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
PA97-19
TO: Participating Agency Health Benefits Insurance Administrator
FROM:
SUBJECT: 1998 Rates for NYSHIP
DATE: November 18, 1997
November 26, 1997
Dear Participating Agency Health Benefits Insurance Administrator:
Attached are the 1998 rates for the New York State Health Insurance Program (NYSHIP). Schedule 1 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 1998 coverage will reflect the new rates.
The net 5 Tier Mediprime rates for the Core plus enhancements option have in the aggregate increased 4.9%. Among the factors contributing to the rate action are:
- Going forward trend of 5.0%.
- A modest increase in the dividend applied against the gross premium liability
- A $6 million charge required to balance premium previously paid by Participating Agencies under the five tier Mediprime rate structure to premium paid by the plan for this coverage under our contractual two tier rate structure (individual and family only).
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. The 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 77% of available dividend. The balance of the earned dividend as well as dividend earned in 1997 will be held in reserve to lessen the impact of future premium increases.
The net rate increase for the Mediprime group is higher than the rate increase for the Plan Prime group because 1998 is the first year that the dividend credit is based on the five tier rate structure. Consequently, while the total Participating Agency dividend remains the same as it would have been under the two tier rate structure, the allocation is different. This results in a lower amount of dividend being allocated to Mediprime. Historically, dividend credits are allocated in relation to the original premiums billed. Since Mediprime premium is lower than PlanPrime premium, the dividend allocation reflects the premium differential. This practice is integral to the 1998 rate development and is the primary reason for the percentage change difference between the Mediprime and PlanPrime groups.
Medicare Premium
The Health Care Financing Administration has announced that there will be no change to the $43.80 monthly Medicare Part B premium in 1998.
Retiree Deductions
Due to the late approval of the 1998 Health Insurance Rates, we were unable to update the pension contributions for your retirees in the November 30, 1997 check as scheduled. Therefore, the December 31, 1997 check will contain the new rate plus an adjustment for the difference between the 1997 and 1998 rates. The January 31, 1998 check will have the regular deduction for the 1998 rate year.
Participating Agency Administrative Charge
The 1998 monthly administrative charge agency fee will decrease 4.5% from $14.92 to $14.25 while the per enrollee charge will increase 15.5% from $.922 to $1.065. The increase in the enrollee fee is a direct result of allocating the fixed charges over a smaller PA enrollment. Any difference between the actual and estimated costs will be a factor in the development of 1999 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.
If you have any questions about this rate change, please contact our Operations Unit at (518) 485-6619.
Sincerely,
Robert W. DuBois
Director
Employee Benefits Division
NEW YORK STATE DEPARTMENT OF CIVIL SERVICE
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, 1998
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 | 213.42 | 233.78 | 4.68 | 238.46 | 192.11 |
| Family | 8 | 2 | 0 | 438.81 | 483.20 | 9.66 | 492.86 | 398.40 |
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 | 144.57 | 161.07 | Cobra Not Applicable | Cobra Not Applicable | Continuity Not Applicable |
| Family - 1 | 8 | 2 | 1 | 370.65 | 411.20 | Cobra Not Applicable | Cobra Not Applicable | Continuity Not Applicable |
| Family - 2 | 8 | 2 | 2 | 301.00 | 337.71 | Cobra Not Applicable | Cobra Not Applicable | Continuity Not Applicable |
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 | 246.07 | 267.89 | 5.36 | 273.25 | 226.22 |
| Family | 7 | 2 | 0 | 503.78 | 552.00 | 11.04 | 563.04 | 467.20 |
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 | 151.34 | 167.91 | Cobra Not Applicable | Cobra Not Applicable | Continuity Not Applicable |
| Family - 1 | 7 | 2 | 1 | 409.76 | 452.73 | Cobra Not Applicable | Cobra Not Applicable | Continuity Not Applicable |
| Family - 2 | 7 | 2 | 2 | 314.25 | 351.98 | Cobra Not Applicable | Cobra Not Applicable | Continuity Not Applicable |
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 | 244.95 | 265.36 | 5.31 | 270.64 | 223.69 |
| Family | 6 | 2 | 0 | 501.61 | 546.09 | 10.92 | 557.01 | 461.29 |
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 | 151.35 | 167.82 | Cobra Not Applicable | Cobra Not Applicable | Continuity Not Applicable |
| Family - 1 | 6 | 2 | 1 | 408.71 | 449.26 | Cobra Not Applicable | Cobra Not Applicable | Continuity Not Applicable |
| Family - 2 | 6 | 2 | 2 | 314.34 | 350.95 | Cobra Not Applicable | Cobra Not Applicable | Continuity Not Applicable |
NEW YORK STATE EMPLOYEES HEALTH INSURANCE PROGRAM
EMPLOYEE-EMPLOYER VARIABLE CONTRIBUTION RATE TABLE
Monthly rates Effective January 1, 1998
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% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 8 | 1 | 0 | 0.00 | 213.42 | 0.00 | 213.42 | 0.00 | 213.42 | 0.00 | 213.42 | 0.00 | 213.42 |
| Family | 8 | 2 | 0 | 78.89 | 359.92 | 56.35 | 382.46 | 45.08 | 393.73 | 22.54 | 416.27 | 11.27 | 427.54 |
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% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual - 1 | 8 | 1 | 1 | 0.00 | 144.57 | 0.00 | 144.57 | 0.00 | 144.57 | 0.00 | 144.57 | 0.00 | 144.57 |
| Family - 1 | 8 | 2 | 1 | 79.13 | 291.52 | 56.52 | 314.13 | 45.22 | 325.43 | 22.61 | 348.04 | 11.30 | 359.35 |
| Family - 2 | 8 | 2 | 2 | 54.75 | 246.25 | 39.11 | 261.89 | 31.29 | 269.71 | 15.64 | 285.36 | 7.82 | 293.18 |
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% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 7 | 1 | 0 | 0.00 | 246.07 | 0.00 | 246.07 | 0.00 | 246.07 | 0.00 | 246.07 | 0.00 | 246.07 |
| Family | 7 | 2 | 0 | 90.20 | 413.58 | 64.43 | 439.35 | 51.54 | 452.24 | 25.77 | 478.01 | 12.89 | 490.89 |
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% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual - 1 | 7 | 1 | 1 | 0.00 | 151.34 | 0.00 | 151.34 | 0.00 | 151.34 | 0.00 | 151.34 | 0.00 | 151.34 |
| Family - 1 | 7 | 2 | 1 | 90.45 | 319.31 | 64.60 | 345.16 | 51.68 | 358.08 | 25.84 | 383.92 | 12.92 | 396.84 |
| Family - 2 | 7 | 2 | 2 | 57.02 | 257.23 | 40.73 | 273.52 | 32.58 | 281.67 | 16.29 | 297.96 | 8.15 | 306.10 |
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% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 6 | 1 | 0 | 0.00 | 244.95 | 0.00 | 244.95 | 0.00 | 244.95 | 0.00 | 244.95 | 0.00 | 244.95 |
| Family | 6 | 2 | 0 | 89.83 | 411.78 | 64.16 | 437.45 | 51.33 | 450.28 | 25.67 | 475.94 | 12.83 | 488.78 |
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% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual - 1 | 6 | 1 | 1 | 0.00 | 151.35 | 0.00 | 151.35 | 0.00 | 151.35 | 0.00 | 151.35 | 0.00 | 151.35 |
| Family - 1 | 6 | 2 | 1 | 90.08 | 318.63 | 64.34 | 344.37 | 51.47 | 357.24 | 25.74 | 382.97 | 12.87 | 395.84 |
| Family - 2 | 6 | 2 | 2 | 57.05 | 257.29 | 40.75 | 273.59 | 32.60 | 281.74 | 16.30 | 298.04 | 8.14 | 306.20 |
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% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 8 | 1 | 0 | 21.34 | 192.08 | 21.34 | 192.08 | 10.67 | 202.75 | 10.67 | 202.75 | 0.00 | 213.42 |
| Family | 8 | 2 | 0 | 55.15 | 383.66 | 43.88 | 394.93 | 44.48 | 394.33 | 21.94 | 416.87 | 146.50 | 146.50 |
MediPrime - 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% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual - 1 | 8 | 1 | 1 | 14.46 | 130.11 | 14.46 | 130.11 | 7.23 | 137.34 | 7.23 | 137.34 | 0.00 | 144.57 |
| Family - 1 | 8 | 2 | 1 | 48.37 | 322.28 | 37.07 | 333.58 | 41.14 | 329.51 | 18.53 | 352.12 | 146.95 | 223.70 |
| Family - 2 | 8 | 2 | 2 | 37.92 | 263.08 | 30.10 | 270.90 | 30.69 | 270.31 | 15.05 | 285.95 | 101.68 | 199.32 |
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% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 7 | 1 | 0 | 24.61 | 221.46 | 24.61 | 221.46 | 12.30 | 233.77 | 12.30 | 233.77 | 0.00 | 246.07 |
| Family | 7 | 2 | 0 | 63.27 | 440.51 | 50.38 | 453.40 | 50.96 | 452.82 | 25.19 | 478.59 | 167.51 | 336.27 |
MediPrime - 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% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual - 1 | 7 | 1 | 1 | 15.13 | 136.21 | 15.13 | 136.21 | 7.57 | 143.77 | 7.57 | 143.77 | 0.00 | 151.34 |
| Family - 1 | 7 | 2 | 1 | 53.89 | 355.87 | 40.97 | 368.79 | 46.33 | 363.43 | 20.49 | 389.27 | 167.97 | 241.79 |
| Family - 2 | 7 | 2 | 2 | 39.57 | 274.68 | 31.42 | 282.83 | 32.01 | 282.24 | 15.72 | 298.53 | 105.89 | 208.36 |
Plan Prime - Core Plus Medical 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% | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 6 | 1 | 0 | 24.49 | 220.46 | 24.49 | 220.46 | 12.25 | 232.70 | 12.25 | 232.70 | 0.00 | 244.95 |
| Family | 6 | 2 | 0 | 62.99 | 438.62 | 50.16 | 451.45 | 50.75 | 450.86 | 25.08 | 476.53 | 166.83 | 334.78 |
MediPrime - Core Plus Medical 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% |
|---|