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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.

State Seal

ANDREW M. CUOMO
GOVERNOR

STATE OF NEW YORK
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov

PA11-17
PAEX11-15

TO: Participating Agency Health Benefit Administrators
FROM: Robert W. DuBois, Director of the Employee Benefits Division
SUBJECT: Empire Plan Quarterly Experience Report
DATE: September 14, 2011

Enclosed are the Second Quarter Empire Plan Experience Report for 2011 and the cover letter to the Chief Executive Officers. This report presents the projected 2011 Empire Plan experience and the projected 2012 premium rates.

 


September 14, 2011

Dear Chief Executive Officer:

Attached is the Empire Plan Second Quarter Experience Report for 2011. This report presents the projected 2011 Empire Plan experience, based on claims paid through June 30, 2011, and the projected 2012 premium rates.

For the 2011 Plan Year, the Empire Plan carriers project a net surplus of $65.7 million, 1.0% of premium. This report presents the basis for these projections and future reports will include a revised projection based on additional claims experience.

In Exhibit II, you will find the 2012 premium rates projected by both the Department and the Empire Plan carriers. These projections include a tentative dividend application amount of $177 million, $193 million less than the amount loaded in the 2011 rates, as well as a tentative $48.6 million credit for monies received from the Early Retirement Reinsurance Program (ERRP). ERRP was established by the Affordable Care Act and is a temporary Federal program which became effective June 1, 2010 and ends no later than January 1, 2014. ERRP provides reimbursement to employer and union sponsors of participating employment-based plans for a portion of the cost of health benefits for early retirees and their spouses, surviving spouses, and dependents. The Department filed an application for the ERRP subsidy on behalf of all NYSHIP participants. ERRP subsidies received by NYSHIP will be credited to all payors, as is done with earned dividends and earned interest.

The insurer driven "best estimate" projected net premium increases for 2012 are 13.6% in aggregate for The Empire Plan and 13.1% in aggregate for The Excelsior Plan. The Department' projects 2012 net premium increases of 10.1% and 9.8% for The Empire Plan and The Excelsior Plan, respectively, using the dividend and ERRP application assumptions presented above.

Given the fiscal challenges that the State and its localities continue to face, our goal is to develop 2012 NYSHIP rates that are as low as possible. The rate development and carrier negotiations will begin this month. We intend to aggressively negotiate each premium element and include both retrospective premium agreements with the carriers and the application of dividend and ERRP monies to the rates to accomplish this goal. However, it is important to recognize that given the application of substantial dividend amounts to the 2009, 2010 and 2011 rates coupled with the relatively low earned dividend for 2009 and 2010, the dividend available to apply to the 2012 premium rates is more limited. Therefore, the percentage increase in the 2012 net premium is expected to be modestly higher than the increases in recent Plan trend. Please be assured that we will consider every possible option for achieving as low a rate of increase as possible for 2012 while promoting rate stability for the near future.

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

Produced for

PARTICIPATING AGENCIES IN THE
NEW YORK STATE
HEALTH INSURANCE PROGRAM

by

the Employee Benefits Division
New York State Department of Civil Service

 

 

 

Exhibits

I. Projected 2011 Empire Plan Experience

II. Projected 2012 PA Premium Rates

III. Empire Plan PA 5-Tier Group Rates (2003-2012)

IV. Empire Plan PA 2-Tier Group Rates (2003-2012)

 

 

 


NEW YORK STATE HEALTH INSURANCE PROGRAM
PARTICIPATING AGENCY GROUP
EMPIRE PLAN EXPERIENCE REPORT
2nd QUARTER REPORT

PROJECTED 2011 EMPIRE PLAN EXPERIENCE

The Empire Plan carriers project that the 2011 premiums, which included no margin, will generate a composite surplus of $65.7 million (1.0% of premium). The 2011 annual experience projected by the insurance carriers is reported in Exhibit I.

This projection is based on six months of 2011 paid claim data. The following chart presents the percentage of the projected incurred claims actually paid as well as the most recent projected 2011 trend as compared to the trend assumed during the 2011 premium rate development:

 

 

% of Actual Paid Claims to Projected Incurred Claims

Projected 2011 Trend
  20102011@ Final Renewal@ 2011 2nd Quarter
Blue Cross Hospital 99.1% 37.7% 11.9% 11.5%
UHC Medical 99.7% 39.9% 8.7% 6.2%
UHC MHSA 98.0% 35.1% 8.0% 12.8%
UHC Rx 99.9% 46.7% 11.8% 10.6%

 

The 2011 projected dividend for each carrier as compared to the margin level used in the 2011 premium development is as follows:

 

  Margin2011 Projected
Dividend/(Loss)
Increase/(Decrease)
over Margin
Blue Cross Hospital $0 $15,530,000 $15,530,000
UHC Medical $0 $16,232,000 $16,232,000
UHC MHSA $0 ($11,284,000) ($11,284,000)
UHC Rx $0 $45,263,000 $45,263,000
Total $0 505.29 13.1% 405.64 490.34 20.9%
Family - 1 Medprime 1,311.39 1,474.75 12.5% 1,225.62 1,433.28 16.9%
Family - 2+ Medprime 1,024.28 1,157.51 13.0% 937.31 1,124.65 20.0%
Aggregate     12.3%     16.1%

(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating agency.
(3) Projected Rates

2012 Premium Projections

Excelsior Plan

Department Projections

Monthly Gross Premium Rates (1)
2011

Monthly Gross Premium Rates (1)
2012 (3)

Monthly Gross Premium Rates (1)
% Change

Monthly Net Premium Rates (2)
2011

Monthly Net Premium Rates (2)
2012 (3)

Monthly Net Premium Rates (2)
% Change

Individual Plan Prime 647.47 691.29 6.8% 613.90 671.90 9.4%
Family Plan Prime 1,417.28 1,514.82 6.9% 1,346.35 1,473.37 9.4%
Individual Medprime 381.00 397.15 4.2% 344.73 384.95 11.7%
Family - 1 Medprime 1,150.80 1,220.66 6.1% 1,077.16 1,186.40 10.1%
Family - 2+ Medprime 884.31 926.52 4.8% 807.97 899.48 11.3%
Aggregate     6.4%     9.8%

 

Carrier Optimistic Projections

Monthly Gross Premium Rates (1)
2011

Monthly Gross Premium Rates (1)
2012 (3)

Monthly Gross Premium Rates (1)
% Change

Monthly Net Premium Rates (2)
2011

Monthly Net Premium Rates (2)
2012 (3)

Monthly Net Premium Rates (2)
% Change

Individual Plan Prime 647.47 681.29 5.2% 613.90 661.90 7.8%
Family Plan Prime 1,417.28 1,492.80 5.3% 1,346.35 1,451.35 7.8%
Individual Medprime 381.00 391.35 2.7% 344.73 379.15 10.0%
Family - 1 Medprime 1,150.80 1,202.84 4.5% 1,077.16 1,168.58 8.5%
Family - 2+ Medprime 884.31 912.88 3.2% 807.97 885.84 9.6%
Aggregate     4.9%     8.1%

 

Carrier Best Estimate Projections

Monthly Gross Premium Rates (1)
2011

Monthly Gross Premium Rates (1)
2012 (3)

Monthly Gross Premium Rates (1)
% Change

Monthly Net Premium Rates (2)
2011

Monthly Net Premium Rates (2)
2012 (3)

Monthly Net Premium Rates (2)
% Change

Individual Plan Prime 647.47 708.70 9.5% 613.90 689.31 12.3%
Family Plan Prime 1,417.28 1,551.97 9.5% 1,346.35 1,510.52 12.2%
Individual Medprime 381.00 416.76 9.4% 344.73 404.56 17.4%
Family - 1 Medprime 1,150.80 1,260.01 9.5% 1,077.16 1,225.75 13.8%
Family - 2+ Medprime 884.31 968.07 9.5% 807.97 941.03 16.5%
Aggregate     9.5%     13.1%

 

Carrier Pessimistic Projections

Monthly Gross Premium Rates (1)
2011

Monthly Gross Premium Rates (1)
2012 (3)

Monthly Gross Premium Rates (1)
% Change

Monthly Net Premium Rates (2)
2011

Monthly Net Premium Rates (2)
2012 (3)

Monthly Net Premium Rates (2)
% Change

Individual Plan Prime 647.47 722.85 11.6% 613.90 703.46 14.6%
Family Plan Prime 1,417.28 1,582.87 11.7% 1,346.35 1,541.42 14.5%
Individual Medprime 381.00 426.25 11.9% 344.73 414.05 20.1%
Family - 1 Medprime 1,150.80 1,286.27 11.8% 1,077.16 1,252.01 16.2%
Family - 2+ Medprime 884.31 989.65 11.9% 807.97 962.61 19.1%
Aggregate     11.8%     15.5%

(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating agency.
(3) Projected Rates

 


Exhibit III

EMPIRE PLAN
PA 5 TIER GROUP RATES
2003-2012 Monthly Rates

Individual Planprime

YearGross Rate (1)% ChangeNet Rate (2)% Change
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 660.24 4.7% 612.34 2.3%
2011 734.00 11.2% 693.92 13.3%
2012 Department Projection 784.97 6.9% 761.42 9.7%

Average Percent Increase

 Gross Rate % ChangeNet Rate % Change
From Inception of 5 Tier Structure (1996) 8.0% 8.5%
Most Recent 10 Years 8.4% 8.3%
Most Recent 5 Years 5.6% 6.3%

Family Planprime

YearGross Rate (1)% ChangeNet Rate (2)% Change
2003 842.38 13.4% 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 1,431.43 6.0% 1,330.93 3.8%
2011 1,598.49 11.7% 1,513.92 13.7%
2012 Department Projection 1,711.40 7.1% 1,661.36 9.7%

Average Percent Increase

 Gross Rate % ChangeNet Rate % Change
From Inception of 5 Tier Structure (1996) 7.7% 8.2%
Most Recent 10 Years 8.8% 8.7%
Most Recent 5 Years 6.1% 6.8%

Individual Medprime

YearGross Rate (1)% ChangeNet Rate (2)% Change
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 400.76 4.3% 367.37 2.3%
2011 446.90 11.5% 405.64 10.4%
2012 Department Projection 470.01 5.2% 455.06 12.2%

Average Percent Increase

 Gross Rate % ChangeNet Rate % Change
From Inception of 5 Tier Structure (1996) 5.3% 5.9%
Most Recent 10 Years 6.3% 6.2%
Most Recent 5 Years 5.4% 6.5%

(1) Represents premiums paid to the carriers.
(2) Represents cost to a participating agency.
(3) Inception of Medprime Rate Structure.

Family - 1 Medprime

YearGross Rate (1)% ChangeNet Rate (2)% Change
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 1,171.95 6.2% 1,085.94 4.1%
2011 1,311.39 11.9% 1,225.62 12.9%
2012 Department Projection 1,396.47 6.5% 1,355.00 10.6%

Average Percent Increase

 Gross Rate % ChangeNet Rate % Change
From Inception of 5 Tier Structure (1996) 6.6% 7.1%
Most Recent 10 Years 8.0% 8.0%
Most Recent 5 Years 6.2% 7.1%

Family - 2 or More Medprime

YearGross Rate (1)% ChangeNet Rate (2)% Change
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 912.48 6.4% 840.98 4.7%
2011 1,024.28 12.3% 937.31 11.5%
2012 Department Projection 1,081.50 5.6% 1,048.64 11.9%

Average Percent Increase

 Gross Rate % ChangeNet Rate % Change
From Inception of 5 Tier Structure (1996) 5.4% 6.1%
Most Recent 10 Years 7.0% 7.0%
Most Recent 5 Years 6.4% 7.5%

(1) Represents premiums paid to the carriers.
(2) Represents cost to a participating agency.
(3) Inception of Medprime Rate Structure

 


Exhibit IV

EMPIRE PLAN
PA 2 TIER GROUP RATES
2003-2012 Monthly Rates
(For Illustrative Purposes Only)

Individual

YearGross Rate (1)% ChangeNet Rate (2)% Change
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 557.46 5.8% 515.75 3.6%
2011 621.78 11.5% 581.69 12.8%
2012 Department Projection 653.58 5.1% 631.78 8.6%

Average Percent Increase

 Gross Rate % ChangeNet Rate % Change
From Inception (1986) 7.6% 7.7%
Most Recent 10 Years 7.7% 7.6%
Most Recent 5 Years 5.1% 5.8%

Family

YearGross Rate (1)% ChangeNet Rate (2)% Change
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 1,297.06 5.5% 1,203.56 3.3%
2011 1,441.84 11.2% 1,353.97 12.5%
2012 Department Projection 1,546.04 7.2% 1,495.64 10.5%

Average Percent Increase

 Gross Rate % ChangeNet Rate % Change
From Inception (1986) 8.1% 8.2%
Most Recent 10 Years 8.3% 8.2%
Most Recent 5 Years 6.0% 8.5%

(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating agency.

 


NYSHIP News Information for local governments participating in NYSHIP

Second Quarter Report - 2011

Federal Health Care Reform

  • Early Retiree Reinsurance Program (ERRP): This temporary program, which will end January 1, 2014 or sooner if funding is exhausted, is intended to encourage employers to continue to provide coverage to retired employees who are not yet eligible for Medicare coverage by reimbursing 80% of the cost of claims greater than $15,000 and less than $90,000. On March 31, the Department filed its second claim for reimbursement under this program. The request was approved by HHS on April 21, and we received the $40.5 million payment, which was deposited into the Health Insurance Fund. The proceeds of the reinsurance program are being used in the same manner as plan dividend to help offset future premium increases for all plan participants. HHS recently changed the reporting requirement necessary to apply for reimbursement under the ERRP. We have been working with the NYSHIP insurance carriers to comply with the new requirements and expect to file two additional claims for reimbursement in the very near future.
  • W-2 Health Cost Reporting: The Patient Protection and Affordable Care Act (PPACA) amended the Internal Revenue Code (Code) to require employers to report the aggregate cost of employer-sponsored group health plan coverage on Form W-2 for taxable years beginning on or after January 1, 2011. The IRS has issued Notice 2011-28 [http://www.irs.gov/pub/irs-drop/n-11-28.pdf], which provides interim guidance for the reporting requirement. The Notice generally delays reporting of health costs on any W-2 Form until forms are generated for the 2012 tax year. Employers will not be required to report on those individuals whom there is no obligation to issue a W-2, such as retirees or COBRA enrollees. The Code requires the employer to determine the aggregate cost under rules similar to those for determining the applicable premium for COBRA continuation coverage. Additional information regarding this requirement can be found in IRS Notice 2010-26 [http://www.irs.gov/pub/irs-drop/n-2010-69.pdf].

Employee Benefits Division staff continues to review and monitor updates and clarifications related to Federal Healthcare Reform and its numerous provisions which NYSHIP will be required to implement in the future. We will continue to provide information as it becomes available.

2011 Regional Meetings for Participating Agencies

Registration for the 2011 Regional Meetings concluded on September 9. This year's meetings will cover a wide range of topics, including financial and program updates, legislative and policy updates, and an agency services update. The meetings also provide the opportunity for PAs to ask questions of both Department of Civil Service staff and NYSHIP insurance carrier representatives. We look forward to seeing you at this year's meetings!

Upcoming Events

Employee Benefits Division staff will be exhibiting on behalf of NYSHIP at the following annual events, and will be available to answer any questions you may have:

  • NYS Conference of Mayors (NYCOM) Fall Training School
    Saratoga Hilton
    September 19th - 22nd
  • NYS Association of Counties (NYSAC) Fall Seminar
    Crowne Plaza Lake Placid
    September 21st - 22nd
  • NYS Association of Municipal Purchasing Officials (SAMPO) Western Region Conference
    Niagara Falls Convention Center
    October 20th
  • NYS School Boards Association Annual Convention
    Buffalo-Niagara Conference Center
    October 28th - 29th

2011 Participating Agency Self-Audit

If your agency has not yet completed the 2011 Self-Audit it is very important that you complete it as soon as possible. The Self-Audit can be accessed at http://www.cs.state.ny.us/paaudit/index.cfm. If a PA does not complete the Self-Audit, the Employee Benefits Division may conduct an on-site audit of an agency's records.

NYSHIP Coverage for Volunteer Firefighters and Ambulance Workers

To date, 38 PAs have elected to extend coverage to qualified members of 177 volunteer fire and ambulance companies. For information on this coverage, refer to Memo PA10-29/PAEX10-25, issued September 1, 2010, which summarizes the provisions of Chapter 71 of the Laws of 2010 which amended Civil Service Law to extend NYSHIP eligibility to active members of volunteer fire and ambulance companies and to provide guidelines to PAs for administering this new legislation. As indicated in the memo, an agency is permitted, but not required, to provide coverage. PAs that elect to provide coverage are required to submit the form, Notice of Election to Extend NYSHIP Coverage to Volunteer Firefighters and/or Ambulance Workers, which was included with the PA Memo.

Agency Experience Reports

Agency specific Empire Plan and Excelsior Plan financial experience reports are available from the Employee Benefits Division upon request. These reports are calendar year based and provide aggregate data broken down by Plan component - hospital, medical/surgical, mental health/substance abuse and prescription drug. To obtain a financial experience report, PAs may submit an official written request on agency letterhead indicating the calendar years for which reports are desired. The request may be directed to the Employee Benefits Division - Director's Office.

In recent months, several requests have been received as FOIL requests - it is not necessary to obtain them through the FOIL process. They are available as described above.

GASB 45 Assumptions Report and Census Data

The 2011 Buck Consultants report Development of Recommended Actuarial Assumptions for New York State/SUNY GASB Valuation - Participating Agency Version is now available online at: http://www.cs.state.ny.us/gasb_pa/2011PAAssumptionsReport.pdf. 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 an agency's NYBEAS file is up-to-date, including correctly identifying and coding retirees before requesting census data. Requests for census data can be e-mailed to: Kevin.Hill@cs.state.ny.us. Please include your name, agency name, five digit agency code, phone number and e-mail address. For additional information about GASB 45, please refer to Memos PA06-11 and PA06-18.

Prompt Payment of NYSHIP Premium

The Employee Benefits Division continues to aggressively monitor 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 premium. To avoid disruption of NYSHIP coverage, agencies must ensure submission of premium payments by the due date, as we must submit premium to the NYSHIP insurers on time. Agencies may wish to consider submitting payments electronically to promote timely payments.

Availability of Reports Electronically

The Empire Plan Experience Reports are available through the following direct link to our website: http://www.cs.state.ny.us/ebd/ebdonlinecenter/pamarket/qer.cfm.

CEO, CFO & HBA Name & Address Changes

Agencies must notify the Employee Benefits Division of any changes in the names and/or addresses (including e-mail addresses) of agency CEOs, CFOs and/or HBAs to ensure that our mailing and contact lists are up-to-date. Any updates should be e-mailed to Deborah.DOrazio@cs.state.ny.us or mailed to:

NYS Department of Civil Service
Employee Benefits Division - Room 529
Attn.: Deborah D'Orazio
Alfred E. Smith State Office Building
Albany, NY 12239