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.
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
COMMISSIONER
DANIEL E. WALL
EXECUTIVE
DEPUTY COMISSIONER
PA94-14
TO: Participating Agency Health Benefits Insurance Administrator
FROM:
SUBJECT: November 10, 1994
DATE: November 10, 1994
We are pleased to inform you that the 1995 net rates for the Core plus enhancements option have been reduced by 2% and 1.5% for individual and family coverages respectively. Please note that the 4 year annual average increase is less than 2%. The financial stability of NYSHIP premium for Participating Agencies is the result of favorable trends, plan design changes, improved management controls, and judicious use of plan dividend.
The 1995 rate reduction includes 74% of available dividend. The balance is being held in reserve to temper the impact of future premium increases.
The attached schedules show the full share amount as well as the rates for COBRA and New York State Continuity of Coverage enrollees. Also enclosed is the Employee/Employer Variable Contribution Rate table effective January 1, 1995. The centralized billing for January 1995 coverage will reflect the new rates.
Retiree Deductions
Retiree pension deductions will change in the checks issued by the retirement systems at the end of November 1994.
Medicare Premium
Effective January 1, 1995 the reimbursement required for Medicare Part "B" premium is $46.10. This represents an increase of $5.00 (12.2%) over the 1994 Medicare rate.
Participating Agency Administrative Charge
Effective with January 1, 1995 coverage, the 1995 monthly billing rate will consist of an agency fee of $14.83 and a per enrollee charge of $.964 which will be assessed on the number of enrollee billing units. These amounts represent a decrease of 22.3% for the agency fee rate and a 24.7% decrease per enrollee billing unit. In the aggregate, the Participating Agency administrative charge represents approximately .3% of net premiums. Also, please note that these billing factors are estimates and will remain in force throughout 1995.
Any difference between estimated and actual costs will be an adjustment factor in developing the 1996 administrative cost rates. The decrease in the 1995 administrative charge is primarily attributable to a credit for the 1994 billing rates as well as a reduction in chargeable costs.
The administrative cost charge is shown separately and is added to the premium bill. Send just one check each month for the combined amount made payable to the "New York State Employees' Health Insurance Pending Account". Please note that the administrative charge must be borne entirely by the agency and may not be passed on to active employees, retirees or other enrollees.
If you have questions about this rate change or the new administrative cost billing, please contact our Accounting Operations Unit at (518) 457-5766.
Sincerely,
Robert DuBois
Director
Division of Employee Benefits
NEW YORK STATE EMPLOYEES HEALTH INSURANCE PROGRAM
EMPLOYEE-EMPLOYER VARIABLE CONTRIBUTION RATE TABLE
Monthly rates Effective January 1, 1995
Participating Agencies
Empire Plan - Core Only
| | Code | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 81 | 16.41 | 147.68 | 16.41 | 147.68 | 8.20 | 155.89 | 8.20 | 155.89 | 0.00 | 164.09 | 0.00 | 164.09 |
| Ind & Dependent | 82 | 68.09 | 302.72 | 37.08 | 333.73 | 39.21 | 331.60 | 18.54 | 352.27 | 134.37 | 236.44 | 103.36 | 267.45 |
Empire Plan - Core Plus All Enhancements
| | Code | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 71 | 19.35 | 174.19 | 19.35 | 174.19 | 9.68 | 183.86 | 9.68 | 183.86 | 0.00 | 193.54 | 0.00 | 193.54 |
| Ind & Dependent | 72 | 81.05 | 359.30 | 44.03 | 396.32 | 46.70 | 393.65 | 22.02 | 418.33 | 160.43 | 279.92 | 123.40 | 316.95 |
Empire Plan - Core Plus Medical Enhancements
| | Code | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 61 | 18.96 | 170.67 | 18.96 | 170.67 | 9.48 | 180.15 | 9.48 | 180.15 | 0.00 | 189.63 | 0.00 | 189.63 |
| Ind & Dependent | 62 | 78.62 | 349.64 | 42.82 | 385.44 | 45.27 | 382.99 | 21.41 | 406.85 | 155.11 | 273.15 | 119.31 | 308.95 |
Empire Plan - Core Plus Medical Enhancements
| | Code | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 51 | 16.80 | 151.21 | 16.80 | 151.21 | 8.40 | 159.61 | 8.40 | 159.61 | 0.00 | 168.01 | 0.00 | 168.01 |
| Ind & Dependent | 52 | 70.52 | 312.37 | 38.29 | 344.60 | 40.63 | 342.26 | 19.14 | 363.75 | 139.67 | 243.22 | 107.44 | 275.45 |
Empire Plan - Core Plus Medical Enhancements
| | Code | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 65% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 80% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 81 | 0.00 | 164.09 | 0.00 | 164.09 | 0.00 | 164.09 | 0.00 | 164.09 | 0.00 | 164.09 | 0.00 | 164.09 |
| Ind & Dependent | 82 | 72.35 | 298.46 | 51.68 | 319.13 | 41.34 | 329.47 | 20.67 | 350.14 | 10.34 | 360.47 | 0.00 | 370.81 |
Empire Plan - Core Plus All Enhancements
| | Code | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 65% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 80% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 71 | 0.00 | 193.54 | 0.00 | 193.54 | 0.00 | 193.54 | 0.00 | 193.54 | 0.00 | 193.54 | 0.00 | 193.54 |
| Ind & Dependent | 72 | 86.38 | 353.97 | 61.70 | 378.65 | 49.36 | 390.99 | 24.68 | 415.67 | 12.34 | 428.01 | 0.00 | 440.35 |
Empire Plan - Core Plus Medical Enhancements
| | Code | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 65% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 80% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 61 | 0.00 | 189.63 | 0.00 | 189.63 | 0.00 | 189.63 | 0.00 | 189.63 | 0.00 | 189.63 | 0.00 | 189.63 |
| Ind & Dependent | 62 | 83.52 | 344.74 | 59.66 | 368.60 | 47.73 | 380.53 | 23.86 | 404.40 | 11.93 | 416.33 | 0.00 | 428.26 |
Empire Plan - Core Plus Mental Health/Substance Abuse
| | Code | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 65% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 80% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: 95% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 51 | 0.00 | 168.01 | 0.00 | 168.01 | 0.00 | 168.01 | 0.00 | 168.01 | 0.00 | 168.01 | 0.00 | 168.01 |
| Ind & Dependent | 52 | 75.21 | 307.68 | 59.66 | 329.17 | 42.98 | 339.91 | 21.49 | 361.40 | 10.74 | 372.15 | 0.00 | 382.89 |
Empire Plan - Core Only
| | Code | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 60% | If Employer Pays - Ind / Dep Rate: 60% | If Employer Pays - Ind / Dep Rate: 65% | If Employer Pays - Ind / Dep Rate: 45% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 81 | 82.04 | 82.05 | 82.04 | 82.05 | 65.64 | 98.45 | 57.43 | 106.66 | 41.02 | 123.07 | 41.02 | 123.07 |
| Ind & Dependent | 82 | 216.41 | 154.40 | 185.40 | 185.41 | 148.33 | 222.48 | 171.13 | 199.68 | 175.39 | 195.42 | 144.38 | 226.43 |
Empire Plan - Core Plus All Enhancements
| | Code | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 60% | If Employer Pays - Ind / Dep Rate: 60% | If Employer Pays - Ind / Dep Rate: 65% | If Employer Pays - Ind / Dep Rate: 45% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 71 | 96.77 | 96.77 | 96.77 | 96.77 | 77.42 | 116.12 | 67.74 | 125.80 | 48.38 | 145.16 | 48.38 | 145.16 |
| Ind & Dependent | 72 | 257.20 | 183.15 | 220.17 | 220.18 | 176.14 | 264.21 | 203.49 | 236.86 | 208.81 | 231.54 | 171.78 | 268.57 |
Empire Plan - Core Plus Medical Enhancements
| | Code | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 60% | If Employer Pays - Ind / Dep Rate: 60% | If Employer Pays - Ind / Dep Rate: 65% | If Employer Pays - Ind / Dep Rate: 45% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 61 | 94.81 | 94.82 | 94.81 | 94.82 | 75.85 | 113.78 | 66.37 | 123.26 | 47.41 | 142.22 | 47.41 | 142.22 |
| Ind & Dependent | 62 | 249.92 | 178.34 | 214.12 | 214.14 | 171.30 | 256.96 | 197.62 | 230.64 | 202.52 | 225.74 | 166.72 | 261.54 |
Empire Plan - Core Plus Mental Health/Substance Abuse
| | Code | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 60% | If Employer Pays - Ind / Dep Rate: 60% | If Employer Pays - Ind / Dep Rate: 65% | If Employer Pays - Ind / Dep Rate: 45% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 35% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 51 | 84.00 | 84.01 | 84.00 | 84.01 | 67.20 | 100.81 | 58.80 | 109.21 | 42.00 | 126.01 | 42.00 | 126.01 |
| Ind & Dependent | 52 | 223.67 | 159.22 | 191.44 | 191.45 | 153.15 | 229.74 | 176.98 | 205.91 | 181.67 | 201.22 | 149.44 | 233.45 |
Empire Plan - Core Only
| | Code | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 81 | 41.02 | 123.07 | 24.61 | 139.48 | 24.61 | 139.48 | 24.61 | 139.48 | 16.41 | 147.68 | 0.00 | 164.09 |
| Ind & Dependent | 82 | 92.70 | 278.11 | 127.97 | 242.84 | 76.29 | 294.52 | 55.62 | 315.19 | 119.77 | 251.04 | 0.00 | 370.81 |
Empire Plan - Core Plus All Enhancements
| | Code | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 71 | 48.38 | 145.16 | 29.03 | 164.51 | 29.03 | 164.51 | 29.03 | 164.51 | 19.35 | 174.19 | 0.00 | 193.54 |
| Ind & Dependent | 72 | 110.08 | 330.27 | 152.43 | 287.92 | 90.73 | 349.62 | 66.05 | 374.30 | 142.75 | 297.60 | 0.00 | 440.35 |
Empire Plan - Core Plus Medical Enhancements
| | Code | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 61 | 47.41 | 142.22 | 28.44 | 161.19 | 28.44 | 161.19 | 28.44 | 161.19 | 18.96 | 170.67 | 0.00 | 189.63 |
| Ind & Dependent | 62 | 107.07 | 321.19 | 147.75 | 280.51 | 88.10 | 340.16 | 64.23 | 364.03 | 138.27 | 289.99 | 0.00 | 428.26 |
Empire Plan - Core Plus Mental Health/Substance Abuse
| | Code | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 75% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 85% | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 50% | If Employer Pays - Ind / Dep Rate: 100% | If Employer Pays - Ind / Dep Rate: |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual | 51 | 42.00 | 126.01 | 25.20 | 142.81 | 25.20 | 142.81 | 25.20 | 142.81 | 16.80 | 151.21 | 0.00 | 168.01 |
| Ind & Dependent | 52 | 95.72 | 287.17 | 132.64 | 250.25 | 78.92 | 303.97 | 57.43 | 325.46 | 124.24 | 258.65 | 0.00 | 382.89 |
Medical Credit: 46.10
NEW YORK STATE EMPLOYEES HEALTH INSURANCE PROGRAM
EMPLOYEE-EMPLOYER VARIABLE CONTRIBUTION RATE TABLE
Monthly rates Effective January 1, 1995
Participating Agencies
Empire Plan - Core Only
| | Code | Net Full Share | COBRA PA Billing | COBRA 2% Charge | COBRA Employee Cost | Continuity of Coverage No Drugs |
|---|---|---|---|---|---|---|
| Individual | 81 | 164.09 | 185.11 | 3.70 | 188.81 | 143.97 |
| Ind & Dependent | 82 | 370.01 | 417.11 | 8.34 | 425.45 | 335.68 |
Empire Plan - Core Plus All Enhancements
| | Code | Net Full Share | COBRA PA Billing | COBRA 2% Charge | COBRA Employee Cost | Continuity of Coverage No Drugs |
|---|---|---|---|---|---|---|
| Individual | 71 | 193.54 | 214.70 | 4.29 | 218.99 | 173.56 |
| Ind & Dependent | 72 | 440.35 | 486.99 | 9.74 | 496.73 | 405.56 |
Empire Plan - Core Plus Medical Enhancements
| | Code | Net Full Share | COBRA PA Billing | COBRA 2% Charge | COBRA Employee Cost | Continuity of Coverage No Drugs |
|---|---|---|---|---|---|---|
| Individual | 61 | 189.63 | 210.77 | 4.22 | 214.99 | 169.63 |
| Ind & Dependent | 62 | 428.26 | 474.85 | 9.50 | 484.35 | 393.42 |
Empire Plan - Core Plus Mental Health/Substance Abuse
| | Code | Net Full Share | COBRA PA Billing | COBRA 2% Charge | COBRA Employee Cost | Continuity of Coverage No Drugs |
|---|---|---|---|---|---|---|
| Individual | 51 | 168.01 | 189.04 | 3.78 | 192.82 | 147.90 |
| Ind & Dependent | 52 | 382.89 | 429.25 | 8.59 | 437.84 | 347.82 |
Medicare Credit: 46.10