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.
DAVID A. PATERSON
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
NANCY G. GROENWEGEN
COMMISSIONER
PA09-26
TO: Participating Agency Health Benefit Administrators
FROM: Robert W. DuBois, Director of the Employee Benefits Division
SUBJECT: Empire Plan Quarterly Experience Report
DATE: September 15, 2009
Enclosed are the Second Quarter Empire Plan Experience Report for 2009 and the cover letter to the Chief Executive Officers. This report presents the projected 2009 Empire Plan experience and the projected 2010 premium rates.
September 15, 2009
Dear Chief Executive Officer:
Attached is the Empire Plan Second Quarter Experience Report for 2009. This report presents the projected 2009 Empire Plan experience, based on claims paid through June 30, 2009, and the projected 2010 premium rates.
The Empire Plan carriers project a net dividend of $76.3 million, 1.4% of premium. This report presents the basis for these projections and future reports will include revised projections based on additional claims experience.
The projected 2010 premium rates based on The Empire Plan carriers’ premium projections and a dividend application comparable to the amount loaded in the 2009 rates are presented in Exhibit II. This yields insurer driven “best estimate” net premium increases of 6.3% in aggregate for The Empire Plan and 5.9% in aggregate for The Excelsior Plan. The Department’s actuarial consultant, Buck Consultants, developed an independent premium projection using the same dividend application assumption. Buck projects 2010 premium increases of 4.5% and 4.3% for The Empire Plan and The Excelsior Plan, respectively.
Given the fiscal challenges currently faced by the State and its localities, our goal is to develop 2010 NYSHIP rates that are as low as possible without generating substantial rate “spikes” in subsequent years. We intend to aggressively negotiate for premium reductions with the insurers and will use both retrospective premium agreements with the carriers and application of dividend to the rates to accomplish this goal. Taking these factors into consideration, our best estimate of the projected net premium increases for 2010 are 3.5% for The Empire Plan and 3.3% for The Excelsior Plan. Please be assured that we will consider every possible option for achieving both low rates for 2010 and rate stability for the near future. We will share the final rates with you as soon as they are approved by the Division of the Budget.
I hope this report is informative. If you have any questions, comments or suggestions, please don’t hesitate to contact me.
Sincerely,
Robert W. DuBois, CEBS
Director
Employee Benefits Division
EMPIRE PLAN EXPERIENCE REPORT
SECOND QUARTER 2009
Produced for
PARTICIPATING AGENCIES IN THE
NEW YORK STATE
HEALTH INSURANCE PROGRAM
by
the Employee Benefits Division
New York State Department of Civil Service
Nancy G. Groenwegen
President, New York State Civil Service Commission
Exhibits
- Projected 2009 Empire Plan Experience
- Projected 2010 PA Premium Rates
- Empire Plan PA 5-Tier Group Rates (2001-2010)
- Empire Plan PA 2-Tier Group Rates (2001-2010)
PROJECTED 2009 EMPIRE PLAN EXPERIENCE
The Empire Plan carriers project that the 2009 premiums, which included no margin, will generate a composite dividend of $76.3 million (1.4% of premium). The 2009 annual experience projected by the insurance carriers is reported in Exhibit I.
This projection is based on only six months of 2009 paid claim data. The following chart presents the percentage of the projected incurred claims actually paid as well as the current 2009 trend as compared to the trend assumed during the 2009 premium rate development:
| % of Paid Claims to Projected Incurred Claims | Projected 2009 Trend | |||
| 2008 | 2009 | @ Final Renewal | @ 2nd Quarter | |
|---|---|---|---|---|
| Blue Cross Hospital | 98.8% | 38.5% | 11.5% | 11.6% |
| UHC Medical | 99.4% | 40.3% | 7.5% | 6.5% |
| MHSA | 98.0% | 32.4% | 9.2% | 13.6% |
| UHC Rx | 99.9% | 47.4% | 9.0% | 6.6% |
T he 2009 projected dividend for each carrier as compared to the margin level used in the 2009 premium development is as follows:
| Margin | 2009 Projected Dividend/(Loss) | Increase/(Decrease) over margin | |
|---|---|---|---|
| Blue Cross Hospital | $0 | $22,403,000 | $22,403,000 |
| UHC Medical | $0 | $3,552,000 | $3,552,000 |
| UHC MHSA | $0 | ($9,626,000) | ($9,626,000) |
| UHC Rx | $0 | $59,943,000 | $59,943,000 |
| Total | $0 | $76,272,000 | $76,272,000 |
The increase in the dividend projection is primarily attributable to the decrease in the 2008 claims base for the hospital program projected during the development of the 2008 rates and an improvement in 2009 trend equivalent to $46 million for the medical and prescription drug programs. In addition, an increase in the pharma revenue is projected to be offset by an increase in retention and assessments among all the carriers. The latter is primarily due to increases in projected assessments (NYS Insurance Department Assessment, Bad Debt and Charity Surcharge and Covered Lives Assessment) made through legislation. The projected loss for the Mental Health and Substance Abuse Program is primarily the result of a continued shift observed since the implementation of Timothy’s Law in 2007 in utilization to higher cost non-participating providers.
Historically, experience projections made by the insurance carriers in the 2nd Quarter Experience Reports have been conservative compared to the actual experience and to the second quarter experience projections made by our benefit consultant, Buck Consultants (Buck). Buck currently projects a 2009 dividend of $122.2 million. Based on past performance, our opinion, at this time, is that the actual 2009 dividend will more closely resemble the Buck dividend projection.
2010 PROJECTED PREMIUM RATES
The Department will negotiate aggressively with the Empire Plan carriers to achieve reductions in the premium levels projected in the narrative below and the attached exhibits. Additionally we will continue to use retrospective agreements with the carriers and the application of dividend to lower the Plan’s net premiums. In an effort to provide maximum, immediate relief to NYSHIP Participating Agencies, our goal is to achieve the lowest rates possible for 2010 while maintaining rate stability for the coming years. Taking all of these rate factors into account, the Department’s best estimate for the projected net premium increases for 2010 are 3.5% and 3.3% for The Empire Plan and The Excelsior Plan, respectively.
Exhibit II presents the projected 2010 Empire Plan gross and net premium rates, as projected by the insurance carriers, assuming the application of $400.0 million in dividend to all payors. In aggregate, The Empire Plan gross premium is projected to increase 8.3% while the net premium is projected to increase 6.3%. In aggregate, The Excelsior Plan gross premium is projected to increase 8.0% while the net premium is projected to increase 5.9%. Exhibit II also includes a range of gross and net premium rates projected by the carriers (2.1% - 10.5% net increase for the Empire Plan).
Exhibit III presents The Empire Plan individual and family 5-tier billing rate history since 2001. Exhibit IV presents, for illustrative purposes only, the 2-tier rate history from 2001 to 2010.
As noted above, the 2010 premium projections in Exhibit II are based on The Empire Plan insurance carriers’ 2009 second quarter reports reflecting only six months of 2009 paid claim activity. Historically, premium projections made at this time of the year have been conservative. Over the past five years, the actual premium rates negotiated with the carriers in October for the following plan year have been slightly greater than the 2nd quarter optimistic rate projections.
The Department receives quarterly premium rate projections from Buck Consultants. Buck projects an aggregate 2010 premium increase of 4.5% with the application of $400 million in dividend. This level of projected increase is between the carriers’ optimistic and best estimate projections at this time. While each agency should assess its budgetary environment in using the projected information contained in this report, we believe the actual increases will more closely match the Buck projections.
The current assumed dividend application of $400 million is reflective of a strategy to promote rate stability over a number of years while also providing a greater level of fiscal relief to State and Local governments from the level provided in prior 2010 rate projections. However, the actual amount of dividend to be applied as a credit in the 2010 premium rates will be determined in October 2009 based on a number of factors including, but not limited to, the following:
- The final results of premium negotiations with the carriers.
- The impact on the stability of premium over time (2010 – 2014)
- The status of the economy, as well as the State and Local Government fiscal climate.
We will work together with the Division of the Budget to ensure that NYSHIP rates for local governments are kept as low as fiscally prudent.
Exhibit I
2009 PROJECTED EMPIRE PLAN EXPERIENCE
In (000's)
| BLUE CROSS HOSPITAL | UNITED HEALTHCARE MEDICAL Core | UNITED HEALTHCARE MEDICAL NY Enhancement | UNITED HEALTHCARE MEDICAL PA Enhancement | UNITED HEALTHCARE MEDICAL Combined | UHC MHSA Core | UHC MHSA NY Enhancement | UHC MHSA PA Enhancement | UHC MHSA Combined | UHC DRUG | TOTAL | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| (A) Premium (1) | 1,891,016 | 1,679,890 | 239,211 | 228,417 | 2,147,518 | 111,765 | 4,792 | 4,062 | 120,619 | 1,485,388 | 5,644,541 |
| (B) Incurred Claims (2) | 1,732,318 | 1,521,984 | 212,493 | 202,971 | 1,937,448 | 100,828 | 5,531 | 5,426 | 111,785 | 1,343,129 | 5,124,680 |
| (C) Administrative Expense (3) | 136,295 | 170,424 | 18,452 | 17,642 | 206,518 | 17,106 | 733 | 621 | 18,460 | 82,316 | 443,589 |
| (D) Gain/(Loss) (A-B-C) | 22,403 | (12,518) | 8,266 | 7,804 | 3,552 | (6,169) | (1,472) | (1,985) | (9,626) | 59,943 | 76,272 |
(1) Earned Premium - Premium which pays for coverage for the period reported (accrual basis).
(2) Incurred Claims - Represents the cost of covered services provided during the period reported by the insurance company (accrual basis).
(3) Administrative Expenses - All charges by the insurance carrier other than for the payment of claims. Includes carrier’s cost to administer the program, interest charges, and other retention.
Source: Carrier 2009 2nd Quarter Experience Reports
Exhibit II
Participating Agency Premium Rates
Comparison of 2009 and Projected 2010 Rates
EMPIRE PLAN
Plan Prime: Individual Coverage
| Gross Rates (1) 2009 | Gross Rates (1) 2010 (3) | Gross Rates (1) % Change | Net Rates (2) 2009 | Net Rates (2) 2010 (3) | Net Rates (2) % Change | |
|---|---|---|---|---|---|---|
| Carrier Projections: Optimistic | 630.73 | 657.80 | 4.3% | 598.58 | 610.90 | 2.1% |
| Carrier Projections: Best estimate | 630.73 | 682.18 | 8.2% | 598.58 | 635.28 | 6.1% |
| Carrier Projections: Pessimistic | 630.73 | 706.80 | 12.1% | 598.58 | 659.90 | 10.2% |
| Buck Consultants | 630.73 | 670.61 | 6.3% | 598.58 | 623.71 | 4.2% |
Plan Prime: Family Coverage
| Gross Rates (1) 2008 | Gross Rates (1) 2009 (3) | Gross Rates (1) % Change | Net Rates (2) 2008 | Net Rates (2) 2009 (3) | Net Rates (2) % Change | |
|---|---|---|---|---|---|---|
| Carrier Projections: Optimistic | 1,350.26 | 1,409.94 | 4.4% | 1,282.17 | 1,311.47 | 2.3% |
| Carrier Projections: Best estimate | 1,350.26 | 1,461.51 | 8.2% | 1,282.17 | 1,363.04 | 6.3% |
| Carrier Projections: Pessimistic | 1,350.26 | 1,513.57 | 12.1% | 1,282.17 | 1,415.10 | 10.4% |
| Buck Consultants | 1,350.26 | 1,436.07 | 6.4% | 1,282.17 | 1,337.60 | 4.3% |
MedPrime: Individual Coverage
| Gross Rates (1) 2008 | Gross Rates (1) 2009 (3) | Gross Rates (1) % Change | Net Rates (2) 2008 | Net Rates (2) 2009 (3) | Net Rates (2) % Change | |
|---|---|---|---|---|---|---|
| Carrier Projections: Optimistic | 384.38 | 396.40 | 3.1% | 359.22 | 362.57 | 0.9% |
| Carrier Projections: Best estimate | 384.38 | 414.61 | 7.9% | 359.22 | 380.78 | 6.0% |
| Carrier Projections: Pessimistic | 384.38 | 432.88 | 12.6% | 359.22 | 399.05 | 11.1% |
| Buck Consultants | 384.38 | 412.29 | 7.3% | 359.22 | 378.46 | 5.4% |
MedPrime: Family Coverage - 1
| Gross Rates (1) 2008 | Gross Rates (1) 2009 (3) | Gross Rates (1) % Change | Net Rates (2) 2008 | Net Rates (2) 2009 (3) | Net Rates (2) % Change | |
|---|---|---|---|---|---|---|
| Carrier Projections: Optimistic | 1,103.90 | 1,148.53 | 4.0% | 1,042.81 | 1,063.13 | 1.9% |
| Carrier Projections: Best estimate | 1,103.90 | 1,193.93 | 8.2% | 1,042.81 | 1,108.53 | 6.3% |
| Carrier Projections: Pessimistic | 1,103.90 | 1,239.67 | 12.3% | 1,042.81 | 1,154.27 | 10.7% |
| Buck Consultants | 1,103.90 | 1,177.72 | 6.7% | 1,042.81 | 1,092.32 | 4.7% |
MedPrime: Family Coverage - 2(+)
| Gross Rates (1) 2008 | Gross Rates (1) 2009 (3) | Gross Rates (1) % Change | Net Rates (2) 2008 | Net Rates (2) 2009 (3) | Net Rates (2) % Change | |
|---|---|---|---|---|---|---|
| Carrier Projections: Optimistic | 857.54 | 887.09 | 3.4% | 803.45 | 814.72 | 1.4% |
| Carrier Projections: Best estimate | 857.54 | 926.35 | 8.0% | 803.45 | 853.98 | 6.3% |
| Carrier Projections: Pessimistic | 857.54 | 965.77 | 12.6% | 803.45 | 893.40 | 11.2% |
| Buck Consultants | 857.54 | 919.40 | 7.2% | 803.45 | 847.03 | 5.4% |
(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating agency.
(3) Projected Rates
Note: Projected rates presented above reflect the carrier and Buck Consultant estimates. The Department is projecting a 3.5% aggregate net premium increase for 2010.
EXCELSIOR PLAN
Plan Prime: Individual Coverage
| Gross Rates (1) 2009 | Gross Rates (1) 2010 (3) | Gross Rates (1) % Change | Net Rates (2) 2009 | Net Rates (2) 2010 (3) | Net Rates (2) % Change | |
|---|---|---|---|---|---|---|
| Carrier Projections: Optimistic | 557.49 | 581.24 | 4.3% | 529.17 | 539.44 | 1.9% |
| Carrier Projections: Best estimate | 557.49 | 601.93 | 8.0% | 529.17 | 560.13 | 5.9% |
| Carrier Projections: Pessimistic | 557.49 | 622.82 | 11.7% | 529.17 | 581.02 | 9.8% |
| Buck Consultants | 557.49 | 591.93 | 6.2% | 529.17 | 550.13 | 4.0% |
Plan Prime: Family Coverage
| Gross Rates (1) 2008 | Gross Rates (1) 2009 (3) | Gross Rates (1) % Change | Net Rates (2) 2008 | Net Rates (2) 2009 (3) | Net Rates (2) % Change | |
|---|---|---|---|---|---|---|
| Carrier Projections: Optimistic | 1,197.21 | 1,249.58 | 4.4% | 1,137.16 | 1,161.78 | 2.2% |
| Carrier Projections: Best estimate | 1,197.21 | 1,293.44 | 8.0% | 1,205.64 | 1,231.01 | 6.0% |
| Carrier Projections: Pessimistic | 1,197.21 | 1,337.77 | 11.7% | 1,137.16 | 1,249.97 | 9.9% |
| Buck Consultants | 1,197.21 | 1,271.47 | 6.2% | 1,137.16 | 1,183.67 | 4.1% |
MedPrime: Individual Coverage
| Gross Rates (1) 2008 | Gross Rates (1) 2009 (3) | Gross Rates (1) % Change | Net Rates (2) 2008 | Net Rates (2) 2009 (3) | Net Rates (2) % Change | |
|---|---|---|---|---|---|---|
| Carrier Projections: Optimistic | 320.35 | 329.39 | 2.8% | 296.43 | 297.62 | 0.4% |
| Carrier Projections: Best estimate | 320.35 | 344.16 | 7.4% | 296.43 | 312.39 | 5.4% |
| Carrier Projections: Pessimistic | 320.35 | 358.98 | 12.1% | 296.43 | 327.21 | 10.4% |
| Buck Consultants | 320.35 | 343.26 | 7.2% | 296.43 | 311.49 | 5.1% |
MedPrime: Family Coverage - 1
| Gross Rates (1) 2008 | Gross Rates (1) 2009 (3) | Gross Rates (1) % Change | Net Rates (2) 2008 | Net Rates (2) 2009 (3) | Net Rates (2) % Change | |
|---|---|---|---|---|---|---|
| Carrier Projections: Optimistic | 960.08 | 997.71 | 3.9% | 904.43 | 919.94 | 1.7% |
| Carrier Projections: Best estimate | 960.08 | 1,035.66 | 7.9% | 904.43 | 957.89 | 5.9% |
| Carrier Projections: Pessimistic | 960.08 | 1,073.93 | 11.9% | 904.43 | 996.16 | 10.1% |
| Buck Consultants | 960.08 | 1,022.78 | 6.5% | 904.43 | 945.01 | 4.5% |
MedPrime: Family Coverage - 2
| Gross Rates (1) 2008 | Gross Rates (1) 2009 (3) | Gross Rates (1) % Change | Net Rates (2) 2008 | Net Rates (2) 2009 (3) | Net Rates (2) % Change | |
|---|---|---|---|---|---|---|
| Carrier Projections: Optimistic | 722.95 | 745.83 | 3.2% | 671.71 | 678.09 | 0.9% |
| Carrier Projections: Best estimate | 722.95 | 777.89 | 7.6% | 671.71 | 710.15 | 5.7% |
| Carrier Projections: Pessimistic | 722.95 | 810.09 | 12.1% | 671.71 | 742.35 | 10.5% |
| Buck Consultants | 722.95 | 774.09 | 7.1% | 671.71 | 706.35 | 5.2% |
(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating agency.
(3) Projected Rates
Note: Projected rates presented above reflect the carrier and Buck Consultant estimates. The Department is projecting a 3.5% aggregate net premium increase for 2010.
Exhibit III
EMPIRE PLAN
PA 5 TIER GROUP RATES
2001-2010 Monthly Rates
Individual Planprime
| Year | Gross Rate (1) | % Change | Net Rate (2) | % Change |
|---|---|---|---|---|
| 2001 | 325.23 | 10.3% | 314.26 | 9.7% |
| 2002 | 353.81 | 8.8% | 344.66 | 9.7% |
| 2003 | 400.00 | 13.1% | 384.89 | 11.7% |
| 2004 | 448.00 | 12.0% | 438.15 | 13.8% |
| 2005 | 490.41 | 9.5% | 478.49 | 9.2% |
| 2006 | 547.86 | 11.7% | 529.76 | 10.7% |
| 2007 | 600.69 | 9.6% | 564.84 | 6.6% |
| 2008 | 633.79 | 5.5% | 592.38 | 4.9% |
| 2009 | 630.73 | -0.5% | 598.58 | 1.0% |
| 2010 projected* | 682.18 | 8.2% | 635.28 | 6.1% |
Average Percent Increase
| Gross Rate % Change | Net Rate % Change | |
|---|---|---|
| From Inception of 5 Tier Structure (1996) | 8.1% | 8.3% |
| Most Recent 10 Years | 8.8% | 8.3% |
| Most Recent 5 Years | 6.9% | 5.9% |
Family Planprime
| Year | Gross Rate (1) | % Change | Net Rate (2) | % Change |
|---|---|---|---|---|
| 2001 | 673.67 | 10.9% | 651.09 | 10.3% |
| 2002 | 742.98 | 10.3% | 723.97 | 11.2% |
| 2003 | 842.38 | 10.4% | 811.41 | 12.1% |
| 2004 | 945.29 | 12.2% | 924.74 | 14.0% |
| 2005 | 1,038.64 | 9.9% | 1,013.68 | 9.6% |
| 2006 | 1,164.16 | 12.1% | 1,126.19 | 11.1% |
| 2007 | 1,273.96 | 9.4% | 1,198.07 | 6.4% |
| 2008 | 1,346.27 | 5.7% | 1,258.78 | 5.1% |
| 2009 | 1,350.26 | 0.3% | 1,282.17 | 1.9% |
| 2010 projected* | 1,461.51 | 8.2% | 1,363.04 | 6.3% |
Average Percent Increase
| Gross Rate % Change | Net Rate % Change | |
|---|---|---|
| From Inception of 5 Tier Structure (1996) | 7.7% | 7.9% |
| Most Recent 10 Years | 9.2% | 8.8% |
| Most Recent 5 Years | 7.1% | 6.1% |
Individual Medprime
| Year | Gross Rate (1) | % Change | Net Rate (2) | % Change |
|---|---|---|---|---|
| 2001 | 245.64 | 12.7% | 239.94 | 12.0% |
| 2002 | 259.96 | 5.8% | 253.82 | 5.8% |
| 2003 | 307.02 | 18.1% | 297.50 | 17.2% |
| 2004 | 341.87 | 11.4% | 334.22 | 12.3% |
| 2005 | 340.50 | -0.4% | 331.93 | -0.7% |
| 2006 | 359.35 | 5.5% | 338.88 | 2.1% |
| 2007 | 363.02 | 1.0% | 333.18 | -1.7% |
| 2008 | 397.23 | 9.4% | 360.41 | 8.2% |
| 2009 | 384.38 | -3.2% | 359.22 | -0.3% |
| 2010 projected* | 414.61 | 7.9% | 380.78 | 6.0% |
Average Percent Increase
| Gross Rate % Change | Net Rate % Change | |
|---|---|---|
| From Inception of 5 Tier Structure (1996) | 5.1% | 5.5% |
| Most Recent 10 Years | 6.8% | 6.1% |
| Most Recent 5 Years | 4.1% | 2.9% |
Family - 1 Medprime
| Year | Gross Rate (1) | % Change | Net Rate (2) | % Change |
|---|---|---|---|---|
| 2001 | 595.25 | 12.1% | 577.95 | 11.5% |
| 2002 | 649.14 | 9.1% | 633.13 | 9.5% |
| 2003 | 749.40 | 15.4% | 724.05 | 14.4% |
| 2004 | 839.18 | 12.0% | 820.82 | 13.4% |
| 2005 | 888.71 | 5.9% | 867.09 | 5.6% |
| 2006 | 975.66 | 9.8% | 935.32 | 7.9% |
| 2007 | 1,036.30 | 6.2% | 966.44 | 3.3% |
| 2008 | 1,109.74 | 7.1% | 1,026.86 | 6.3% |
| 2009 | 1,103.90 | -0.5% | 1,042.81 | 1.6% |
| 2010 projected* | 1,193.93 | 8.2% | 1,108.53 | 6.3% |
Average Percent Increase
| Gross Rate % Change | Net Rate % Change | |
|---|---|---|
| From Inception of 5 Tier Structure (1996) | 6.3% | 6.6% |
| Most Recent 10 Years | 8.5% | 8.0% |
| Most Recent 5 Years | 6.1% | 5.1% |
Family - 2 or More Medprime
| Year | Gross Rate (1) | % Change | Net Rate (2) | % Change |
|---|---|---|---|---|
| 2001 | 514.40 | 13.5% | 502.37 | 12.8% |
| 2002 | 555.29 | 7.9% | 542.29 | 7.9% |
| 2003 | 656.42 | 18.2% | 636.67 | 17.4% |
| 2004 | 733.05 | 11.7% | 716.88 | 12.6% |
| 2005 | 738.79 | 0.8% | 720.53 | 0.5% |
| 2006 | 787.16 | 6.5% | 744.45 | 3.3% |
| 2007 | 798.65 | 1.5% | 734.81 | -1.3% |
| 2008 | 873.21 | 9.3% | 794.94 | 8.2% |
| 2009 | 857.54 | -1.8% | 803.45 | 1.1% |
| 2010 projected* | 926.35 | 8.0% | 853.98 | 6.3% |
Average Percent Increase
| Gross Rate % Change | Net Rate % Change | |
|---|---|---|
| From Inception of 5 Tier Structure (1996) | 5.0% | 5.4% |
| Most Recent 10 Years | 7.6% | 6.9% |
| Most Recent 5 Years | 4.7% | 3.5% |
* Projected 2010 rates based on Carrier 2nd Quarter Best Estimates. The Department is projecting a 3.5% aggregate net premium increase:
(1) Premiums paid to the carriers.
(2) Cost to a PA.
(3) Inception of Medprime Rate structure.
EMPIRE PLAN
PA 2 TIER GROUP RATES
2001-2010 Monthly Rates
(For Illustrative Purposes Only)
Individual
| Year | Gross Rate (1) | % Change | Net Rate (2) | % Change |
|---|---|---|---|---|
| 2001 | 289.41 | 11.0% | 280.25 | 10.3% |
| 2002 | 313.58 | 8.4% | 305.67 | 9.1% |
| 2003 | 357.44 | 14.0% | 345.36 | 13.0% |
| 2004 | 402.70 | 12.7% | 394.31 | 14.2% |
| 2005 | 433.70 | 7.7% | 423.31 | 7.4% |
| 2006 | 477.33 | 10.1% | 459.25 | 8.5% |
| 2007 | 511.23 | 7.1% | 477.96 | 4.1% |
| 2008 | 536.84 | 5.0% | 498.88 | 4.4% |
| 2009 | 527.09 | -1.8% | 497.91 | -0.2% |
| 2010 projected* | 580.03 | 10.0% | 538.42 | 8.1% |
Average Percent Increase
| Gross Rate % Change | Net Rate % Change | |
|---|---|---|
| From Inception (1986) | 7.8% | 7.6% |
| Most Recent 10 Years | 8.4% | 7.9% |
| Most Recent 5 Years | 6.1% | 5.0% |
Family
| Year | Gross Rate (1) | % Change | Net Rate (2) | % Change |
|---|---|---|---|---|
| 2001 | 640.64 | 10.8% | 619.28 | 10.0% |
| 2002 | 703.61 | 9.8% | 685.83 | 10.7% |
| 2003 | 805.64 | 14.5% | 778.82 | 13.6% |
| 2004 | 899.98 | 11.7% | 881.48 | 13.2% |
| 2005 | 968.40 | 7.6% | 945.11 | 7.2% |
| 2006 | 1,073.28 | 10.8% | 1,034.40 | 9.4% |
| 2007 | 1,158.16 | 7.9% | 1,084.90 | 4.9% |
| 2008 | 1,233.38 | 6.5% | 1,150.41 | 6.0% |
| 2009 | 1,230.02 | -0.3% | 1,165.24 | 1.3% |
| 2010 projected* | 1,324.85 | 7.7% | 1,232.08 | 5.7% |
Average Percent Increase
| Gross Rate % Change | Net Rate % Change | |
|---|---|---|
| From Inception (1986) | 8.2% | 8.0% |
| Most Recent 10 Years | 8.7% | 8.2% |
| Most Recent 5 Years | 6.5% | 5.5% |
* Projected 2010 rates are based on Carrier 2nd Quarter Best Estimated projections. The Department is projecting a 3.5% aggregate net premium increase for 2010.
(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating agency.
Second Quarter – 2009
Dependent Eligibility Audit Update
As indicated in the previous report, the 60-day amnesty period, during which enrollees were able to remove ineligible dependents without penalty, ended on June 12 and these dependents were voluntarily removed from coverage effective July 1. To ensure that all forms postmarked by June 12th were recognized, Budco processed Special Amnesty Forms received through June 23, 2009; any forms received after that date were not processed and the dependent will not be removed, but will be included in the Dependent Eligibility Verification Period.
The Dependent Eligibility Verification Period began August 28th and will continue for 90 days to November 25, 2009. During this period, enrollees will be required to submit documentation of each dependent’s eligibility for coverage. Please encourage your enrollees with family coverage to comply with the verification requirements. Failure to provide acceptable documentation by the due date will result in the removal of any unverified dependent from the enrollment file effective February 1, 2009 and enrollees will be responsible for claim payments made on behalf of ineligible dependents back to that date. The State will be offering COBRA coverage to those dependents of State enrollees removed. Please refer to PA Memo 09-24, dated August 14, 2009, which provides a detailed update on this project and includes copies of correspondence sent/to be sent to enrollees.
The Employee Benefits Division will continue to keep you informed of the status of this important project.
New Laws Regarding Continuation of Coverage and Unmarried Children Through Age 29
Legislation has recently been passed and signed by the Governor which amends the State Insurance Law relative to the following:
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Continuation of Coverage - Extends the benefit period from 18 months to 36 months for all individuals eligible for COBRA coverage.
The Employee Benefits Division implemented this effective July 1, 2009.
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Young Adult Coverage - Expands access to health insurance coverage for unmarried children through age 29, regardless of financial dependence on their parents. These children will be eligible for coverage that is identical to the coverage provided to the parent by a group health insurance policy.
It is expected that this new provision will be administered in a COBRA-like manner, with the child enrolled as an individual and responsible for the full premium. This change must be implemented no later than January 1, 2010.
You can find general information about these two changes on the NYS Insurance Department website at: www.ins.state.ny.us/hottopic.htm. Also, these topics will be covered at the upcoming PA Regional Meetings.
Legislation Regarding Health Benefits for Volunteer Firefighters and EMTs
As indicated in the previous report, legislation was passed in 2008 to allow emergency services volunteers to participate in public employee health insurance plans. There is no change in the status of this legislation. It does not currently apply to NYSHIP since it did not include an amendment to Civil Service Law with regard to eligibility of volunteers. This could be changed by a future amendment. We will keep you informed of any new developments on this issue.
Medicare Part D Employer Subsidy Update
To date, NYSHIP applied for and received estimated Employer Subsidies through the second quarter of 2009 (through June 2009); the latest subsidy was recently received and was applied to the bill issued the first week of September for October 2009 coverage. The Department will continue to credit PA bills as the employer subsidies are received.
PA Regional Meetings - Fall 2009
The PA Regional Meeting announcement was issued as PA Memo 09-23, dated August 27th. They are scheduled as follows:
October 14 Saratoga
October 21 Rockland County
October 22 Long Island
The meeting details are included in the announcement and you may begin registering online on September 1. We hope a representative from your agency will be able to attend, as we have many important topics to discuss.
Fall 2009 Health Fairs - New Procedure
If you are planning a health fair for this fall and would like a NYSHIP representative to attend, please complete the Employee Information Day/Health Fair Planning Information Form, which can be accessed on HBA Online. To access the form log into HBA Online and click on the following:
Publications and Forms > Employees of Participating Agencies > Employee Information Day/Health Fair Planning Information Form > Choose this Format
Since we receive so many requests, we will do our best to accommodate your agency. Please note that a submitted form is not a guarantee that a NYSHIP representative will be available to attend your event.
Prompt Payment of NYSHIP Premium
As indicated in previous reports, the Employee Benefits Division has been aggressively monitoring agencies that fail to submit premium payments in a timely manner. This procedure includes suspension of claims for enrollees of any agency that falls three months behind in their premiums. To avoid disruption of your employees’ benefits, please be sure to submit your premium payments by the due date, as we must submit premium to the Empire Plan insurers on time. You may wish to consider submitting your payments electronically to promote timely payments. Attached are guidelines to initiate electronic transfer of funds.
GASB 45 Census Reports
As indicated in previous reports, NYSHIP will provide agency census reports upon request for use in complying with the provisions of GASB 45. Since the data included in these reports will be current at the time they are provided, it is important that your agency NYBEAS file is up-to-date, including correctly identifying and coding retirees before requesting census reports. To request a copy of your agency’s census information, please send an e-mail to: Kevin.Hill@cs.state.ny.us and include your name, agency name & code number, mailing address, phone number and e-mail address. For additional information about GASB 45, please refer to PA Memos 06-11 and 06-18.
Transmission of Reports Electronically
Many Participating Agencies have requested to receive the Empire Plan Experience Reports via e-mail. Beginning with this report, we are now offering all agencies the opportunity to have an easy access electronically through the following direct link to our website: http://cs.ny.gov/employee-benefits/pa-market/financial-reports.cfm
CEO & HBA Name and Address Changes
Please be sure to notify EBD of any changes in the names and/or addresses (including E-mail address) of your agency’s CEO or HBA, so that we may keep our mailing lists up-to-date. This updated information should be sent to:
Debbie D’Orazio
NYS Department of Civil Service
Employee Benefits Division
Alfred E. Smith State Office Building
Albany, NY 12239
or E-mail: Deborah.Dorazio@cs.state.ny.us