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
PA96-15
TO: Participating Agency Health Benefits Administrator
FROM: Employee Benefits Division
SUBJECT: 1997 Rates for NYSHIP
DATE: November 25, 1996
November 25, 1996
Dear Participating Agency Health Benefits Insurance Administrator:
Attached are the 1997 rates for the New York State Health Insurance Program (NYSHIP). The net rates for the Core plus enhancements option have in the aggregate increased 5.3%. Among the factors contributing to this rate action are:
- Going forward trend of 4.5%
- A decrease in the dividend applied against gross premium liability
- A non recurring adjustment to the PA enhancement rate to make that component sufficient to cover 1997 claim cost
While it is difficult to predict long term trends in the health care market, we are confident that NYSHIP will continue to lead the industry in premium trends. In gauging the financial performance of a health insurance program such as NYSHIP it is appropriate to examine premium trend over time. We are pleased to note that the five year annual average increase in the NYSHIP premium for Participating Agencies has been less than 2% and actually decreased in both 1995 and 1996. This long term 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 1997 rates include application of 87% of available dividend. The balance of the earned dividend as well as dividend earned in 1996 will be held in reserve to lessen the impact of future premium increases.
MediPrime
The attached schedules reflect the MediPrime 5 Tier rate structure. In promulgating the 1996 MediPrime rates PA's were advised that the rate was based on estimates of the number of Medicare eligibles and Medicare/Plan Prime (MIPP) experience estimated by the insurance companies. The 1997 rates are derived from actual experience. This produces a lower MediPrime rate and a higher Plan Prime rate. Going forward we would expect to have less volatile unit premium adjustments among the 5 tiers. Specifically, for the Core Plus Medical and Psychiatric Enhancements option, the comparison is:
| 1996 | 1997 | % Difference | |
| Individual Plan Prime | $207.60 | $240.22 | 15.7% |
| Individual Medicare Prime | $131.72 | $129.28 | -1.9% |
| Family Plan Prime | $459.16 | $489.22 | 6.5% |
| Family - 1 Medicare | $383.30 | $378.82 | -1.2% |
| Family - 2 or More Medicare | $307.07 | $267.15 | -13.0% |
The attached Schedule I represents the full share rates, the COBRA rates and the NYS Continuity of Coverage rates. Also attached is Schedule II, the Employee/Employer Variable Contribution Rate Table (PS-508). The centralized billing for January 1997 coverage will reflect the new rates.
Medicare Premium
The Health Care Financing Administration has announced that, effective January 1, 1997 the Medicare Part B premium will increase to $43.80. This is 3.1% higher than the 1996 premium.
Retiree Deductions
Retiree Pension deductions for health insurance will change in the checks issued by the retirement systems at the end of November 1996. The November deduction pays for January coverage.
Participating Agency Administrative Charge
We are also pleased to inform you that in 1997 there will be a 4.3% decrease in the unit enrollee fee and a modest .5% increase is the agency fee. We are able to realize this overall reduction through strict expenditure controls. Any difference between the actual and estimated costs will be a factor in the development of 1998 administrative fees.
The administrative cost charge is shown separately on your premium bill. Send one check each month for the combined amount made apyable 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 enrolles.
If you have any questions about this rate change, please contact our Operations Unit at (518) 457-5766.
Sincerely,
Robert W. DuBois
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
Schedule I
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 | 212.92 | 226.25 | 4.53 | 230.78 | 189.91 |
| Family | 8 | 2 | 0 | 436.52 | 465.78 | 9.32 | 475.10 | 391.80 |
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 | 8 | 1 | 1 | 128.07 | 141.10 | Cobra NA | Cobra NA | Continuity NA |
| Family-1 | 8 | 2 | 1 | 352.21 | 381.17 | Cobra NA | Cobra NA | Continuity NA |
| Family-2 | 8 | 2 | 2 | 266.64 | 295.30 | 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 | 240.22 | 261.80 | 5.24 | 267.04 | 225.46 |
| Family | 7 | 2 | 0 | 489.22 | 537.96 | 10.76 | 548.72 | 463.98 |
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 | 7 | 1 | 1 | 129.28 | 150.53 | Cobra NA | Cobra NA | Continuity NA |
| Family-1 | 7 | 2 | 1 | 378.82 | 427.23 | Cobra NA | Cobra NA | Continuity NA |
| Family-2 | 7 | 2 | 2 | 267.15 | 315.24 | 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 | 238.01 | 258.45 | 5.17 | 263.62 | 222.11 |
| Family | 6 | 2 | 0 | 484.94 | 530.18 | 10.60 | 540.78 | 456.20 |
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 | 1 | 130.24 | 150.37 | Cobra NA | Cobra NA | Continuity NA |
| Family-1 | 6 | 2 | 1 | 377.71 | 422.64 | Cobra NA | Cobra NA | Continuity NA |
| Family-2 | 6 | 2 | 2 | 269.22 | 313.84 | Cobra NA | Cobra NA | Continuity NA |
Schedule II
Plan Prime - Core Only
| Opt | Cov | Med | 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: 50% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 8 | 1 | 0 | 106.46 | 106.46 | 106.46 | 106.46 | 85.17 | 127.75 | 74.52 | 138.40 | 53.23 | 159.69 | 53.23 | 159.69 |
| Family | 8 | 2 | 0 | 251.80 | 184.72 | 218.26 | 218.26 | 174.61 | 261.91 | 197.50 | 239.02 | 198.57 | 237.95 | 165.03 | 271.49 |
MediPrime - Core Only
| Opt | Cov | Med | 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: 50% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual-1 | 8 | 1 | 1 | 64.03 | 64.04 | 64.03 | 64.04 | 51.23 | 76.84 | 44.82 | 83.25 | 32.02 | 96.05 | 32.02 | 96.05 |
| Family-1 | 8 | 2 | 1 | 209.72 | 142.49 | 176.10 | 176.11 | 140.89 | 211.32 | 168.10 | 184.11 | 177.71 | 174.50 | 144.09 | 208.12 |
| Family-2 | 8 | 2 | 2 | 154.10 | 112.54 | 133.31 | 133.33 | 106.66 | 159.98 | 121.03 | 145.61 | 122.09 | 144.55 | 101.330 | 165.34 |
Plan Prime - Core Plus All Enhancements
| Opt | Cov | Med | 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: 50% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 7 | 1 | 0 | 120.11 | 120.11 | 120.11 | 120.11 | 96.09 | 144.13 | 84.08 | 156.14 | 60.05 | 180.17 | 60.05 | 180.17 |
| Family | 7 | 2 | 0 | 281.96 | 207.26 | 244.61 | 244.61 | 195.69 | 293.53 | 221.03 | 286.19 | 221.90 | 267.32 | 184.55 | 304.67 |
MediPrime - Core Plus All Enhancements
| Opt | Cov | Med | 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: 50% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual-1 | 7 | 1 | 1 | 64.64 | 64.64 | 64.64 | 64.64 | 51.71 | 77.57 | 45.25 | 84.03 | 32.32 | 96.96 | 32.32 | 96.96 |
| Family-1 | 7 | 2 | 1 | 226.84 | 151.98 | 189.41 | 189.41 | 151.53 | 227.29 | 182.50 | 196.32 | 194.52 | 184.30 | 157.09 | 221.73 |
| Family-2 | 7 | 2 | 2 | 154.26 | 112.89 | 133.57 | 133.58 | 106.86 | 160.29 | 121.08 | 146.07 | 121.94 | 145.21 | 101.25 | 165.90 |
Plan Prime - Core Plus Medical Enhancements
| Opt | Cov | Med | 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: 50% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 6 | 1 | 0 | 119.00 | 119.01 | 119.00 | 119.01 | 95.20 | 142.81 | 83.30 | 154.71 | 59.50 | 178.51 | 59.50 | 178.51 |
| Family | 6 | 2 | 0 | 279.50 | 205.44 | 242.47 | 242.47 | 193.97 | 290.97 | 219.11 | 265.83 | 220.00 | 264.94 | 182.96 | 301.98 |
MediPrime - Core Plus Medical Enhancements
| Opt | Cov | Med | 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: 50% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual-1 | 6 | 1 | 1 | 65.12 | 65.12 | 65.12 | 65.12 | 52.10 | 78.14 | 45.58 | 84.66 | 32.56 | 97.68 | 32.56 | 97.68 |
| Family-1 | 6 | 2 | 1 | 225.98 | 151.73 | 188.86 | 188.85 | 151.09 | 226.62 | 181.69 | 196.02 | 193.42 | 184.29 | 156.29 | 221.42 |
| Family-2 | 6 | 2 | 2 | 155.46 | 113.76 | 134.62 | 134.60 | 107.69 | 161.53 | 122.02 | 147.20 | 122.90 | 146.32 | 102.05 | 167.17 |
Schedule II
Plan Prime - Core Only
| Opt | Cov | Med | 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: 90% | If Employer Pays - Ind / Dep Rate: 75% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 8 | 1 | 0 | 53.23 | 159.69 | 31.94 | 180.98 | 31.94 | 180.98 | 31.94 | 180.98 | 21.29 | 191.63 | 21.29 | 191.63 |
| Family | 8 | 2 | 0 | 109.13 | 327.39 | 143.74 | 292.78 | 87.84 | 348.68 | 65.48 | 371.04 | 133.09 | 303.43 | 77.19 | 359.33 |
MediPrime - Core Only
| Opt | Cov | Med | 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: 90% | If Employer Pays - Ind / Dep Rate: 75% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual-1 | 8 | 1 | 1 | 32.02 | 96.05 | 19.21 | 108.86 | 19.21 | 108.86 | 19.21 | 108.86 | 12.81 | 115.26 | 12.81 | 115.26 |
| Family-1 | 8 | 2 | 1 | 88.05 | 264.16 | 131.28 | 220.93 | 75.24 | 276.97 | 52.83 | 299.38 | 124.88 | 227.33 | 68.84 | 283.37 |
| Family-2 | 8 | 2 | 2 | 66.66 | 199.98 | 88.49 | 178.15 | 53.85 | 212.79 | 40.00 | 226.64 | 82.09 | 184.55 | 47.45 | 219.19 |
Plan Prime - Core Plus All Enhancements
| Opt | Cov | Med | 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: 90% | If Employer Pays - Ind / Dep Rate: 75% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 7 | 1 | 0 | 60.05 | 180.17 | 36.03 | 204.19 | 36.03 | 204.19 | 36.03 | 204.19 | 24.02 | 216.20 | 24.02 | 216.20 |
| Family | 7 | 2 | 0 | 122.30 | 366.92 | 160.53 | 328.69 | 98.28 | 390.94 | 73.38 | 415.84 | 148.52 | 340.70 | 86.27 | 402.95 |
MediPrime - Core Plus All Enhancements
| Opt | Cov | Med | 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: 90% | If Employer Pays - Ind / Dep Rate: 75% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual-1 | 7 | 1 | 1 | 32.32 | 96.96 | 19.39 | 109.89 | 19.39 | 109.89 | 19.39 | 109.89 | 12.93 | 12.93 | 12.81 | 116.35 |
| Family-1 | 7 | 2 | 1 | 94.70 | 284.12 | 144.16 | 234.66 | 81.77 | 297.05 | 56.82 | 322.00 | 137.70 | 75.31 | 68.84 | 303.51 |
| Family-2 | 7 | 2 | 2 | 66.79 | 200.36 | 88.32 | 178.83 | 53.86 | 213.29 | 40.07 | 227.08 | 81.86 | 47.40 | 47.45 | 219.75 |