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.
NY15-30
TO: New York State Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: 2016 New York State Health Insurance Program (NYSHIP) Rates for New York State Enrollees
DATE: November 13, 2015
Attached are the 2016 NYSHIP health benefit rates and Medicare Part B reimbursement rates that become effective January 1, 2016. The NYSHIP rates are presented in the following groupings:
- Empire Plan Rates
- Schedule I – Ratified Groups: CSEA, PEF, UUP, APSU, NYSCOPBA, Council 82, UUP Lifeguards, DC-37, PBA Supervisors and Unrepresented Enrollees
- Schedule II – Ratified Group: PBA Troopers
- Schedule III – Non-Ratified Group: PIA - NYSHIP HMO Rates
- Schedule I – Ratified Groups: CSEA, PEF, UUP, APSU, NYSCOPBA, Council 82, UUP Lifeguards, DC-37, PBA Supervisors and Unrepresented Enrollees
- Schedule II – Ratified Group: PBA Troopers
- Schedule III – Non-Ratified Group: PIA - Dental and Vision Rates
- Student Employee Health Plan Rates for Graduate Student Employees
The attached schedules reflect the rates applicable to employees in the various bargaining units based on the status and terms of each group’s agreement with the State.
The Empire Plan rates, in aggregate, will increase 7.4%. The percentage change for the individual and family rates vary due to the separate rating of enrollee and dependent experience as well as the impact of the collective bargaining agreements in effect for the respective groups.
Overall, the HMO rates have increased an average of 3.6%. The actual percentage change varies by HMO and coverage type (Individual vs. Family). The change in the employee deduction for each HMO can vary due to the impact of the HMO capping formula. The capping formula affects 18 of the 19 HMO option codes for individual coverage and 14 of the 19 HMO option codes for family coverage.
If you have any questions about this rate change, please contact the HBA Help Line at (518) 474-2780 and a processor will assist you.
Attachments:
2016 NYS Biweekly Empire Plan Rates (Schedule I, II and III)2016 NYS Biweekly HMO Ratified Rates (Schedule I)
2016 NYS PBA-Troopers Biweekly HMO Ratified Rates (Schedule II)
2016 NYS PIA Biweekly HMO Non-Ratified Rates (Schedule III)
2016 NYS Dental and Vision Rates
2016 Biweekly SEHP Rates