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
PA95-15
TO: Participating Agency Health Benefits Insurance Administrator
FROM:
SUBJECT: 1996 Net Rates for Core Plus Enhancements
DATE: November 21, 1995
November 21, 1995
Dear Participating Agency Health Benefits Insurance Administrator:
We are pleased to inform you that the 1996 net rates for the Core plus enhancements option have in the aggregate decreased 2.6%. Please note that the five year annual average increase in the NYSHIP premium for Participating Agencies has been less than 1%. 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 1996 rates include application of 75% of available dividend. The balance of the dividend is being held in reserve to lessen the impact of future premium increases.
MediPrime
The attached schedules reflect the new MediPrime 5 Tier rate structure. The MediPrime unit premium relationship to the 1995 unit rate is more favorable than the relationship discussed in our second quarter 1995 report. Specifically, for the Core Plus Medical and Psychiatric Enhancements option, the comparison is:
| 1995 | 1996 | %Difference | ||
| Individual Coverage | $193.54 | Individual Plan Prime | $207.66 | 7.3% |
| Individual Medicare Prime | $131.72 | -31.9% | ||
| Family Coverage | $440.35 | Family Plan Prime | $459.16 | 4.3% |
| Family - 1 Medicare | $383.23 | -13.0% | ||
| Family - 2 or More Medicare | $307.07 | -30.3% |
Schedule I presents the full share rates, the COBRA rates and the NYS Continuity of Coverage rates. Also attached as Schedule II is the Employee/Employer Variable Contribution Rate Table effective January 1, 1996. The centralized billing for January 1996 coverage will reflect the new rates. Please note that we have deleted the Core plus Mental Health Substance Abuse option because no Participating Agencies purchase this coverage.
Medicare Premium
Although Medicare is currently being deliberated at the Federal level the Health Care Financing Administration has announced a Medicare Part B Premium of $42.50 effective January 1, 1996. We will advise you of any Part B premium change that may result from Medicare reform.
Retiree Deductions
Retiree pension deductions for health insurance will change in the checks issued by the retirement systems at the end of November 1995. This November deduction pays for January coverage.
Participating Agency Administrative Charge
We are also pleased to inform you that in 1996, there will be no change to the agency and enrollee administrative charge fee. We are able to keep these estimated fees flat for 1996 as a result of strict expenditure controls. Any difference between the actual and estimated costs will be a factor in the development of 1997 administrative fees.
The administrative cost charge is shown separately on your premium bill. Send 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.
An announcement on MediPrime will be included in the December Empire Plan Report which is sent directly to enrollees.
If you have questions about this rate change, please contact our Operations Unit at (518) 457-5766.
Sincerely,
Robert W. DuBois, CEBS
Director
Employee Benefits Division
NEW YORK STATE DEPARTMENT OF CIVIL SERVICE
W. AVERELL HARRIMAN
STATE OFFICE BUILDING CAMPUS
ALBANY, NEW YORK 12239
NEW YORK STATE EMPLOYEES HEALTH INSURANCE PROGRAM
EMPLOYEE-EMPLOYER VARIABLE CONTRIBUTION RATE TABLE
Monthly rates Effective January 1, 1997
Participating Agencies
Plan Prime - Core Only
| Opt | Cov | Med | Net Full Share | Gross PA Billing Rate | COBRA 2% Charge | Employee Cost | Continuity of Coverage No Drug Coverage | |
| Individual | 8 | 1 | 0 | 203.99 | 225.10 | 4.50 | 229.60 | 187.74 |
| Family | 8 | 2 | 0 | 450.19 | 499.74 | 9.99 | 509.73 | 419.36 |
MediPrime - Core Only
| Opt | Cov | Med | Net Full Share | Gross PA Billing Rate | COBRA 2% Charge | Employee Cost | Continuity of Coverage No Drug Coverage | |
| Individual-1 | 8 | 1 | 1 | 133.91 | 155.11 | Cobra NA | Cobra NA | Continuity NA |
| Family-1 | 8 | 2 | 1 | 380.21 | 429.76 | Cobra NA | Cobra NA | Continuity NA |
| Family-2 | 8 | 2 | 2 | 309.98 | 359.53 | Cobra NA | Cobra NA | Continuity NA |
Plan Prime - Core Plus All Enhancements
| Opt | Cov | Med | Net Full Share | Gross PA Billing Rate | COBRA 2% Charge | Employee Cost | Continuity of Coverage No Drug Coverage | |
| Individual | 7 | 1 | 0 | 207.66 | 234.59 | 4.69 | 239.28 | 197.23 |
| Family | 7 | 2 | 0 | 459.16 | 521.96 | 10.44 | 532.40 | 441.58 |
MediPrime - Core Plus All Enhancements
| Opt | Cov | Med | Net Full Share | Gross PA Billing Rate | COBRA 2% Charge | Employee Cost | Continuity of Coverage No Drug Coverage | |
| Individual-1 | 7 | 1 | 1 | 131.72 | 158.65 | Cobra NA | Cobra NA | Continuity NA |
| Family-1 | 8 | 2 | 1 | 383.23 | 446.03 | Cobra NA | Cobra NA | Continuity NA |
| Family-2 | 8 | 2 | 2 | 307.07 | 369.87 | Cobra NA | Cobra NA | Continuity NA |
Plan Prime - Core Plus Medical Enhancements
| Opt | Cov | Med | Net Full Share | Gross PA Billing Rate | COBRA 2% Charge | Employee Cost | Continuity of Coverage No Drug Coverage | |
| Individual | 6 | 1 | 0 | 204.00 | 230.91 | 4.62 | 235.53 | 193.55 |
| Family | 6 | 2 | 0 | 449.50 | 512.24 | 10.24 | 522.48 | 431.86 |
MediPrime - Core Plus Medical Enhancements
| Opt | Cov | Med | Net Full Share | Gross PA Billing Rate | COBRA 2% Charge | Employee Cost | Continuity of Coverage No Drug Coverage | |
| Individual-1 | 6 | 1 | 1 | 131.44 | 158.35 | Cobra NA | Cobra NA | Continuity NA |
| Family-1 | 6 | 2 | 1 | 376.95 | 439.69 | Cobra NA | Cobra NA | Continuity NA |
| Family-2 | 6 | 2 | 2 | 304.16 | 366.90 | Cobra NA | Cobra NA | Continuity NA |
NEW YORK STATE DEPARTMENT OF CIVIL SERVICE
W. AVERELL HARRIMAN
STATE OFFICE BUILDING CAMPUS
ALBANY, NEW YORK 12239
NEW YORK STATE EMPLOYEES HEALTH INSURANCE PROGRAM
EMPLOYEE-EMPLOYER VARIABLE CONTRIBUTION RATE TABLE
Monthly rates Effective January 1, 1996
Participating Agencies
Plan Prime - Core Only
| Opt | Cov | Med | 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: 100% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 8 | 1 | 0 | 0.00 | 203.90 | 0.00 | 203.90 | 0.00 | 203.90 | 0.00 | 203.90 | 0.00 | 203.90 | 0.00 | 203.90 |
| Family | 8 | 2 | 0 | 86.20 | 363.99 | 61.57 | 388.62 | 49.26 | 400.93 | 24.63 | 425.56 | 12.31 | 437.88 | 0.00 | 450.19 |
MediPrime - Core Only
| Opt | Cov | Med | 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: 100% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual-1 | 8 | 1 | 1 | 0.00 | 133.91 | 0.00 | 133.91 | 0.00 | 133.91 | 0.00 | 133.91 | 0.00 | 133.91 | 0.00 | 133.91 |
| Family-1 | 8 | 2 | 1 | 86.20 | 294.01 | 61.57 | 318.64 | 49.26 | 330.95 | 24.63 | 355.58 | 12.31 | 367.90 | 0.00 | 380.21 |
| Family-2 | 8 | 2 | 2 | 61.62 | 248.36 | 44.02 | 265.96 | 35.21 | 274.77 | 17.61 | 292.37 | 8.80 | 301.18 | 0.00 | 309.98 |
Plan Prime - Core Plus All Enhancements
| Opt | Cov | Med | 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: 100% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 8 | 1 | 0 | 0.00 | 207.66 | 0.00 | 207.66 | 0.00 | 207.66 | 0.00 | 207.66 | 0.00 | 207.66 | 0.00 | 207.66 |
| Family | 8 | 2 | 0 | 88.02 | 371.14 | 62.87 | 396.29 | 50.30 | 408.86 | 25.15 | 434.01 | 12.57 | 446.59 | 0.00 | 459.16 |
MediPrime - Core Plus All Enhancements
| Opt | Cov | Med | 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: 100% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual-1 | 7 | 1 | 1 | 0.00 | 131.72 | 0.00 | 131.72 | 0.00 | 131.72 | 0.00 | 131.72 | 0.00 | 131.72 | 0.00 | 131.72 |
| Family-1 | 7 | 2 | 1 | 88.03 | 295.20 | 62.88 | 320.35 | 50.30 | 332.93 | 25.15 | 358.08 | 12.58 | 370.65 | 0.00 | 383.23 |
| Family-2 | 7 | 2 | 2 | 61.37 | 245.70 | 43.84 | 263.23 | 35.07 | 272.00 | 17.53 | 289.54 | 8.77 | 298.30 | 0.00 | 307.07 |
Plan Prime - Core Plus Medical Enhancements
| Opt | Cov | Med | 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: 100% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 6 | 1 | 0 | 0.00 | 204.00 | 0.00 | 204.00 | 0.00 | 204.00 | 0.00 | 204.00 | 0.00 | 204.00 | 0.00 | 204.00 |
| Family | 6 | 2 | 0 | 85.92 | 363.58 | 61.37 | 388.13 | 49.10 | 400.40 | 24.55 | 24.55 | 12.27 | 437.23 | 0.00 | 449.50 |
MediPrime - Core Plus Medical Enhancements
| Opt | Cov | Med | 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: 100% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual-1 | 6 | 1 | 1 | 0.00 | 131.44 | 0.00 | 131.44 | 0.00 | 131.44 | 0.00 | 131.44 | 0.00 | 131.44 | 0.00 | 131.44 |
| Family-1 | 6 | 2 | 1 | 85.93 | 291.02 | 61.38 | 315.57 | 49.10 | 327.85 | 24.55 | 352.40 | 12.28 | 364.67 | 0.00 | 376.95 |
| Family-2 | 6 | 2 | 2 | 60.45 | 243.71 | 43.18 | 260.98 | 34.54 | 269.62 | 17.27 | 286.89 | 8.64 | 295.52 | 0.00 | 304.16 |
Plan Prime - Core Only
| Opt | Cov | Med | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 85% | 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: 50% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 8 | 1 | 0 | 20.39 | 183.51 | 20.39 | 183.51 | 10.19 | 193.71 | 10.19 | 193.71 | 0.00 | 203.90 | 0.00 | 203.90 |
| Family | 8 | 2 | 0 | 57.33 | 392.86 | 45.02 | 405.17 | 47.13 | 403.06 | 22.50 | 427.69 | 160.09 | 290.10 | 123.14 | 327.05 |
MediPrime - Core Only
| Opt | Cov | Med | 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: 100% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual-1 | 8 | 1 | 1 | 13.39 | 120.52 | 13.39 | 120.52 | 6.70 | 127.21 | 6.70 | 127.21 | 0.00 | 133.91 | 0.00 | 133.91 |
| Family-1 | 8 | 2 | 1 | 50.33 | 329.88 | 38.02 | 342.19 | 43.64 | 336.57 | 19.01 | 361.20 | 160.09 | 220.12 | 123.15 | 257.06 |
| Family-2 | 8 | 2 | 2 | 39.80 | 270.18 | 31.00 | 278.98 | 33.11 | 276.87 | 15.50 | 294.48 | 114.45 | 195.53 | 88.03 | 221.95 |
Plan Prime - Core Plus All Enhancements
| Opt | Cov | Med | If Employer Pays - Ind / Dep Rate: 90% | If Employer Pays - Ind / Dep Rate: 85% | 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: 50% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 7 | 1 | 0 | 20.77 | 186.89 | 20.77 | 186.89 | 10.38 | 197.28 | 10.38 | 197.28 | 0.00 | 207.66 | 0.00 | 207.66 |
| Family | 7 | 2 | 0 | 58.49 | 400.67 | 45.92 | 413.24 | 48.10 | 411.06 | 22.95 | 436.21 | 163.47 | 295.69 | 125.75 | 333.41 |
MediPrime - Core Plus All Enhancements
| Opt | Cov | Med | 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: 100% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual-1 | 7 | 1 | 1 | 13.17 | 118.55 | 13.17 | 118.55 | 6.59 | 125.13 | 6.59 | 125.13 | 0.00 | 131.72 | 0.00 | 131.72 |
| Family-1 | 7 | 2 | 1 | 50.90 | 332.33 | 38.32 | 344.91 | 44.32 | 338.91 | 19.17 | 364.06 | 163.48 | 219.75 | 125.75 | 257.48 |
| Family-2 | 7 | 2 | 2 | 39.47 | 267.60 | 30.70 | 276.37 | 32.89 |