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The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. Empire Plan benefits include inpatient and outpatient hospital coverage, medical/surgical coverage, Centers of Excellence for transplants, infertility and cancer, home care services, equipment and supplies, mental health and substance abuse coverage and prescription drug coverage.

2018 Participating Agency Empire Plan Cost Estimate Calculator

Rate Per Coverage Type
2018 Monthly Rate
Enter the Total Number of Individual Enrollees in Each Coverage Type
Total
Individual Coverage $1014.98 = $
Family Coverage
(Individuals & Dependents)
$2348.15 = $
Medicare-primary - Individual $444.39 = $
Medicare-primary - Family
(with one Medicare)
$1777.54 = $
Medicare-primary - Family
(with two Medicare)
$1206.95 = $
Total Number of Individual Enrollees: Total Monthly Premium:
$

Other Monthly Charges

Administrative Charge
Per Enrollee
$2.493 x Total Enrollees as Reported Above = $
Medicare Reimbursement
(If Agency covers Medicare primary enrollees)
Note: this rate is based on the Base Medicare Reimbursement Rate.
$134.00 * x (Enter total # of Medicare Primary Enrollees and Dependents ) = $
Total Medicare Reimbursement
Total Monthly Cost to Agency: $
Total Annual Cost: $

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* Note: You may have enrollees subject to Income - Related Medicare Adjustment Amount (IRMMA). For more information, visit www.medicare.gov.