GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
COMMISSIONER
DANIEL E. WALL
EXECUTIVE
DEPUTY COMISSIONER
NY01-60
TO: Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: 2002 Domestic Partner Imputed Income Amount Chart
DATE: December 28, 2001
Attached is the 2002 Domestic Partner Imputed Income Amount Chart. This rate chart provides the amount of biweekly imputed income for enrollees covering domestic partners who are not federally qualified dependents. The chart lists NYSHIP health insurance options on the left, in option code order. Applicable rate schedules are given at the top of the chart and explained in detail below the chart.
These rates will become effective with the 1/3/02 Administration and 12/27/01 Institution paychecks. Imputed Income amounts are added to the enrollee's taxable income - they are not a deduction.
If you have any questions regarding domestic partners, please refer Chapter 4 of your HBA Manual.
New York State Health Insurance Program
2002 Imputed Income Amounts by Option
| Plan | Code | Schedule I | Schedule II | Schedule III |
|---|---|---|---|---|
| Empire Plan | 001 | 98.46 | 109.04 | 63.48 |
| HIP | 050 | 67.95 | 75.85 | 52.93 |
| Univera Healthcare - CNY | 055 | 45.16 | 54.85 | 32.93 |
| Univera Healthcare - WNY | 057 | 53.64 | 61.93 | 43.22 |
| Preferred Care | 058 | 60.03 | 69.17 | 45.39 |
| Independent Health - Western NY | 059 | 48.85 | 55.90 | 40.11 |
| Mohawk Valley Physicians' Health Plan | 060 | 40.06 | 46.35 | 30.59 |
| Capital District PHP | 063 | 58.63 | 65.39 | 48.28 |
| Blue Choice | 066 | 57.39 | 67.37 | 41.21 |
| Community Blue | 067 | 55.60 | 63.70 | 45.40 |
| Elderplan, Inc. | 068 | 0.00 | 0.00 | 0.00 |
| Vytra Health Plans | 070 | 56.48 | 68.20 | 39.42 |
| HMO-CBY | 072 | 38.29 | 47.21 | 24.88 |
| HMO Blue | 160 | 35.54 | 42.46 | 20.78 |
| Aetna US Healthcare | 210 | 49.91 | 57.45 | 37.10 |
| GHI HMO Select, Inc. | 220 | 46.93 | 55.03 | 34.09 |
| BlueChoice HMO-Upstate | 280 | 49.82 | 59.85 | 34.75 |
| BlueChoice HMO-Downstate | 290 | 46.88 | 56.84 | 31.91 |
| Capital District PHP-Central | 300 | 59.01 | 65.63 | 48.75 |
| Capital District PHP-W. Hudson Valley | 310 | 53.88 | 60.52 | 43.60 |
Schedule I
A02, A03, A05, A06, A07, A09, A10, A13, A15, A17, A19, A20, A22, A23, L19
PEF, UUP, M/C, PBA, PBA Supervisors, Courts, CSEA, Cornell
Schedule II
A01, A04, A11, A12, A14, A25
CSEA, NYSCOPBA, PIA, DC-37, Courts, DC-37, Council-82
Schedule III
A26
Courts (Civil Service Forum)