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
JOHN F. BARR
EXECUTIVE DEPUTY COMMISSIONER
PA04-17
TO: Participating Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Empire Plan Basic Medical Program Annual Deductible and Coinsurance Maximum Amounts for 2005
DATE: October 4, 2004
Below is a chart for Participating Agencies showing The Empire Plan Basic Medical Program Annual Deductible and Coinsurance Maximum for calendar year 2005. You may want to copy and post it, or you may want to prepare a posting for your agency. If you are a Health Benefits Administrator in an agency with more than one office, please distribute notices to each location as well.
These changes will be announced in the fall 2004 Empire Plan Reports.
Note: If your agency has any enrollees with dual coverage through a spouse who is enrolled in The Empire Plan as a New York State enrollee or through a NYSHIP Participating Employer, please refer to HBA memos NY04-20 and PE04-19 for 2005 annual deductibles and coinsurance maximums, which can be located on PA-MARKET at www.cs.state.us/ebd.
EMPIRE PLAN Basic Medical Program
Effective January 1, 2005
| 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 contract) |
|---|---|---|
| Participating Agencies with Core Benefits | $550 | $2,650 |
| Participating Agencies with Core Plus Enhancements | $350 | $1,650 |