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.
ANDREW M. CUOMO
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
PA11-21
PAEX11-18
TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Empire Plan Basic Medical Program, Non-Network Hospital Program and Non-Network Mental Health and Substance Abuse Program Combined Annual Deductible and Coinsurance Maximum Amounts for 2012
DATE: December 5, 2011
Below is a chart showing The Empire Plan Basic Medical Program, Non-Network Hospital Program and Non-Network Mental Health and Substance Abuse Program Combined Annual Deductible and Coinsurance Maximum for calendar year 2012. You may want to distribute or post it, or you may want to prepare a posting specific to your agency. If you are a Health Benefits Administrator in an agency with regional offices, please distribute notices to the regional locations as well.
These changes will be announced in the January 2012 Empire Plan Reports and referenced in the 2012 At A Glance publications.
EMPIRE PLAN Basic Medical Program, Non-Network Hospital Program and
Non-Network Mental Health and Substance Abuse Program
Effective January 1, 2012
| Employee Group | Combined Annual Deductible * (per enrollee; per spouse or domestic partner; per all dependent children combined) | Combined Coinsurance Maximum * (per enrollee; per spouse or domestic partner; per all dependent children combined) |
|---|---|---|
| Participating Agencies - Empire Plan |
$1,000 | $3,000 |
| Participating Agencies - Excelsior Plan |
$750 | $2,500 |
* Each program's deductible, coinsurance and maximum coinsurance amount is combined to satisfy the annual deductible and coinsurance maximum shown above.
Note: You have no deductible or coinsurance when you use The Empire Plan Participating Provider Program.