2009 Health Insurance Contribution Biweekly Rates, 2009 Dental and Vision Rates for Leave without Pay

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

STATE OF NEW YORK
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov

NANCY G. GROENWEGEN
COMMISSIONER

NY08-37

TO: State Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: 2009 Health Insurance Contribution Biweekly Rates, 2009 Dental and Vision Rates for Leave without Pay
DATE: December 4, 2008

Attached are the 2009 New York State Health Insurance Program (NYSHIP) premium rates and Medicare Part "B" reimbursement rates effective January 1, 2009. The NYSHIP rates are presented in three basic groupings:

Schedule I – Settled With Drug Coverage
Schedule II – Unsettled With Drug Coverage
Schedule III – CSEA and Courts

These schedules differentiate the rates applicable to employees in bargaining units whose contract negotiations have remained unsettled, from those that have reached agreement with the Governor’s Office of Employee Relations.

The Empire Plan rates, in aggregate, will increase 1.15%. The percentage changes for individual and family rates vary due to the separate rating of enrollee and dependent experience as well as the bargaining status of the respective groups.

Overall, the HMO rates have increased an average of 15.2%, with varying percentage changes for both individual HMOs and coverage types. The increase in the employee deduction by HMO can vary significantly due to the impact of the HMO capping formulas. The capping formula affects 18 of the 20 HMO option codes for individual and family coverage.

Employee deductions will be changed automatically through PayServ as follows:

Employees Exempt from Lag Payroll

Administrative payroll checks dated December 10, 2008
Institution payroll checks dated December 18, 2008

Employees Subject to Lag Payroll

Administrative payroll checks dated December 24, 2008
Institution payroll checks dated December 31, 2008

Questions may be directed to your processor.

NYS Health Insurance Program
Dental and Vision Rates
Effective January 1, 2009

Biweekly Benefit Programs Dental Program

A02, A04, A05, A07, A09, A10, A11, A15, A17, A19, A22, A23, A24, A25, A33, A35, A36, A37, A43, A46, A48, A50, A51, L19, R11, R16, R17, R18, R19, R20, R25, R61, R69, R75

Full Share LWOP rates

	Biweekly	Monthly
Individual	$ 13.03	$ 28.32
Family	$ 34.17	$ 74.24

Biweekly Benefit Programs Vision Program

A02, A04, A05, A09, A10, A11, A22, A23, A24, A33, R16, R17, R18, R19, R20, R61, R69, R75

Full Share LWOP rates

	Biweekly	Monthly
Individual	$ 1.65	$ 3.59
Family	$ 4.43	$ 9.62

Biweekly Benefit Programs Vision Program With Laser Benefits

A25, A37, A50, A51

Full Share LWOP rates

	Biweekly	Monthly
Individual	$ 3.90	$ 8.47
Family	$ 6.67	$ 14.50

January 1, 2009 Premium Rate Change
NYS Health Insurance Program Biweekly Rates

Administrative Paycheck December 10, 2008 - Employees exempt from Lag Payroll
Administrative Paycheck December 24, 2008 - Employees subject to Lag Payroll
Institution Paycheck December 31, 2008 - Employees subject to Lag Payroll
Institution Paycheck December 18, 2008 - Employees not subject to Lag Payroll

*Medicare : 44.37

Schedule I
Drug Coverage
Benefit Programs: A02, A03, A05, A06, A07, A09, A10, A11, A12, A19, A22, A23, A28, A29, A33, A34 A35, A40, L19

Empire Plan	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	001	1	0	22.16	221.64
Medicare	001	1	1	(22.21)	177.27
Family	001	4	0	97.06	521.24
1 Medicare	001	4	1	52.69	476.87
2 Medicares	001	4	2	8.32	432.50

Schedule II
Unsettled
Benefit Programs: A04, A24, A25, A37, A48, A50, A51

Empire Plan	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	001	1	0	22.61	226.11
Medicare	001	1	1	(21.76)	181.74
Family	001	4	0	98.77	530.75
1 Medicare	001	4	1	54.40	486.38
2 Medicares	001	4	2	10.03	442.01

Rates include Medical Only

* Medicare :
Biweekly 44.37
Monthly 96.40

Schedule lll
CSEA & COURTS
Benefit Programs: A01, A13, A14, A15, A17, A20, A21, A36, A39, A41, A43, A44, A45, A46, A47

Empire Plan	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	001	1	0	22.46	224.63
Medicare	001	1	1	(21.91)	128.23
Family	001	4	0	98.16	527.44
1 Medicare	001	4	1	53.79	431.04
2 Medicares	001	4	2	9.42	334.64

*Medicare: 44.37

Schedule I
Drug Coverage
Benefit Programs: A01, A02, A03, A05, A06, A07, A09, A10, A11, A12, A13, A14, A15, A17, A19, A20, A21, A22, A23, A28, A29 A33, A34, A35, A36, A39, A40, A41 A42, A43, A44, A46, A47, L19

HIP (050)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	050	1	0	34.92	225.00
Medicare	050	1	1	(9.45)	180.63
Family	050	4	0	129.53	551.15
1 Medicare	050	4	1	85.16	506.78
2 Medicares	050	4	2	40.79	462.41

Univera Healthcare - WNY, Inc (057)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	057	1	0	92.73	260.34
Medicare	057	1	1	48.36	215.97
Family	057	4	0	343.26	719.65
1 Medicare	057	4	1	298.89	675.28
2 Medicares	057	4	2	254.52	630.91

Preferred Care (058)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	058	1	0	17.56	175.63
Medicare	058	1	1	(26.81)	131.26
Family	058	4	0	83.20	438.20
1 Medicare	058	4	1	38.83	393.83
2 Medicares	058	4	2	(5.54)	349.46

Independent Health - Western NY (059)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	059	1	0	21.26	206.52
Medicare	059	1	1	(23.11)	162.15
Family	059	4	0	126.99	543.59
1 Medicare	059	4	1	82.62	499.22
2 Medicares	059	4	2	38.25	454.85

MVP Health Care, Inc. - East Region (060)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	060	1	0	17.68	176.77
Medicare	060	1	1	(26.69)	132.40
Family	060	4	0	87.86	457.51
1 Medicare	060	4	1	43.49	413.14
2 Medicares	060	4	2	(0.88)	368.77

Capital District PHP - Capital (063)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	063	1	0	18.91	189.08
Medicare	063	1	1	(25.46)	144.71
Family	063	4	0	93.04	485.60
1 Medicare	063	4	1	48.67	441.23
2 Medicares	063	4	2	4.30	396.86

Blue Choice (066)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	066	1	0	22.53	194.89
Medicare	066	1	1	(21.84)	150.52
Family	066	4	0	106.78	490.41
1 Medicare	066	4	1	62.41	446.04
2 Medicares	066	4	2	18.04	401.67

Community Blue (067)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	067	1	0	38.86	230.78
Medicare	067	1	1	(5.51)	186.41
Family	067	4	0	202.20	640.48
1 Medicare	067	4	1	157.83	596.11
2 Medicares	067	4	2	113.46	551.74

HMO Blue - CNY (072)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	072	1	0	66.28	249.24
Medicare	072	1	1	21.91	204.87
Family	072	4	0	232.48	635.34
1 Medicare	072	4	1	188.11	590.97
2 Medicares	072	4	2	143.74	546.60

HMO Blue - Utica/Watertown (160)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	160	1	0	31.77	215.47
Medicare	160	1	1	(12.60)	171.10
Family	160	4	0	169.93	578.08
1 Medicare	160	4	1	125.56	533.71
2 Medicares	160	4	2	81.19	489.34

Aetna (210)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	210	1	0	97.26	273.07
Medicare	210	1	1	52.89	228.70
Family	210	4	0	363.03	746.04
1 Medicare	210	4	1	318.66	701.67
2 Medicares	210	4	2	274.29	657.30

GHI HMO Albany Region (220)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	220	1	0	42.54	228.76
Medicare	220	1	1	(1.83)	184.39
Family	220	4	0	185.78	601.72
1 Medicare	220	4	1	141.41	557.35
2 Medicares	220	4	2	97.04	512.98

Empire BlueCross BlueShield HMO - Upstate (280)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	280	1	0	60.17	256.32
Medicare	280	1	1	15.80	211.95
Family	280	4	0	228.20	669.13
1 Medicare	280	4	1	183.83	624.76
2 Medicares	280	4	2	139.46	580.39

Empire BlueCross BlueShield HMO - Downstate (290)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	290	1	0	82.62	279.23
Medicare	290	1	1	38.25	234.86
Family	290	4	0	286.97	728.95
1 Medicare	290	4	1	242.60	684.58
2 Medicares	290	4	2	198.23	640.21

Capital District PHP - Central (300)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	300	1	0	44.48	223.54
Medicare	300	1	1	0.11	179.17
Family	300	4	0	173.98	574.07
1 Medicare	300	4	1	129.61	529.70
2 Medicares	300	4	2	85.24	485.33

Capital District PHP - W. Hudson Valley (310)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	310	1	0	50.24	228.64
Medicare	310	1	1	5.87	184.27
Family	310	4	0	188.61	587.16
1 Medicare	310	4	1	144.24	542.79
2 Medicares	310	4	2	99.87	498.42

Empire BlueCross BlueShield HMO - Mid-Hudson (320)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	320	1	0	105.69	301.87
Medicare	320	1	1	61.32	257.50
Family	320	4	0	347.14	788.12
1 Medicare	320	4	1	302.77	743.75
2 Medicares	320	4	2	258.40	699.38

MVP Health Care, Inc. - Central Region (330)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	330	1	0	38.04	209.77
Medicare	330	1	1	(6.33)	165.40
Family	330	4	0	161.35	542.91
1 Medicare	330	4	1	116.98	498.54
2 Medicares	330	4	2	72.61	454.17

MVP Health Care, Inc. - Mid-Hudson (340)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	340	1	0	56.19	230.22
Medicare	340	1	1	11.82	185.85
Family	340	4	0	209.09	595.82
1 Medicare	340	4	1	164.72	551.45
2 Medicares	340	4	2	120.35	507.08

GHI HMO - HV & Ulster Regions (350)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	350	1	0	59.24	245.46
Medicare	350	1	1	14.87	201.09
Family	350	4	0	237.02	652.95
1 Medicare	350	4	1	192.65	608.58
2 Medicares	350	4	2	148.28	564.21

MVP Health Care Inc - North Region (360)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	360	1	0	59.41	233.44
Medicare	360	1	1	15.04	189.07
Family	360	4	0	217.42	604.15
1 Medicare	360	4	1	173.05	559.78
2 Medicares	360	4	2	128.68	515.41

January 1, 2009 Premium Rate Change
NYS Health Insurance Program Biweekly Rates
UNSETTLED

*Medicare: 44.37

Schedule I
Drug Coverage
UNSETTLED
Benefit Programs: A04, A24, A25, A37, A48, A50, A51

HIP (050)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	050	1	0	34.25	225.00
Medicare	050	1	1	(10.12)	180.63
Family	050	4	0	128.08	551.15
1 Medicare	050	4072	1	0	65.61	249.24
Medicare	072	1	1	21.24	204.87
Family	072	4	0	231.03	635.34
1 Medicare	072	4	1	186.66	590.97
2 Medicares	072	4	2	142.29	546.60

HMO Blue - Utica/Watertown (160)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	160	1	0	31.10	215.47
Medicare	160	1	1	(13.27)	171.10
Family	160	4	0	168.48	578.08
1 Medicare	160	4	1	124.11	533.71
2 Medicares	160	4	2	79.74	489.34

Aetna (210)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	210	1	0	96.59	273.07
Medicare	210	1	1	52.22	228.70
Family	210	4	0	361.58	746.04
1 Medicare	210	4	1	317.21	701.67
2 Medicares	210	4	2	272.84	657.30

GHI HMO Albany Region (220)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	220	1	0	41.87	228.76
Medicare	220	1	1	(2.50)	184.39
Family	220	4	0	184.33	601.72
1 Medicare	220	4	1	139.96	557.35
2 Medicares	220	4	2	95.59	512.98

Empire BlueCross BlueShield HMO - Upstate (280)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	280	1	0	59.50	256.32
Medicare	280	1	1	15.13	211.95
Family	280	4	0	226.75	669.13
1 Medicare	280	4	1	182.38	624.76
2 Medicares	280	4	2	138.01	580.39

Empire BlueCross BlueShield HMO - Downstate (290)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	290	1	0	81.95	279.23
Medicare	290	1	1	37.58	234.86
Family	290	4	0	285.52	728.95
1 Medicare	290	4	1	241.15	684.58
2 Medicares	290	4	2	196.78	640.21

Capital District PHP - Central (300)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	300	1	0	43.81	223.54
Medicare	300	1	1	(0.56)	179.17
Family	300	4	0	172.53	574.07
1 Medicare	300	4	1	128.16	529.70
2 Medicares	300	4	2	83.79	485.33

Capital District PHP - W. Hudson Valley (310)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	310	1	0	49.57	228.64
Medicare	310	1	1	5.20	184.27
Family	310	4	0	187.16	587.16
1 Medicare	310	4	1	142.79	542.79
2 Medicares	310	4	2	98.42	498.42

Empire BlueCross BlueShield HMO - Mid-Hudson (320)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	320	1	0	105.02	301.87
Medicare	320	1	1	60.65	257.50
Family	320	4	0	345.69	788.12
1 Medicare	320	4	1	301.32	743.75
2 Medicares	320	4	2	256.95	699.38

MVP Health Care, Inc. - Central Region (330)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	330	1	0	37.37	209.77
Medicare	330	1	1	(7.00)	165.40
Family	330	4	0	159.90	542.91
1 Medicare	330	4	1	115.53	498.54
2 Medicares	330	4	2	71.16	454.17

MVP Health Care, Inc. - Mid-Hudson (340)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	340	1	0	55.52	230.22
Medicare	340	1	1	11.15	185.85
Family	340	4	0	207.64	595.82
1 Medicare	340	4	1	163.27	551.45
2 Medicares	340	4	2	118.90	507.08

GHI HMO - HV & Ulster Regions (350)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	350	1	0	58.57	245.46
Medicare	350	1	1	14.20	201.09
Family	350	4	0	235.57	652.95
1 Medicare	350	4	1	191.20	608.58
2 Medicares	350	4	2	146.83	564.21

MVP Health Care Inc - North Region (360)

	OPT	COV	MED	Employee	Full Share/ LWOP
Individual	360	1	0	58.74	233.44
Medicare	360	1	1	14.37	189.07
Family	360	4	0	215.97	604.15
1 Medicare	360	4	1	171.60	559.78
2 Medicares	360	2	4	127.23	515.41

PDF Version

Department of Civil Service

NYS Health Insurance Program Dental and Vision Rates Effective January 1, 2009

Biweekly Benefit Programs Dental Program

Biweekly

Monthly

Biweekly Benefit Programs Vision Program

Biweekly

Monthly

Biweekly Benefit Programs Vision Program With Laser Benefits

Biweekly

Monthly

January 1, 2009 Premium Rate Change NYS Health Insurance Program Biweekly Rates

Schedule I Drug Coverage Benefit Programs: A02, A03, A05, A06, A07, A09, A10, A11, A12, A19, A22, A23, A28, A29, A33, A34 A35, A40, L19

Schedule II Unsettled Benefit Programs: A04, A24, A25, A37, A48, A50, A51

Schedule lll CSEA & COURTS Benefit Programs: A01, A13, A14, A15, A17, A20, A21, A36, A39, A41, A43, A44, A45, A46, A47

Schedule I Drug Coverage Benefit Programs: A01, A02, A03, A05, A06, A07, A09, A10, A11, A12, A13, A14, A15, A17, A19, A20, A21, A22, A23, A28, A29 A33, A34, A35, A36, A39, A40, A41 A42, A43, A44, A46, A47, L19

HIP (050)

Univera Healthcare - WNY, Inc (057)

Preferred Care (058)

Independent Health - Western NY (059)

MVP Health Care, Inc. - East Region (060)

Capital District PHP - Capital (063)

Blue Choice (066)

Community Blue (067)

HMO Blue - CNY (072)

HMO Blue - Utica/Watertown (160)

Aetna (210)

GHI HMO Albany Region (220)

Empire BlueCross BlueShield HMO - Upstate (280)

Empire BlueCross BlueShield HMO - Downstate (290)

Capital District PHP - Central (300)

Capital District PHP - W. Hudson Valley (310)

Empire BlueCross BlueShield HMO - Mid-Hudson (320)

MVP Health Care, Inc. - Central Region (330)

MVP Health Care, Inc. - Mid-Hudson (340)

GHI HMO - HV & Ulster Regions (350)

MVP Health Care Inc - North Region (360)

January 1, 2009 Premium Rate Change NYS Health Insurance Program Biweekly Rates UNSETTLED

Schedule I Drug Coverage UNSETTLED Benefit Programs: A04, A24, A25, A37, A48, A50, A51

HIP (050)

HMO Blue - Utica/Watertown (160)

Aetna (210)

GHI HMO Albany Region (220)

Empire BlueCross BlueShield HMO - Upstate (280)

Empire BlueCross BlueShield HMO - Downstate (290)

Capital District PHP - Central (300)

Capital District PHP - W. Hudson Valley (310)

Empire BlueCross BlueShield HMO - Mid-Hudson (320)

MVP Health Care, Inc. - Central Region (330)

MVP Health Care, Inc. - Mid-Hudson (340)

GHI HMO - HV & Ulster Regions (350)

MVP Health Care Inc - North Region (360)

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NYS Health Insurance Program
Dental and Vision Rates
Effective January 1, 2009

January 1, 2009 Premium Rate Change
NYS Health Insurance Program Biweekly Rates

Schedule I
Drug Coverage
Benefit Programs: A02, A03, A05, A06, A07, A09, A10, A11, A12, A19, A22, A23, A28, A29, A33, A34 A35, A40, L19

Schedule II
Unsettled
Benefit Programs: A04, A24, A25, A37, A48, A50, A51

Schedule lll
CSEA & COURTS
Benefit Programs: A01, A13, A14, A15, A17, A20, A21, A36, A39, A41, A43, A44, A45, A46, A47

Schedule I
Drug Coverage
Benefit Programs: A01, A02, A03, A05, A06, A07, A09, A10, A11, A12, A13, A14, A15, A17, A19, A20, A21, A22, A23, A28, A29 A33, A34, A35, A36, A39, A40, A41 A42, A43, A44, A46, A47, L19

January 1, 2009 Premium Rate Change
NYS Health Insurance Program Biweekly Rates
UNSETTLED

Schedule I
Drug Coverage
UNSETTLED
Benefit Programs: A04, A24, A25, A37, A48, A50, A51