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
PA98-15
TO: Participating Agency Health Benefits Insurance Administrators
FROM: Employee Benefits Division
SUBJECT: New York State Health Insurance Program
DATE: November 23, 1998
November 23, 1998
Dear Participating Agency Health Benefits Insurance Administrator:
Attached are the 1999 rates for the New York State Health Insurance Program (NYSHIP). Schedule I represents the full share rates, the COBRA rates and the NYS Continuity of Coverage rates. Schedule II represents the Employee/Employer Variable Contribution Rate Table (PS-SOB). The centralized billing for January 1998 coverage will reflect the new rates.
The net Five-Tier Mediprime rates for the Core plus enhancements option have in the aggregate increased 7.2%. Among the factors contributing to the rate action are:
- A 1998 premium base driving a projected dividend representing 1.6% of premium.
- Going forward trend of 6.6%.
- A 16% reduction in dividend applied against the gross premium liability.
- The award of the Prescription Drug Program to Cigna and the award of the Mental Health and Substance Abuse Program to Group Health Incorporated.
The 1999 rates include application of 76% of available dividend. The balance of the earned dividend as well as dividend earned in 1998 will be held in reserve to lessen the impact of future premium increases.
Medicare Premium
The Health Care Financing Administration has announced that the monthly Medicare Part B Premium will increase to $45.50 in 1999.
Retiree Deductions
Retiree pension deductions for health insurance will change in the checks issued by the retirement systems at the end of November 1998. This November deduction pays for January coverage.
Participating Agency Administrative Charge
The 1998 monthly administrative charge agency fee will increase 36.8% from $14.25 to $19.50 while the per enrollee charge will increase 34.2% from $1.065 to $1.43. Please recognize that this large percentage increase is a function of certain non-recurring items and that this administrative expense component is less than .4% of premium. Any difference between the actual and estimated costs will be a factor in the development of the 2000 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 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 EMPLOYEES HEALTH INSURANCE PROGRAM
NEW YORK STATE DEPARTMENT OF CIVIL SERVICE
W. AVERELL HARRIMAN
STATE OFFICE BUILDING CAMPUS
ALBANY, NEW YORK 12239
EMPLOYEE-EMPLOYER VARIABLE CONTRIBUTION RATE TABLE
Monthly rates Effective January 1, 1999
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 | 233.20 | 247.05 | 4.94 | 251.99 | 201.28 |
| Family | 8 | 2 | 0 | 476.31 | 507.42 | 10.15 | 517.57 | 414.80 |
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- 1 | 8 | 1 | 1 | 169.33 | 178.22 | COBRA N/A | COBRA N/A | Continuity N/A |
| Family - 1 | 8 | 2 | 1 | 413.18 | 439.33 | COBRA N/A | COBRA N/A | Continuity N/A |
| Family - 2 | 8 | 2 | 2 | 348.51 | 369.71 | COBRA N/A | COBRA N/A | Continuity N/A |
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 | 261.18 | 279.56 | 5.59 | 285.15 | 233.79 |
| Family | 7 | 2 | 0 | 531.89 | 573.33 | 11.47 | 584.80 | 480.71 |
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 | 175.61 | 186.46 | COBRA N/A | COBRA N/A | Continuity N/A |
| Family - 1 | 7 | 2 | 1 | 447.05 | 480.95 | COBRA N/A | COBRA N/A | Continuity N/A |
| Family - 2 | 7 | 2 | 2 | 360.66 | 387.05 | COBRA N/A | COBRA N/A | Continuity N/A |
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 | 260.48 | 277.67 | 5.55 | 283.22 | 231.90 |
| Family | 6 | 2 | 0 | 530.54 | 568.84 | 11.38 | 580.22 | 476.22 |
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 | 175.61 | 186.36 | COBRA N/A | COBRA N/A | Continuity N/A |
| Family - 1 | 6 | 2 | 1 | 446.33 | 478.26 | COBRA N/A | COBRA N/A | Continuity N/A |
| Family - 2 | 6 | 2 | 2 | 360.73 | 386.15 | COBRA N/A | COBRA N/A | Continuity N/A |
EMPLOYEE-EMPLOYER VARIABLE CONTRIBUTION RATE TABLE
Monthly rates Effective January 1, 1999
Participating Agencies
If Employer Pays - Ind/Dep Rate
Plan Prime - Core Only
| | Opt | Cov | Med | 100% | 65% | 100% | 75% | 100% | 80% | 100% | 90% | 100% | 95% | 100% | 100% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 8 | 1 | 0 | 0.00 | 233.20 | 0.00 | 233.20 | 0.00 | 233.20 | 0.00 | 233.20 | 0.00 | 233.20 | 0.00 | 233.20 |
| Family | 8 | 2 | 0 | 85.09 | 391.22 | 60.78 | 415.53 | 48.62 | 427.69 | 24.31 | 452.00 | 12.16 | 464.15 | 0.00 | 476.31 |
MediPrime - Core Only
| | Opt | Cov | Med | 50% | 35% | 50% | 50% | 60% | 60% | 65% | 45% | 75% | 35% | 75% | 50% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual - 1 | 8 | 1 | 1 | 0.00 | 169.33 | 0.00 | 169.33 | 0.00 | 169.33 | 0.00 | 169.33 | 0.00 | 169.33 | 0.00 | 169.33 |
| Family - 1 | 8 | 2 | 1 | 85.35 | 327.83 | 60.96 | 352.22 | 48.77 | 364.41 | 24.38 | 388.80 | 12.19 | 400.99 | 0.00 | 413.18 |
| Family - 2 | 8 | 2 | 2 | 62.71 | 285.80 | 44.79 | 303.72 | 35.84 | 312.67 | 17.92 | 330.59 | 8.96 | 339.55 | 0.00 | 348.51 |
Plan Prime - Core Plus All Enhancements
| | Opt | Cov | Med | 100% | 65% | 100% | 75% | 100% | 80% | 100% | 90% | 100% | 95% | 100% | 100% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 7 | 1 | 0 | 0.00 | 261.18 | 0.00 | 261.18 | 0.00 | 261.18 | 0.00 | 261.18 | 0.00 | 261.18 | 0.00 | 261.18 |
| Family | 7 | 2 | 0 | 94.75 | 437.14 | 67.68 | 464.21 | 54.14 | 477.75 | 27.07 | 504.82 | 13.54 | 518.35 | 0.00 | 531.89 |
MediPrime - Core Plus All Enhancements
| | Opt | Cov | Med | 50% | 35% | 50% | 50% | 60% | 60% | 65% | 45% | 75% | 35% | 75% | 50% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual - 1 | 7 | 1 | 1 | 0.00 | 175.61 | 0.00 | 175.61 | 0.00 | 175.61 | 0.00 | 175.61 | 0.00 | 175.61 | 0.00 | 175.61 |
| Family - 1 | 7 | 2 | 1 | 95.00 | 352.05 | 67.86 | 379.19 | 54.29 | 392.76 | 27.14 | 419.91 | 13.57 | 433.48 | 0.00 | 447.05 |
| Family - 2 | 7 | 2 | 2 | 64.77 | 295.89 | 46.26 | 314.40 | 37.01 | 323.65 | 18.50 | 342.16 | 9.25 | 351.41 | 0.00 | 360.66 |
Plan Prime - Core Plus Medical Enhancements
| | Opt | Cov | Med | 100% | 65% | 100% | 75% | 100% | 80% | 100% | 90% | 100% | 95% | 100% | 100% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 6 | 1 | 0 | 0.00 | 260.48 | 0.00 | 260.48 | 0.00 | 260.48 | 0.00 | 260.48 | 0.00 | 260.48 | 0.00 | 260.48 |
| Family | 6 | 2 | 0 | 94.52 | 436.02 | 67.51 | 463.03 | 54.01 | 476.53 | 27.01 | 503.53 | 13.50 | 517.04 | 0.00 | 530.54 |
MediPrime - Core Plus Medical Enhancements
| | Opt | Cov | Med | 50% | 35% | 50% | 50% | 60% | 60% | 65% | 45% | 75% | 35% | 75% | 50% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual - 1 | 6 | 1 | 1 | 0.00 | 175.61 | 0.00 | 175.61 | 0.00 | 175.61 | 0.00 | 175.61 | 0.00 | 175.61 | 0.00 | 175.61 |
| Family - 1 | 6 | 2 | 1 | 94.74 | 351.59 | 67.67 | 378.66 | 54.13 | 392.20 | 27.06 | 419.27 | 13.53 | 432.80 | 0.00 | 446.33 |
| Family - 2 | 6 | 2 | 2 | 64.79 | 295.94 | 46.28 | 314.45 | 37.02 | 323.71 | 18.51 | 342.22 | 9.26 | 351.47 | 0.00 | 360.73 |
1999 Medicare: $45.50
Plan Prime - Core Only
| | Opt | Cov | Med | 90% | 85% | 90% | 90% | 95% | 85% | 95% | 95% | 100% | 35% | 100% | 50% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 8 | 1 | 0 | 23.32 | 209.88 | 23.32 | 209.88 | 11.66 | 221.54 | 11.66 | 221.54 | 0.00 | 233.20 | 0.00 | 233.20 |
| Family | 8 | 2 | 0 | 59.79 | 416.52 | 47.63 | 428.68 | 48.13 | 428.18 | 23.82 | 452.49 | 158.02 | 318.29 | 121.55 | 354.76 |
MediPrime - Core Only
| | Opt | Cov | Med | 90% | 85% | 90% | 90% | 95% | 85% | 95% | 95% | 100% | 35% | 100% | 50% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual - 1 | 8 | 1 | 1 | 16.93 | 152.40 | 16.93 | 152.40 | 8.47 | 160.86 | 8.47 | 160.86 | 0.00 | 169.33 | 0.00 | 169.33 |
| Family - 1 | 8 | 2 | 1 | 53.51 | 359.67 | 41.31 | 371.87 | 45.05 | 368.13 | 20.66 | 392.52 | 158.50 | 254.68 | 121.92 | 291.26 |
| Family - 2 | 8 | 2 | 2 | 43.81 | 304.70 | 34.85 | 313.66 | 35.35 | 313.16 | 17.43 | 331.08 | 116.47 | 232.04 | 89.59 | 258.92 |
Plan Prime - Core Plus All Enhancements
| | Opt | Cov | Med | 90% | 85% | 90% | 90% | 95% | 85% | 95% | 95% | 100% | 35% | 100% | 50% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 7 | 1 | 0 | 26.12 | 235.06 | 26.12 | 235.06 | 13.06 | 248.12 | 13.06 | 248.12 | 0.00 | 261.18 | 0.00 | 261.18 |
| Family | 7 | 2 | 0 | 66.73 | 465.16 | 53.19 | 478.70 | 53.67 | 478.22 | 26.60 | 505.29 | 175.96 | 355.93 | 135.35 | 396.54 |
MediPrime - Core Plus All Enhancements
| | Opt | Cov | Med | 90% | 85% | 90% | 90% | 95% | 85% | 95% | 95% | 100% | 35% | 100% | 50% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual - 1 | 7 | 1 | 1 | 17.56 | 153.05 | 17.56 | 158.05 | 8.78 | 166.83 | 8.78 | 166.83 | 0.00 | 175.61 | 0.00 | 175.61 |
| Family - 1 | 7 | 2 | 1 | 58.28 | 388.77 | 44.70 | 402.35 | 49.50 | 397.55 | 22.35 | 424.70 | 176.44 | 270.61 | 135.72 | 311.33 |
| Family - 2 | 7 | 2 | 2 | 45.32 | 315.34 | 36.06 | 324.60 | 36.54 | 324.12 | 18.03 | 342.63 | 120.28 | 240.38 | 92.52 | 368.14 |
Plan Prime - Core Plus Medical Enhancements
| | Opt | Cov | Med | 90% | 85% | 90% | 90% | 95% | 85% | 95% | 95% | 100% | 35% | 100% | 50% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | |||
| Individual | 6 | 1 | 0 | 26.05 | 234.43 | 26.05 | 234.43 | 13.02 | 247.46 | 13.02 | 247.46 | 0.00 | 260.48 | 0.00 | 260.48 |
| Family | 6 | 2 | 0 | 66.56 | 463.98 | 53.06 | 477.48 | 53.53 | 477.01 | 26.52 | 504.02 | 175.54 | 355.00 | 135.03 | 295.51 |
MediPrime - Core Plus Medical Enhancements
| | Opt | Cov | Med | 90% | 85% | 90% | 90% | 95% | 85% | 95% | 95% | 100% | 35% | 100% | 50% |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Contributions Are: | | | | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER | EE | ER |
| Individual - 1 | 6 | 1 | 1 | 17.55 | 158.06 | 17.55 | 158.06 | 8.77 | 166.84 | 8.77 | 166.84 | 0.00 | 175.61 | 0.00 | 175.61 |
| Family - 1 | 6 | 2 | 1 | 58.16 | 388.17 | 44.62 | 401.71 | 49.38 | 396.95 | 22.31 | 424.02 | 175.97 | 270.36 | 135.36 | 310.97
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