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.
GOVERNOR
DEPARTMENT OF CIVIL SERVICE
ALBANY, NEW YORK 12239
www.cs.ny.gov
COMMISSIONER
DANIEL E. WALL
EXECUTIVE
DEPUTY COMISSIONER
PA00-13
TO: Participating Agency Health Benefits Administrators
FROM: The Employee Benefits Division
SUBJECT: Empire Plan Quarterly Experience Report
DATE: August 31, 2000
Enclosed are the Second Quarter Empire Plan Experience Report for 2000 and the cover letter to Chief Executive Officers.
This report provides projected year 2000 experience and projected premium rates for the year 2001.
August 31, 2000
Dear Chief Executive Officer:
Attached is the Participating Agency Second Quarter Report for 2000. This report provides projected 2000 Empire Plan experience based on claims paid through June 30, 2000, and projected premium rates for 2001.
The Empire Plan carriers are projecting a combined year 2000 surplus of $61.9 million, 2.7% of premium.
The projected premium rates for 2001 are included in Exhibit III. These projections reflect increases in the gross and net premiums of approximately 15.6% and 15.2%, respectively. The report explains the basis for these projections and future reports will include revisions based on additional claims experience.
We are pleased to announce that the New York State Long Term Care Insurance Program will commence in 2001. Please read the "Keeping You Informed" section of this report for more information.
I hope this report is informative and useful to you. If you have any questions, comments or suggestions, please don't hesitate to contact me.
Sincerely,
Robert W. DuBois, CEBS
Director
Employee Benefits Division
EMPIRE PLAN 2000
Second Quarter Experience Report
APRIL - JUNE 2000
Produced for
PARTICIPATING AGENCIES IN THE
NEW YORK STATE
HEALTH INSURANCE PROGRAM
by
the Employee Benefits Division
New York State Department of Civil Service
George C. Sinnott
President, New York State Civil Service Commission
PROJECTED 2000 EMPIRE PLAN EXPERIENCE
Based on claims paid through June 30, 2000, the Empire Plan carriers project a composite dividend of $61.9 million (2.7% of premium), or $3.7 million more than the margin loaded in the 2000 rates. The 2000 annual experience projected by the insurance carriers is reported in Exhibit I.
This modestly higher projected dividend in comparison to the margin load is primarily the blended result of lower projected claims under the Blue Cross component offset by higher projected claims under the UnitedHealthcare (UHC) component. The changes to both carrier projections relate to the 1999 claim base projected at the time the 2000 rates were developed while the expected trend (2000 over 1999) remains generally consistent with the values used in the 2000 rate development.
Though Cigna's dividend projection approximates the margin load, the claims paid in the first six months of the plan year are modestly lower than expected after adjusting for trend. The improved claims experience is not reflected in a larger dividend projection demonstrates the conservatism of insurance carriers. Such projection will be closely examined during the upcoming 2001 rate renewal discussions. Also, any dividends earned under the prescription drug contract will first be used to offset the 1999 loss ($39.8 million).
Historically, the 2nd quarter experience projections have been conservative. Accordingly, there still appears to be room for improvements in the aggregate experience over the remainder of 2000. Any changes in the projected experience for 2000 would also favorably impact the value of the rate projection for plan year 2001.
2001 PREMIUM RATES
Exhibit II presents projected 2001 Empire Plan gross and net premium rates, assuming the application of $68.6 million in dividend to all payors. In the aggregate, the Empire Plan gross premium is projected to increase approximately 15.6% while the net premium is projected to increase 15.2%.
Insurance markets in general and NYSHIP, in particular, are rather dynamic. Given this as well as the apparent caution reflected by the carriers in projecting claims for both 2000 and 2001, the current rate estimates for the year 2001 are considered to be somewhat conservative by the department of Civil Service. A range of the carriers' projected gross and net premium increases is provided in Exhibit II.
For comparison purposes, Exhibit III presents the individual and family rate history for the Core Plus Medical and Psychiatric Enhancements option based on the Two Tier Empire Plan rate structure in effect prior to January 1, 1996, while Exhibit IV presents the five tier history from 1996 to 2001.
KEEPING YOU INFORMED
Long Term Care Insurance Program
Under the provisions of the enabling legislation, Participating Agencies may offer this program to their employees and eligible dependents. The definition of who is eligible for this coverage will be different from the definition for health insurance coverage. We expect that this important new program will offer affordable, valuable protection for employees, dependents and their parents.
We anticipate that the contract for this program will become effective on January 1, 2001, and that you will begin receiving information about this program during the second quarter of next year. As more detailed information becomes available to us we will share it with you in future reports.
Transmission of Reports Electronically
The Employee Benefits Division has the capability to transmit the Participating Agency Quarterly Experience Report via E-mail. Using a software product called Adobe Acrobat Reader™, the PA Quarterly Report is converted into a portable document format (PDF). This is a format that can be read by any recipient, if they have Adobe Acrobat Reader™ installed on their system. Adobe Acrobat Reader™ is available free from Adobe Systems, Inc., at http://www.adobe.com.
There are many advantages to receiving the reports electronically including: reports will be received sooner; there will be less paper to handle; and the reports can be stored electronically and/or a hard copy may be printed.
If you would like to receive the report electronically, please provide your E-mail address by completing the bottom section of Attachment 1 and returning it to the Employee Benefits Division.
PA Regional Meetings
The PA Regional Meetings are being planned for the Fall of 2000. An announcement will be distributed as soon as dates and locations are finalized.
PA-MARKET
PA-MARKET is an internal website which serves as a central resource center for information on health benefits, including: the Empire Plan At A Glance, Empire Plan Reports, Certificate Amendments, HBA and PA Memos, telephone lists, calendar of events/conferences and other general interest items related to benefits. PA-MARKET will become available to you within the next few months. Further details on this new resource are forthcoming.
NYSHIP Representation at Municipal Events
NYSHIP's Empire Plan will be represented at the following municipal events:
- The 2000 Fall Seminar sponsored by the NYS Association of Counties on September 11-12, 2000, in Kerhonkson, NY.
- The Annual Fall Training School sponsored by the NYS Conference of Mayors and the Office of the State Comptroller on September 11-14, 2000, in Lake Placid, NY.
- The 81st Annual Convention and Educational Trade Show sponsored by the NYS School Boards Association on October 19-22, 2000, in Rochester, NY.
Name and Address Changes
Please be sure to notify the Employee Benefits Division of any changes so that we may keep our mailing lists up-to-date. This updated information may be sent to:
Mr. Stephen Kavanaugh
Assistant Director
Employee Benefits Division
NYS Department of Civil Service
State Office Campus, Building #1
Albany, New York 12239
TRANSMISSION OF REPORTS ELECTRONICALLY
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If you would like to receive the report electronically, please complete this form and return it to:
Mr. Stephen Kavanaugh
Assistant Director
Employee Benefits Division
NYS Department of Civil Service
State Office Campus, Building #1
Albany, New York 12239
Agency Code:
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Exhibit I
2000 EMPIRE PLAN EXPERIENCE
In (000's)
|
| BLUE CROSS | UnitedHealthcare MEDICAL - Core | UnitedHealthcare MEDICAL - | UnitedHealthcare MEDICAL - | UnitedHealthcare MEDICAL - | GHI MHSA - Core | GHI MHSA - | GHI MHSA - | GHI MHSA - | CIGNA | TOTAL |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A Premium (1) | 685,840 | 726,353 | 118,366 | 80,428 | 925,147 | 57,779 | 6,531 | 5,507 | 69,817 | 625,064 | 2,305,868 |
| B Incurred Claims (2) | 626,786 | 670,896 | 90,078 | 67,622 | 828,596 | 45,413 | 6,136 | 4,403 | 55,952 | 581,744 | 2,093,078 |
| C Administrative Expense (3) | 31,495 | 75,254 | 10,022 | 7,015 | 92,291 | 9,603 | 1,085 | 916 | 11,604 | 15,411 | 150,801 |
| D Gain/(Loss) (A-B-C) | 27,559 | (19,797) | 18,266 | 5,791 | 4,260 | 2,763 | (690) | 188 | 2,261 | 27,909 | 61,989 |
(1) Earned Premium - Premium that pays for coverage for the period reported (accrual basis).
(2) Incurred Claims - Represents the cost of covered services provided during the period reported by the insurance company (accrual basis).
(3) Administrative Expenses - All charges by the insurance carrier other than for the payment of claims. Includes carrier's cost to administer the program, interest charges, and retention.
Source: 1999 Annual Statement
Exhibit III
EMPIRE PLAN
Participating Agency Premium Rates
Comparison of 2000 and Projected 2001 Rates
CORE ONLY
Plan Prime - Individual
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 261.99 | 296.80 | 13.3% | 256.64 | 287.36 | 12.0% |
| Best Estimate | 261.99 | 305.96 | 16.8% | 256.64 | 296.52 | 15.5% |
| Pessimistic | 261.99 | 315.14 | 20.3% | 256.64 | 305.70 | 19.1% |
Plan Prime - Family
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 540.83 | 611.97 | 13.2% | 529.89 | 592.59 | 11.8% |
| Best Estimate | 540.83 | 630.97 | 16.7% | 529.89 | 611.59 | 15.4% |
| Pessimistic | 540.83 | 650.04 | 20.2% | 529.89 | 630.66 | 19.0% |
MediPrime - Individual
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 209.65 | 246.54 | 17.6% | 206.55 | 241.05 | 16.7% |
| Best Estimate | 209.65 | 250.71 | 19.6% | 206.55 | 245.22 | 18.7% |
| Pessimistic | 209.65 | 254.89 | 21.6% | 206.55 | 249.40 | 20.7% |
MediPrime - Family 1
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 489.15 | 562.87 | 15.1% | 480.46 | 547.44 | 13.9% |
| Best Estimate | 489.15 | 576.88 | 17.9% | 480.46 | 561.45 | 16.9% |
| Pessimistic | 489.15 | 590.95 | 20.8% | 480.46 | 575.52 | 19.8% |
MediPrime - Family 2
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 436.06 | 511.34 | 17.3% | 429.63 | 499.85 | 16.3% |
| Best Estimate | 436.06 | 520.37 | 19.3% | 429.63 | 508.88 | 18.4% |
| Pessimistic | 436.06 | 529.41 | 21.4% | 429.63 | 517.92 | 20.6% |
(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating employer.
Exhibit III
EMPIRE PLAN
Participating Agency Premium Rates
Comparison of 2000 and Projected 2001 Rates
CORE PLUS MEDICAL ENHANCEMENT
Plan Prime - Individual
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 293.01 | 326.34 | 11.4% | 284.97 | 315.86 | 10.8% |
| Best Estimate | 293.01 | 337.05 | 15.0% | 284.97 | 326.57 | 14.6% |
| Pessimistic | 293.01 | 347.79 | 18.7% | 284.97 | 337.31 | 18.4% |
Plan Prime - Family
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 602.75 | 670.93 | 11.3% | 586.46 | 649.49 | 10.7% |
| Best Estimate | 602.75 | 693.03 | 15.0% | 586.46 | 671.59 | 14.5% |
| Pessimistic | 602.75 | 715.20 | 18.7% | 586.46 | 693.76 | 18.3% |
MediPrime - Individual
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 217.84 | 254.34 | 16.8% | 214.16 | 248.57 | 16.1% |
| Best Estimate | 217.84 | 258.92 | 18.9% | 214.16 | 253.15 | 18.2% |
| Pessimistic | 217.84 | 263.51 | 21.0% | 214.16 | 257.74 | 20.3% |
MediPrime - Family 1
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 528.23 | 600.09 | 13.6% | 516.30 | 583.36 | 13.0% |
| Best Estimate | 528.23 | 616.06 | 16.6% | 516.30 | 599.33 | 16.1% |
| Pessimistic | 528.23 | 632.08 | 19.7% | 516.30 | 615.35 | 19.2% |
MediPrime - Family 2
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 452.31 | 526.82 | 16.5% | 444.75 | 514.79 | 15.7% |
| Best Estimate | 452.31 | 536.66 | 18.6% | 444.75 | 524.63 | 18.0% |
| Pessimistic | 452.31 | 546.51 | 20.8% | 444.75 | 534.48 | 20.2% |
(1) Represents premiums charged by the carriers
(2) Represents cost to a participating agency
Exhibit III
EMPIRE PLAN
Participating Agency Premium Rates
Comparison of 2000 and Projected 2001 Rates
CORE PLUS MEDICAL & PSYCHIATRIC ENHANCEMENTS
Plan Prime - Individual
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 294.94 | 328.19 | 11.3% | 286.53 | 317.50 | 10.8% |
| Best Estimate | 294.94 | 339.00 | 14.9% | 286.53 | 328.31 | 14.6% |
| Pessimistic | 294.94 | 349.83 | 18.6% | 286.53 | 339.14 | 18.4% |
Plan Prime - Family
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 607.33 | 675.32 | 11.2% | 590.16 | 653.38 | 10.7% |
| Best Estimate | 607.33 | 697.64 | 14.9% | 590.16 | 675.70 | 14.5% |
| Pessimistic | 607.33 | 720.04 | 18.6% | 590.16 | 698.10 | 18.3% |
MediPrime - Individual
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 217.94 | 254.43 | 16.7% | 214.25 | 248.65 | 16.1% |
| Best Estimate | 217.94 | 259.02 | 18.8% | 214.25 | 253.24 | 18.2% |
| Pessimistic | 217.94 | 263.61 | 21.0% | 214.25 | 257.83 | 20.3% |
MediPrime - Family 1
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 530.97 | 602.72 | 13.5% | 518.52 | 585.68 | 13.0% |
| Best Estimate | 530.97 | 618.82 | 16.5% | 518.52 | 601.78 | 16.1% |
| Pessimistic | 530.97 | 634.98 | 19.6% | 518.52 | 617.94 | 19.2% |
MediPrime - Family 2
| Gross Rates(1) | Gross Rates(1) | Gross Rates(1) | Net Rates(2) | Net Rates(2) | Net Rates(2) | |
|---|---|---|---|---|---|---|
| Optimistic | 453.22 | 527.69 | 16.4% | 445.51 | 515.56 | 15.7% |
| Best Estimate | 453.22 | 537.57 | 18.6% | 445.51 | 525.44 | 17.9% |
| Pessimistic | 453.22 | 547.47 | 20.8% | 445.51 | 535.34 | 20.2% |
(1) Represents premiums charged by the carriers
(2) Represents cost to a participating agency
EMPIRE PLAN
PA GROUP RATES
1985-2001 Monthly Rates
Core Plus Medical & Psychiatric Enhancement
Individual
| Year | Gross Rate | % Changes | Net Rate | % Change |
|---|---|---|---|---|
| 1985* | 95.71 | 92.85 | ||
| 1986 | 91.97 | -3.9% | 91.49 | -1.5% |
| 1987 | 103.14 | 12.1% | 101.65 | 11.1% |
| 1988 (1) | 142.01 | 37.7% | 141.52 | 39.2% |
| 1989 | 168.72 | 18.8% | 168.05 | 18.7% |
| 1990 (2) | 179.50 | 6.4% | 167.09 | -0.6% |
| 1991 (3) | 202.09 | 12.6% | 185.09 | 10.8% |
| 1992 | 198.85 | -1.6% | 181.81 | -1.8% |
| 1993 | 214.30 | 7.8% | 194.64 | 7.1% |
| 1994 | 213.83 | -0.2% | 197.39 | 1.4% |
| 1995 | 214.70 | 0.4% | 193.54 | -2.0% |
| 1996 (4) | 219.20 | 2.1% | 192.27 | -0.7% |
| 1997 | 219.87 | 0.3% | 198.37 | 3.2% |
| 1998 | 227.35 | 3.4% | 204.38 | 3.0% |
| 1999 | 239.24 | 5.2% | 222.00 | 8.6% |
| 2000 | 260.67 | 9.0% | 253.98 | 14.4% |
| 2001 (projected) | 302.36 | 16.0% | 293.79 | 15.7% |
Individual Average Percent Increase
| | Gross Rate % Changes | Net Rate % Change |
|---|---|---|
| From Inception | 7.9% | 7.9% |
| Most Recent 10 Years | 4.2% | 4.9% |
| Most Recent 5 Years | 6.8% | 9.0% |
Family
| Year | Gross Rate | % Changes | Net Rate | % Change |
|---|---|---|---|---|
| 1985* | 203.97 | 197.57 | ||
| 1986 | 195.31 | -4.2% | 194.30 | -1.7% |
| 1987 | 222.39 | 13.9% | 219.20 | 12.8% |
| 1988 (1) | 324.13 | 45.7% | 323.06 | 47.4% |
| 1989 | 383.42 | 18.3% | 381.95 | 18.2% |
| 1990 (2) | 403.75 | 5.3% | 380.15 | -0.5% |
| 1991 (3) | 464.39 | 15.0% | 417.36 | 9.8% |
| 1992 | 445.64 | -4.0% | 407.76 | -2.3% |
| 1993 | 479.37 | 7.6% | 426.35 | 4.6% |
| 1994 | 484.69 | 1.1% | 446.94 | 4.8% |
| 1995 | 486.99 | 0.5% | 440.35 | -1.5% |
| 1996 (4) | 491.07 | 0.8% | 428.27 | -2.7% |
| 1997 | 495.81 | 1.0% | 447.22 | 4.4% |
| 1998 | 514.28 | 3.7% | 463.62 | 3.7% |
| 1999 | 539.14 | 4.8% | 499.75 | 7.8% |
| 2000 | 578.26 | 7.3% | 563.03 | 12.7% |
| 2001 (projected) | 667.96 | 15.5% | 647.93 | 15.1% |
Family Average Percent Increase
| | Gross Rate % Changes | Net Rate % Change |
|---|---|---|
| From Inception | 8.3% | 8.3% |
| Most Recent 10 Years | 3.8% | 4.6% |
| Most Recent 5 Years | 6.5% | 8.7% |
* Statewide Plan Premium Rates
(1) 1988 rates represent the effective amounts of the 1/88 and 8/88 rate changes.
(2) No change in effective net rate over 1989.
(3) Represents rates effective 1/1/91 - 6/30/91.
(4) Represents 2 tier Empire Plan rates; 5 tier rate schedule effective 1/1/96.
EMPIRE PLAN
PA 5 TIER GROUP RATES
1995-2001 Monthly Rates
Core Plus Medical & Psychiatric Enhancement
Individual Planprime
| Year | Gross Rate | % Changes | Net Rate | % Change |
|---|---|---|---|---|
| 1995 | 214.70 | | 193.54 | |
| 1996 (3) | 234.59 | 9.3% | 207.66 | 7.3% |
| 1997 | 261.80 | 11.6% | 240.22 | 15.7% |
| 1998 | 267.89 | 2.3% | 246.07 | 2.4% |
| 1999 | 279.56 | 4.4% | 261.18 | 6.1% |
| 2000 | 294.94 | 5.5% | 286.53 | 9.7% |
| 2001 (projected) | 339.00 | 14.9% | 328.31 | 14.6% |
Individual Planprime Average Percent Increase
| | Gross Rate % Changes | Net Rate % Change |
|---|---|---|
| From Inception of 5 Tier Structure | 8.0% | 9.3% |
Family Planprime
| Year | Gross Rate | % Changes | Net Rate | % Change |
|---|---|---|---|---|
| 1995 | 486.99 | | 440.35 | |
| 1996 (3) | 521.96 | 7.2% | 459.16 | 4.3% |
| 1997 | 537.96 | 3.1% | 489.22 | 6.5% |
| 1998 | 552.00 | 2.6% | 503.78 | 3.0% |
| 1999 | 573.33 | 3.9% | 531.89 | 5.6% |
| 2000 | 607.33 | 5.9% | 590.16 | 11.0% |
| 2001 (projected) | 697.64 | 14.9% | 675.70 | 14.5% |
Family Planprime Average Percent Increase
| | Gross Rate % Changes | Net Rate % Change |
|---|---|---|
| From Inception of 5 Tier Structure | 6.3% | 7.5% |
Individual Medprime
| Year | Gross Rate | % Changes | Net Rate | % Change |
|---|---|---|---|---|
| 1995 | 214.70 | | 193.54 | |
| 1996 (3) | 158.65 | -26.1% | 131.72 | -31.9% |
| 1997 | 150.53 | -5.1% | 129.28 | -1.9% |
| 1998 | 167.91 | 11.5% | 151.34 | 17.1% |
| 1999 | 186.46 | 11.0% | 175.61 | 16.0% |
| 2000 | 217.94 | 16.9% | 214.25 | 22.0% |
| 2001 (projected) | 259.02 | 18.8% | 253.24 | 18.2% |
Individual Medprime Average Percent Increase
| | Gross Rate % Changes | Net Rate % Change |
|---|---|---|
| From Inception of 5 Tier Structure | 4.5% | 6.6% |
Family - 1 Medprime
| Year | Gross Rate | % Changes | Net Rate | % Change |
|---|---|---|---|---|
| 1995 | 486.99 | | 440.35 | |
| 1996 (3) | 446.03 | -8.4% | 383.23 | -13.0% |
| 1997 | 427.23 | -4.2% | 378.82 | -1.2% |