Cost of Coverage
The 2024 NYSHIP health plan rates for Active employees of the State of New York and their enrolled dependents are posted below.
Participating Employers (PEs) will notify their enrollees of 2024 rates.
This year's Option Transfer Period will run from November 30 - December 29, 2023. If you want to change your option for the 2024 plan year, you must complete and submit your form(s) by the December 29th deadline.
Your Share of the Premium
New York State helps to pay for your health insurance coverage. After the State's contribution, you are responsible for paying the balance of your premium, usually through biweekly deductions from your paycheck. Whether you enroll in The Empire Plan or a NYSHIP HMO, the State's share and your share of the cost of coverage are based on the following:
|Enrollee Pay Grade||Individual Coverage||Dependent Coverage|
|State Share||Employee Share||State Share||Employee Share|
|Grade 9 and below*||88%||12%||73%||27%|
|Grade 10 and above*||84%||16%||69%||31%|
* Or salary equivalent, if no Grade assigned. Contact your HBA to confirm.
If you enroll in a NYSHIP HMO, the State's dollar contribution for the hospital, medical/surgical and mental health and substance use components of your HMO premium will not exceed its dollar contribution for those components of The Empire Plan premium. For the prescription drug component of your HMO premium, the State pays the share noted in the table; the dollar amount is not limited by the cost of Empire Plan drug coverage.
Note: This information does not apply to employees of Participating Employers (PEs will provide premium information), COBRA enrollees, Young Adult Option enrollees or enrollees in Leave Without Pay status (who pay the full cost of coverage).
Copayments and Coinsurance
What They Are
The amount of money you are expected to pay upon receiving covered services under your health insurance plan is referred to as either a copayment or coinsurance.
A copayment is a fixed dollar amount that has been set for the service being received, regardless of the total cost of the service.
Coinsurance is a fixed percentage of the cost of the service being received.
Note: Copayment and coinsurance amounts for The Empire Plan and all NYSHIP HMOs may be viewed in Health Insurance Choices for 2024
What It Is
The dollar amount you are required to pay before a health plan begins to reimburse for covered services received from non-network providers.
2024 Deductible Amounts
The 2024 Empire Plan deductible amounts may be viewed in Health Insurance Choices for 2024.
NYSHIP HMOs do not have annual deductibles.
Maximum In-Network Out-of-Pocket Limit
What It Is
The Maximum In-Network Out-of-Pocket (OOP) Limit is the most you will pay out of your own pocket in a given plan year for covered health care services delivered by in-network providers under your plan. Once you reach this limit, your copayments will be reimbursed by your plan for the remainder of the plan year. Additional information about the 2024 Maximum In-Network Out-of-Pocket Limit can be found in Health Insurance Choices for 2024.