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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.

New York State of Opportunity

NY15-33
PE15-26

TO: Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: The Empire Plan Annual Maximum Out-of-Pocket, Deductible and Coinsurance Amounts for 2016
DATE: November 30, 2015

The Empire Plan has annual maximum out-of-pocket limits for covered, in-network services/supplies* and combined annual deductible and coinsurance maximum amounts for non-network (Basic Medical Program) services. In 2016, the maximum out-of-pocket limits for covered, in-network services/supplies will be split between the Prescription Drug Program** and the Hospital, Medical/Surgical and Mental Health and Substance Abuse Programs, combined. The combined annual deductible and coinsurance maximum amounts for non-network (Basic Medical Program) services will be shared among the Hospital, Medical/Surgical and Mental Health and Substance Abuse Programs.*** 

Attached is a chart showing the annual maximum out-of-pocket, deductible and coinsurance maximum amounts for 2016 by employee group. Please distribute or post this chart within your agency. You may also want to prepare a posting specific to your agency. If you are a Health Benefits Administrator in an agency with regional offices, please distribute notices to the regional locations as well.

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 * Does not apply to employees represented by PIA.
** Does not apply to Medicare-primary enrollees.
*** Each deductible and maximum coinsurance amount is combined among the Hospital Program (coinsurance only), Home Care Advocacy Program (deductible only), Medical/Surgical Program and Mental Health and Substance Abuse Program.

Please note: There is a separate deductible for non-network services in the Managed Physical Medicine Program.

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Attachment:

2016 Chart