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
NY09-39
PE09-30
TO: State Agency and Participating Employer Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Empire Plan Basic Medical Program and Non-Network Mental Health and Substance Abuse Practitioner Services Annual Deductible and Coinsurance Maximum Amounts for 2010
DATE: September 2, 2009
Attached is a chart showing The Empire Plan Basic Medical Program and Non-Network Mental Health and Substance Abuse Practitioner Services Annual Deductible and Coinsurance Maximum for calendar year 2010. You may want to distribute or post it, or 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 2009 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), the Basic Medical Program and Non-Network Mental Health and Substance Abuse Practitioner Services annual deductible is $375 and the coinsurance maximum is $1,033. Employees in the Excelsior Plan have a Basic Medical Program and Non-Network Mental Health and Substance Abuse Practitioner Services annual deductible of $750 and a coinsurance maximum of $2,500.
Please post until March 1, 2010
EMPIRE PLAN Basic Medical Program
and Non-Network Mental Health
and Substance Abuse Practitioner Services
Effective January 1, 2010
| 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 and NYSCOPBA (Contract Affected) or per enrollee; per spouse or domestic partner; per all dependent children combined for all other groups listed below) |
|---|---|---|
| Executive Branch CSEA |
$250 | $500/$300*** |
| DC 37 | $290 CPI** | $620 CPI**/ $300*** |
| PBA - Troopers | $375 CPI** | $826 CPI** |
| PBA - Supervisors | $375 CPI** | $826 CPI** |
| PIA | $375 CPI** | $826 CPI** |
| Council 82 | $375 CPI** | $1,389 CPI** |
| ALESU | $375 CPI** | $1,389 CPI** |
| NYSCOPBA (Contract Affected) NYSCOPBA (Arbitration Eligible) |
$375 CPI** $375 CPI** |
$1,389 CPI** $800 |
| UUP | $375 CPI** | $1,033 |
| PEF | $375 CPI** | $1,033 |
| M/C | $375 CPI** | $1,033 |
| Legislature | $375 CPI** | $1,033 |
| Participating Employers | $375 CPI** | $1,033 |
| Unified Court System | $250 | $500/$300*** |
| Retirees, Vestees, Dependent Survivors and Preferred List |
$375 CPI** | $1,033 |
*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 3.3% 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, 2008 through June 30, 2009.
***The coinsurance maximum out-of-pocket expense will be reduced to $300 for calendar year 2010 for employees in (or equated to) salary grade 6 or below on January 1, 2010. 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.