GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
COMMISSIONER
DANIEL E. WALL
EXECUTIVE
DEPUTY COMISSIONER
NY02-02
PE02-01
TO: New York State and Participating Employer Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: 2002 Dental and Vision Rates
DATE: January 7, 2002
Effective January 1, 2002, the premium rates for the New York State Employee’s Dental and Vision Insurance Programs will change for all groups. You will find the 2002 New York State Dental and Vision Leave Without Pay and COBRA premium rate schedules on the reverse side.
Leave Without Pay (LWOP) Full Share Rates
Enrollees who elect to continue Dental and/or Vision coverage while in LWOP status must complete and submit a PS-404 to their agency Health Benefits Administrator (HBA). The HBA should then process an enrollment for the requested benefits on NYBEAS. This transaction will, in turn, notify the carriers to continue to provide the appropriate benefits and will also generate a bill which is mailed directly to the employee.
If you have any questions, please contact your processor.
New York State Health Insurance Program
Dental and Vision Coverage*
Rates Effective January 1, 2002
Full Share LWOP Biweekly Rates
| Individual | Family | |
|---|---|---|
| Dental Preferred Plan BP A02, A04, A05, A07, A09, A10, A11, A15, A17, A19, A22, A23, A24, A25, L19 | $11.07 | $28.60 |
| Vision(1) BP A02, A04, A05, A09, A10, A11, A22, A23, A24, A25 | $1.50 | $4.50 |
Full Share LWOP Monthly Rates
| Individual | Family | |
|---|---|---|
| Dental Preferred Plan BP M04, M05 | $24.06 | $62.13 |
| Vision(1) BP M04, M05 | $3.25 | $9.77 |
COBRA Monthly Rates
| Individual | Family | |
|---|---|---|
| Dental Preferred Plan BP C02, C04, C05, C07, C09, C10, C11, C15, C17, C25, C29, C30 | $24.54 | $63.37 |
| Vision(1) BP C02, C04, C05, C09, C10, C11, C25, C29, C30 | $3.32 | $9.97 |
| GSEU Medical/Dental/Vision BP C27 | $106.80 | $267.80 |
* These rates are only for those eligible for the State administered Dental and Vision benefits. Employees who receive dental and vision benefits through their employee benefit fund (CSEA, DC-37 and UUP) must contact their union benefit fund for LWOP and COBRA rates.