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.
DAVID A. PATERSON
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
NANCY G. GROENWEGEN
COMMISSIONER
NY08-29
PE08-22
TO: State Agency and Participating Employer Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Empire Plan Basic Medical Program and Non-Network Mental Health Practitioner Services Annual Deductible and Coinsurance Maximum Amounts for 2009
DATE: September 30, 2008
On the reverse side of this memo is a chart showing The Empire Plan Basic Medical Program and Non-Network Mental Health Practitioner Services Annual Deductible and Coinsurance Maximum for calendar year 2009. You may want to copy and post it, or you may 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.
These changes will be announced in the December 2008 Empire Plan Reports.
Note: If your agency has any enrollees with dual coverage through a spouse who is enrolled in The Empire Plan through a NYSHIP Participating Agency (local government or school district), you may find the following information useful:
Basic Medical Program
and Non-Network Mental Health Practitioner Services
Effective January 1, 2009
| Participating Agency Employee/Retiree Group | Annual Deductible* (per enrollee; per spouse or domestic partner; per all dependent children combined) | Coinsurance Maximum* (Out-of-Pocket Expense per enrollee; per spouse or domestic partner; per all dependent children combined) |
|---|---|---|
| Empire Plan |
$363 CPI**
|
$1,000
|
| Excelsior Plan 1 |
$750
|
$2,500
|
1 The Excelsior Plan is a new, more affordable NYSHIP option available to local government employees as of July 1, 2008. This plan replaces the Core option as of January 1, 2009.
Please post until March 1, 2009
EMPIRE PLAN Basic Medical Program
and Non-Network Mental Health Practitioner Services
Effective January 1, 2009
| Employee Group |
Annual Deductible*
(per enrollee; per spouse or domestic partner; per all dependent children combined) |
Coinsurance Maximum*
(Out-of-Pocket Expense per contract for Council 82, ALESU, NYSCOPBA and PIA or per enrollee; per spouse or domestic partner; per all dependent children combined for all other groups listed below) |
|---|---|---|
| Executive Branch: CSEA |
$225
|
$500/$300***
|
| Executive Branch: DC 37 |
$281 CPI**
|
$600 CPI*/ $300***
|
| Executive Branch: PBA - Troopers |
$363 CPI**
|
$800
|
| Executive Branch: PBA - Supervisors |
$363 CPI**
|
$800
|
| Executive Branch: PIA |
$363 CPI**
|
$1,345 CPI**
|
| Executive Branch: Council 82 |
$363 CPI**
|
$1,345 CPI**
|
| Executive Branch: ALESU |
$363 CPI**
|
$1,345 CPI**
|
| Executive Branch: NYSCOPBA |
$363 CPI**
|
$1,345 CPI**
|
| Executive Branch: UUP |
$363 CPI**
|
$1,000
|
| Executive Branch: PEF |
$363 CPI**
|
$1,000
|
| Executive Branch: M/C |
$363 CPI**
|
$1,000
|
| Legislature |
$363 CPI**
|
$1,000
|
| Participating Employers |
$363 CPI**
|
$1,000
|
| Unified Court System |
$225
|
$500/$300***
|
| Retirees, Vestees, Dependent Survivors and Preferred List |
$$363 CPI**
|
$1,000
|
* Each program’s deductible, coinsurance and maximum coinsurance amount is separate and not combined with any other deductible, coinsurance or maximum coinsurance amount.
** These changes reflect the 4.1% increase in the medical care component of the Consumer Price Index for Urban Wage Earners and Clerical Workers, all Cities (C.P.I.-W.) for the period July 1, 2007 through June 30, 2008.
*** The coinsurance maximum out-of-pocket expense will be reduced to $300 for calendar year 2009 for employees in (or equated to) salary grade 6 or below on January 1, 2009. This reduction is not available to Judges and Justices.
Note: You have no deductible or coinsurance when you use The Empire Plan Participating Provider Program.