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.
ANDREW M. CUOMO
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
JERRY BOONE
COMMISSIONER
NY13-24
PE13-20
PA13-15
PAEX13-17
TO: New York State Health Benefits Administrators; Participating Employer Health Benefits Administrators; Participating Agency Health Benefits Administrators with The Empire Plan or The Excelsior Plan
FROM: Employee Benefits Division
SUBJECT: 2014 Empire Plan Combined Annual Deductible and Coinsurance Maximum Amounts for Non-Network Services
DATE: November 7, 2013
Below is a chart showing the combined annual deductible and coinsurance maximum amounts for non-network services under The Empire Plan's Hospital, Medical/Surgical and Mental Health and Substance Abuse Programs*, effective January 1, 2014.
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.
Participating Agencies with The Excelsior Plan: Please note the changes to the annual deductible and coinsurance maximum amounts. See memo PAEX 13-16 for more information about The Excelsior Plan Benefit changes for 2014.
* 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.
| Employee Group | Combined Annual Deductible* (per enrollee; per spouse or domestic partner; per all dependent children combined) | Combined Coinsurance Maximum* (per enrollee; per spouse or domestic partner; per all dependent children combined) |
|---|---|---|
| Executive Branch Employee Groups | ||
| APSU | $1,000 | $3,000 |
| Council 82 | $1,000 | $3,000 |
| CSEA | $1,000/$500** | $3,000/$1,500** |
| DC-37 | $329 CPI*** | $705 CPI***/ $300**** |
| M/C | $1,000/$500** | $3,000/$1,500** |
| NYSCOPBA | $1,000/$500** | $3,000/$1,500** |
| PEF | $1,000/$500** | $3,000/$1,500** |
| PBA - Troopers & Supervisors | $426 CPI*** | $939 CPI*** |
| PIA | $426 CPI*** | $939 CPI*** |
| UUP | $1,000/$500** | $3,000/$1,500** |
| Other Employee Groups | ||
| Legislature | $1,000/$500** | $3,000/$1,500** |
| Participating Agencies - Empire Plan | $1,000 | $3,000 |
| Participating Agencies - Excelsior Plan | $1,250 | $4,000 |
| Participating Employers | $1,000 | $3,000 |
| Retirees, Vestees, Dependent Survivors and Preferred List | $1,000 | $3,000 |
| Unified Court System Employees | $1,000/$500** | $3,000/$1,500** |
* 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.
** The annual deductible for calendar year 2014 will be reduced to $500 and the coinsurance maximum will be reduced to $1,500 for CSEA, M/C; Legislature, NYSCOPBA, PEF, UUP and employees of the Unified Court System in (or equated to) Salary Grade 6 or below on January 1, 2014. This reduction is not available to Judges and Justices.
*** These changes reflect the 2.2% 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, 2012 through June 30, 2013.
**** The coinsurance maximum for calendar year 2014 will be reduced to $300 for DC-37 employees in (or equated to) Salary Grade 6 or below on January 1, 2014.
Note: You have no deductible or coinsurance when you use The Empire Plan Participating Provider Program.