Thousands of city employees who subscribe to a popular health insurance plan offered by the city lack coverage for annual checkups, even as Mayor Bloomberg and health officials are stressing the importance of preventive medicine.

Since taking office, Mr. Bloomberg, along with his health commissioner, Dr. Thomas Frieden, has prioritized health care and, in particular, primary care and preventive medicine. Lawmakers have spent millions of dollars to bring electronic health records to primary care clinics. Health officials in 2004 established a 10-point health policy agenda that listed its top priority as urging New Yorkers to have a regular doctor.

But under a contract the city negotiated with GHI, “well visits,” or annual physicals, are not covered for city employees between the ages of 19 and 45, according to the company.

One city employee who showed a copy of her bill to The New York Sun said she was charged $250 for a “preventive medicine” visit. The bill also included a $23 fee for a blood test, and a $30 fee for “specimen handling.” The total came to $303, according to the employee, who requested anonymity to protect her job.

Union officials speculated that employees either do not get physicals or are being screened by specialists.

“The employees of the city are pretty knowledgeable about their health needs and seem to be getting the testing and treatment they need,” the executive director of the welfare fund for the United Federation of Teachers, Arthur Pepper, said. He pointed out that GHI covers mammograms and Pap smears for women over age 18.

“I would suspect that an Ob/Gyn is also doing other screenings as part of the patient visit. As a result, there does not seem to be an outcry regarding the lack of screening available,” Mr. Pepper said.

A mayoral spokesman, John Gallagher, dismissed the notion that thousands of city employees lacked an insurance plan that covers regular checkups. “The City offers a variety of health-care options for employees, including GHI, which include coverage for prophylactic measures like physicals and screenings,” he wrote in an e-mail message.

However, a spokeswoman for GHI, Ilene Margolin, confirmed that coverage for individuals between the ages of 19 and 45 does not include annual checkups. Since September 1, 2000, she said, one yearly physical has been covered for individuals under 19 as well as for individuals between the ages of 45 and 65. “We have numerous clients with a whole range of coverage options and depending on the payer we have different plans,” she said. Individuals in the ages in which annual physicals are covered pay a $15 co-payment for checkups.

According to the Municipal Labor Committee, the city offers 11 different health insurance plans to the city’s 500,000 employees and retirees. Empire BlueCross BlueShield HMO costs $62 monthly for an individual or $213 monthly for a family. Aetna’s Quality Point of Service Program, the most expensive plan offered by the city, costs $531 monthly for an individual and $1,300 monthly for a family.

GHI, which is free, is the most popular, according to officials who estimated that at least 70% of municipal employees choose GHI.
Last month, at a hearing convened to discuss a proposal by HIP Health Plan of New York and GHI to merge into one for-profit entity, Deputy Mayor Edward Skyler estimated that 93% of municipal employees are enrolled in GHI or HIP, largely because the companies offered “significantly lower” rates than their counterparts.

Mr. Skyler, who urged the state Insurance Department to reject the merger, said the city currently spends more than $4 billion annually on employee health care costs, up from $2.4 billion in 2002.

Some union officials cited cost as a possible reason for offering a plan that excludes physicals, but that reasoning prompted some to question whether the Bloomberg administration and the city’s office of labor relations were in sync.

“He’s enormously behind prevention and primary care,” the executive director of the Primary Care Development Corporation, Ronda Kotelchuck, said of Mayor Bloomberg.

“It seems short-sighted or out of date that they don’t cover preventive measures,” she added. “I’d like to ask them, ‘Why would that increase the cost of the premium?’ Overall, it would reduce the costs.”

Asked to explain why the GHI plan did not cover physicals, Mr. Pepper, of the teachers’ union, said the city has issued a request for proposal for health and hospital benefits. “This type of coverage, if lacking, may be included going forward,” he said.