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NYSHIP 2024 Rates for Retirees, Vestees, Dependent Survivors and Enrollees covered under Preferred List Provisions of the State of New York and their Enrolled Dependents

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 2024 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 0.00 427.35 130.86 592.40 174.49 704.40 109.05 536.40 427.35 427.35 1,090.54 2,799.94
066 Blue Choice 0.00 298.57 98.26 420.72 131.02 501.25 81.89 380.46 298.57 298.57 818.86 2,013.14
063 Capital District Physicians' Health Plan (CDPHP) (Capital) 0.00 304.94 112.41 441.75 149.88 528.01 93.68 398.62 304.94 304.94 936.76 2,156.53
300 Capital District Physicians' Health Plan (CDPHP) (Central) 38.10 338.88 158.15 490.61 198.16 586.37 138.14 442.73 338.88 338.88 1,038.44 2,393.96
310 Capital District Physicians' Health Plan (CDPHP) (Hudson Valley) 197.09 552.27 317.29 704.96 357.36 810.00 297.26 652.44 393.35 393.35 1,198.71 2,772.11
050 EmblemHealth – HIP (Downstate) 166.58 622.67 301.73 794.27 346.77 912.20 279.20 735.29 455.71 455.71 1,292.73 3,115.56
220 EmblemHealth – HIP (Capital) 356.94 778.56 477.12 938.65 517.18 1,058.52 457.09 878.71 479.51 479.51 1,358.42 3,276.47
350 EmblemHealth – HIP (Hudson Valley) 357.12 1,022.19 469.99 1,166.14 507.61 1,265.88 451.18 1,116.25 457.48 457.48 1,297.64 3,127.58
067 Highmark Blue Cross Blue Shield of Western New York 0.00 323.42 106.42 455.72 141.89 542.93 88.68 412.10 323.42 323.42 886.84 2,180.53
069 Highmark Blue Shield of Northeastern New York 0.00 341.93 111.98 481.27 149.31 573.31 93.32 435.25 341.93 341.93 933.17 2,300.91
072 HMOBlue (Central New York Region) 0.00 343.27 115.14 485.87 153.52 579.17 95.95 439.22 343.27 343.27 959.50 2,332.58
160 HMOBlue (Utica Region) 0.00 386.56 120.50 537.99 160.67 640.01 100.42 486.98 386.56 386.56 1,004.18 2,550.43
059 Independent Health 0.00 325.30 108.33 459.65 144.44 547.81 90.27 415.57 325.30 325.30 902.74 2,203.93
058 MVP Health Care (Rochester) 0.00 282.70 104.50 409.82 139.34 489.89 87.09 369.79 282.70 282.70 870.86 2,001.67
060 MVP Health Care (East) 0.00 297.67 109.96 431.44 146.62 515.73 91.63 389.30 297.67 297.67 916.35 2,107.03
330 MVP Health Care (Central) 15.79 337.12 137.27 487.46 177.76 582.52 117.02 439.93 337.12 337.12 1,028.05 2,376.54
340 MVP Health Care (Mid-Hudson) 36.16 340.84 156.34 492.63 196.40 588.66 136.31 444.61 340.84 340.84 1,037.62 2,400.99
360 MVP Health Care (North) 0.00 326.68 120.14 472.96 160.19 565.28 100.12 426.80 326.68 326.68 1,001.16 2,307.89

*Enrollees covered under Preferred List provisions pay the same rates as enrollees who retired on or after 1/1/12.

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