Cost of Coverage
2023 Rates
The 2023 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 2023 rates.
This year's Option Transfer Period will run from December 1-30, 2022. If you want to change your option for the 2023 plan year, you must complete and submit your form(s) by the December 30th deadline.
| Note: To enroll in an HMO, you must live or work in the HMO's service area. If you no longer live or work in the NYSHIP service area of the HMO in which you are enrolled, you must change to another option. Service areas may change from year to year. Refer to the NYSHIP Options by County list to see which options are available to you for the 2023 plan year. | Biweekly Costs Schedule | |||||
| For all Employees in titles allocated or equated to Salary Grade 9 and below* | For all Employees in titles allocated or equated to Salary Grade 10 and above* | |||||
| Pages in Choices |
Code | Plan | Individual | Family | Individual | Family |
| 13 | 001 | The Empire Plan | 56.01 | 241.79 | 74.68 | 287.98 |
| 24 | 066 | Blue Choice | 43.18 | 184.91 | 57.57 | 220.30 |
| 26 | 063 | Capital District Physicians' Health Plan (CDPHP) (Capital) | 48.42 | 205.35 | 64.56 | 244.74 |
| 26 | 300 | Capital District Physicians' Health Plan (CDPHP) (Central) | 48.29 | 203.99 | 64.38 | 243.15 |
| 26 | 310 | Capital District Physicians' Health Plan (CDPHP) (Hudson Valley) | 56.52 | 216.38 | 73.25 | 257.87 |
| 28 | 050 | EmblemHealth – HIP (Downstate) | 107.49 | 314.58 | 127.17 | 364.59 |
| 28 | 220 | EmblemHealth – HIP (Capital) | 152.46 | 483.24 | 172.78 | 531.81 |
| 28 | 350 | EmblemHealth – HIP (Hudson Valley) | 173.08 | 458.73 | 189.71 | 501.29 |
| 30 | 067 | Highmark Blue Cross Blue Shield of Western New York | 45.32 | 193.72 | 60.43 | 230.82 |
| 32 | 069 | Highmark Blue Shield of Northeastern New York | 49.52 | 212.45 | 66.03 | 253.10 |
| 34 | 072 | HMOBlue (Central New York Region) | 49.00 | 206.60 | 65.33 | 246.29 |
| 34 | 160 | HMOBlue (Utica Region) | 51.10 | 227.97 | 68.13 | 271.20 |
| 36 | 059 | Independent Health | 44.90 | 190.19 | 59.86 | 226.68 |
| 38 | 058 | MVP Health Care (Rochester) | 45.20 | 177.18 | 60.26 | 211.79 |
| 38 | 060 | MVP Health Care (East) | 46.99 | 184.44 | 62.66 | 220.46 |
| 38 | 330 | MVP Health Care (Central) | 52.54 | 206.63 | 70.05 | 246.97 |
| 38 | 340 | MVP Health Care (Mid-Hudson) | 52.74 | 208.59 | 70.32 | 249.27 |
| 38 | 360 | MVP Health Care (North) | 48.69 | 191.26 | 64.92 | 228.61 |
* UUP Employees with an annualized salary of less than $47,024 are considered to be salary grade 9 and below while UUP employees with an annualized salary of $47,024 or more are considered to be salary grade 10 and above.
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.
Annual Deductible
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.
2023 Deductible Amounts
The 2023 Empire Plan deductible amounts may be viewed in Health Insurance Choices for 2023.
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.
2023 Empire Plan Maximum In-Network OOP Limits
| Prescription Drugs | All Other Covered In-Network Services, Combined | |
|---|---|---|
| Individual Coverage | $3,200* | $5,900 |
| Family Coverage | $6,400* | $11,800 |
* Does not apply to Medicare-primary enrollees.
2023 HMO Maximum In-Network OOP Limits
The 2023 Maximum In-Network OOP Limits for the HMOs participating in NYSHIP vary by plan and may be viewed in Health Insurance Choices for 2023.