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.
PA17-12
PAEX17-11
TO: Participating Agency Chief Executive Officers and Health Benefit Administrators
FROM: David J. Boland, Director of the Employee Benefits Division
SUBJECT: Empire Plan Quarterly Experience Report
DATE: August 23, 2017
Dear Chief Executive Officer:
Attached is the Empire Plan Second Quarter Experience Report for 2017. This report presents the projected 2017 Empire Plan experience, based on claims paid through June 30, 2017 and the projected 2018 premium rates.
For the 2017 plan year, the Empire Plan vendors project an aggregate gain of $104.8 million, or 1.26% of premium. Since the 2017 experience projections are based on six months of paid claim data, the projections are subject to change as actual claims materialize throughout the remainder of the plan year.
Exhibit II presents the projected 2018 Empire Plan premium rates. These projections include a tentative dividend application amount of $125 million, $25 million less than the dividend credit included in the 2017 rates. The "best estimate" projected net premium increase for 2018 is 9.6%, in aggregate, for The Empire Plan and 9.9%, in aggregate, for The Excelsior Plan. These projections are based on various assumptions made by the vendors which include a projected aggregate claims trend of approximately 8.8%. These assumptions are likely to change prior to the development of the final 2018 premium rates.
Given the ongoing fiscal challenges faced by the State and its localities, our continuing goal is to achieve 2018 NYSHIP rates that are as low as possible while promoting rate stability for the near future. The 2018 premium rate development and related proceedings will begin in September.