covered:

- Cosmetic surgery and treatment unless it is reconstructive surgery caused by trauma, infection, or disease of the involved part.
- Prescription drugs and medicines.
- Services and appliances for the treatment of temporomandibular joint (TMJ) dysfunction. iv. Transplantations.

Is there a deductible I have to hit before the health insurance starts paying?
There is a $0 deductible meaning you don’t have to pay anything before the coverage we provide kicks in!

Are there copays or co-insurance?
No. So long as you see an in-network dentist, the plan covers the full expense of all covered services.

What dentists can I see?
You can see any dentist you like with one caveat: As a Preferred Premier Dental Plan, you have access to a network of more than 10,000 dentists and specialists in New York and New Jersey. While you can visit either an in-network or out-of-network dentist, when you visit an in-network dentist, you can be certain that the insurance we provide you with will cover 100% of the set dollar amount for the service or 100% of the bill (depending on the service). When you see an out-of-network dentist, the health insurance provider will pay the full amount they’d pay to an in-network dentist but if your out-of-network dentist charges more than that, you’ll have to pay the difference. Search for an in-network dentist by specialty in your area.

Who are these services for?
Anyone with existing dental benefits at the level provided by Medicaid or the Essential Plan 3 / 4 (or better).

What services are covered?
Everything in the Basic Plan (see above) PLUS implants and orthodontia. The annual limits are such that you can get a full set braces (including all follow-up visits and hardware) and as many as 2-3 implants annually (assuming you don’t have substantial other work done the same year). For full details, check out the Tier II Benefits Summary.

Which services are not covered?
The following services are not covered:

• Cosmetic surgery and treatment unless it is reconstructive surgery caused by trauma, infection, or disease of the involved part.
• Prescription drugs and medicines.
• Services and appliances for the treatment of temporomandibular joint (TMJ) dysfunction.
• Transplantations.

Is there a deductible I have to hit before the health insurance starts paying?
There is a $0 deductible meaning you don’t have to pay anything before the coverage we provide kicks in!

Are there copays or co-insurance?
No. So long as you see an in-network dentist, the plan covers the full expense of all covered services.

What dentists can I see?
You can see any dentist you like with one caveat: As a Preferred Premier Dental Plan, you have access to a network of more than 10,000 dentists and specialists in New York and New Jersey. While you can visit either an in-network or out-of-network dentist, when you visit an in-network dentist, you can be certain that the insurance we provide you with will cover 100% of the set dollar amount for the service or 100% of the bill (depending on the service). When you see an out-of-network dentist, the health insurance provider will pay the full amount they’d pay to an in-network dentist but if your out-of-network dentist charges more than that, you’ll have to pay the difference. Search for an in-network dentist by specialty in your area. 

You offer two types of Dental Coverage: One for folks who already have basic dental coverage and one for those who have little or none. Is it the same with Vision Care?
No. When it comes to Vision Care, we have a single plan that’s great for everyone!

I already have vision coverage through Medicaid or the Essential Plan 3 or 4. It’s ok but not great. How does this vision care coverage compare to that?
We deliberately designed this plan to be a step up from what Medicaid and the Essential Plan 3 and 4 offer (FYI: The Essential Plans 1 and 2 offer little or no vision coverage at all).

What services are covered?
Annual eye exams plus allowances for contact lens fittings. In addition, a $130 annual allowance for frames and 20% off anything spent above that amount. A wide variety of lens options are available (with copays ranging from $0 to $40). An annual contact lens allowance is also available (in lieu of glasses) and discounts on laser corrective surgery. For the full details, check out the Benefits Summary. 

Are there copays?
For the base offerings and services, no. For some items, yes. For the full details, check out the Benefits Summary.

What eye care providers can I see?
Unlike the dental plans, you must see an in-network provider to leverage your vision benefits. Find a list of in-network vision providers near you.

How do the individual counseling sessions work?
A licensed clinician will provide a 45-minute session either in-person or by phone/virtually. In-person sessions can take place either in one of our offices (Harlem and the Bronx) or, by request, at your home.

Are the individual counseling sessions confidential?
Yes, the UFT Member Assistance Program (MAP) is HIPAA-compliant in the State of New York.

What other services are available?
Support groups and wellbeing workshops are also available. Read more details about the services we provide, or for additional information, email uftmap [at] provider-wellness [dot] org (uftmap[at]provider-wellness[dot]org) or call 212-598-6888.

Is this benefit offered in-person or virtually?
These services are 100% virtual.

What types of coaching are there?
There are two types: Individual (one-on-one) and Group. You can do as many or as few one-on-one sessions as you like and schedule them when convenient to you. The group sessions are organized around a cohort of fellow providers (minimum 3, maximum 15) and consist of twelve 30-minute meetings that take place once-per-week in the evening. Read more details about this program. 

I’ve heard about rewards for participation. What are those all about?
Anyone who completes either six individual sessions or a fully twelve-session group program will receive a $50 gift card. While participants may enjoy the benefits of more individual and group sessions throughout the year, they are only eligible for one completion gift card per year. In addition, as an incentive to encourage participation upfront, we are hosting a number of raffles in which we raffle off $100 Amazon gift cards among anyone who has simply registered on the WellSpark platform and are also giving away $25 Amazon gift cards to the first batch of providers who sign up for either group or individual coaching.

If I have Medicaid, one of the Essential Plans offered by NYS, or no health insurance at all, am I eligible for this benefit?
No, this benefit does not apply to you because you are not paying any premiums for your health insurance, either because you don’t have health insurance or because you have Medicaid or one of the Essential Plans, neither of which have any premiums associated with them. As a result, there’s nothing for us to reimburse you for.

I have insurance through my or my spouse/partner’s employer. Am I eligible for this benefit?
No, this benefit will reimburse your out-of-pocket expenses (i.e. your “premiums”) to purchase a qualified health plan on the “NY State of Health” marketplace (a.k.a. “the exchange”). Premiums that you and your family pay to offset the cost of the employer-based plan that you have are not eligible to be reimbursed through this program.

How much of my premiums will you reimburse?
Provider Wellness will reimburse up to 100% of the premiums you actually pay out-of-pocket with the following caveats: (1) For the current benefit year (Oct 2022-Sept 2023), there is a cap of $400 per provider per quarter; (2) The funds allocated to this benefit are not unlimited and will be disbursed on a first-come, first-served basis if and until they run out.

Can I get my out-of-pocket medical expenses reimbursed as well?
No, this benefit only reimburses you for the cost of purchasing health insurance (i.e. “premiums”), not costs you incur for health services (e.g. copays, co-insurance, outlay before you reach your deductible, any other out-of-pocket expense related to your health).

How do I take advantage of this benefit?
Enroll in Provider Wellness and choose this benefit on the Benefits Selection page. You will receive an email with instructions that will tell you exactly what you need to do to take advantage of this benefit. Learn more about the details of this program.