NYSHIP 2025 Rates for Retirees, Vestees, Dependent Survivors and Enrollees covered under Preferred List Provisions of the State of New York and their Enrolled Dependents
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ENROLLEE CONTRIBUTIONS FOR RETIREES, VESTEES, DEPENDENT SURVIVORS AND ENROLLEES COVERED UNDER PREFERRED LIST PROVISIONS* To enroll in an HMO or to remain enrolled in your current HMO, you must live or work in the HMO's NYSHIP service area. 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 2025 plan year. | These rates reflect the monthly cost for NYSHIP retiree coverage. Rates for retirees do not reflect sick leave credits. | ||||||||||||||
| Retirement prior to 1/1/83 | Retirement between 1/1/83 and 12/31/11 (all Salary Grades) or Retirement on or after 1/1/12 from a title allocated or equated to Salary Grade 9 or below* |
Retirement on or after 1/1/12 from a title allocated or equated to Salary Grade 10 or above* | Eligible survivors of active Employees who died on or after 4/1/79 or of Retirees who retired on or after 4/1/79 | Amended Dependent Survivors; Eligible survivors of active Employees who died between 4/1/75 and 3/31/79 | Vestees, Long-Term Disability Enrollees and all other Dependent Survivors | ||||||||||
| Code | Plan | Individual | Family | Individual | Family | Individual | Family | Individual | Family | Individual | Family | Individual | Family | ||
| 001 | The Empire Plan | 0.00 | 427.35 | 130.86 | 592.40 | 174.49 | 704.41 | 109.05 | 536.40 | 427.35 | 427.35 | 1,090.54 | 2,799.95 | ||
| 066 | Blue Choice | 0.00 | 330.79 | 108.49 | 465.75 | 144.65 | 554.83 | 90.41 | 421.20 | 330.79 | 330.79 | 904.08 | 2,227.25 | ||
| 063 | Capital District Physicians' Health Plan (CDPHP) (Capital) | 20.75 | 343.70 | 144.54 | 497.47 | 185.80 | 594.57 | 123.90 | 448.94 | 343.70 | 343.70 | 1,052.33 | 2,427.13 | ||
| 300 | Capital District Physicians' Health Plan (CDPHP) (Central) | 87.39 | 373.80 | 212.98 | 539.79 | 254.84 | 644.96 | 192.04 | 487.20 | 373.80 | 373.80 | 1,133.96 | 2,629.18 | ||
| 310 | Capital District Physicians' Health Plan (CDPHP) (Hudson Valley) | 226.51 | 642.01 | 352.22 | 801.28 | 394.13 | 910.33 | 331.27 | 746.77 | 418.56 | 418.56 | 1,274.12 | 2,948.36 | ||
| 050 | EmblemHealth – HIP (Downstate) | 234.25 | 816.25 | 376.30 | 996.20 | 423.66 | 1,119.36 | 352.62 | 934.62 | 500.81 | 500.81 | 1,418.04 | 3,421.28 | ||
| 220 | EmblemHealth – HIP (Capital) | 480.44 | 1,126.51 | 610.46 | 1,298.36 | 653.80 | 1,425.37 | 588.78 | 1,234.85 | 553.71 | 553.71 | 1,563.93 | 3,778.78 | ||
| 350 | EmblemHealth – HIP (Hudson Valley) | 479.86 | 1,316.47 | 588.29 | 1,454.67 | 624.44 | 1,550.38 | 570.22 | 1,406.83 | 488.31 | 488.31 | 1,383.50 | 3,336.74 | ||
| 067 | Highmark Blue Cross Blue Shield | 0.00 | 358.21 | 117.17 | 504.04 | 156.23 | 600.42 | 97.64 | 455.85 | 358.21 | 358.21 | 976.42 | 2,409.28 | ||
| 069 | Highmark Blue Shield | 0.00 | 368.59 | 120.23 | 518.31 | 160.30 | 617.36 | 100.19 | 468.78 | 368.59 | 368.59 | 1,001.89 | 2,476.27 | ||
| 072 | HMOBlue (Central New York Region) | 0.00 | 381.82 | 127.68 | 540.05 | 170.25 | 643.71 | 106.40 | 488.22 | 381.82 | 381.82 | 1,064.04 | 2,591.34 | ||
| 160 | HMOBlue (Utica Region) | 48.63 | 465.44 | 180.29 | 633.23 | 224.17 | 749.36 | 158.34 | 575.15 | 442.88 | 442.88 | 1,145.78 | 2,917.29 | ||
| 059 | Independent Health | 0.00 | 347.71 | 115.59 | 491.12 | 154.12 | 585.28 | 96.33 | 444.04 | 347.71 | 347.71 | 963.27 | 2,354.11 | ||
| 058 | MVP Health Care (Rochester) | 0.00 | 304.61 | 112.33 | 441.31 | 149.77 | 527.49 | 93.60 | 398.21 | 304.61 | 304.61 | 936.05 | 2,154.50 | ||
| 060 | MVP Health Care (East) | 0.00 | 324.11 | 119.31 | 469.35 | 159.09 | 560.99 | 99.43 | 423.54 | 324.11 | 324.11 | 994.29 | 2,290.73 | ||
| 330 | MVP Health Care (Central) | 62.88 | 368.71 | 190.18 | 533.05 | 232.61 | 636.99 | 168.96 | 481.08 | 368.71 | 368.71 | 1,123.71 | 2,598.54 | ||
| 340 | MVP Health Care (Mid-Hudson) | 80.07 | 372.55 | 205.80 | 537.69 | 247.71 | 642.41 | 184.84 | 485.33 | 372.55 | 372.55 | 1,127.83 | 2,618.03 | ||
| 360 | MVP Health Care (North) | 32.97 | 355.24 | 159.34 | 513.99 | 201.46 | 614.27 | 138.27 | 463.85 | 355.24 | 355.24 | 1,086.06 | 2,507.02 | ||
*Enrollees covered under Preferred List provisions pay the same rates as enrollees who retired on or after 1/1/12.