Skip to main content

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.

State Seal

GEORGE E. PATAKI
GOVERNOR

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

DANIEL E. WALL
COMMISSIONER

JOHN F. BARR
EXECUTIVE DEPUTY COMMISSIONER

PA05-05

TO: Participating Agency Health Benefit Administrators
FROM: Mr. Robert W. DuBois, Director of the Employee Benefits Division
SUBJECT: Empire Plan Quarterly Experience Report
DATE: May 25, 2005

Enclosed are the First Quarter Empire Plan Experience Report for 2005 and the cover letter to the Chief Executive Officers. This report presents the actual 2004 Empire Plan experience, projected 2005 Empire Plan experience and projected 2006 premium rates.

Also, please note that we have replaced the “Keeping You Informed” section of the report with a new feature – NYSHIP News. We are sending this quarterly newsletter to keep your agency CEO better informed about NYSHIP issues and changes.


May 25, 2005

Dear Chief Executive Officer:

Attached is the Empire Plan First Quarter Experience Report for 2005. This report presents the actual 2004 Empire Plan experience, projected 2005 Empire Plan experience, based on claims paid through March 31, 2005, and projected 2006 premium rates.

The Empire Plan carriers declared a 2004 net dividend of $163.8 million or 4.1% of premium. For Plan Year 2005, the Empire Plan carriers project a net dividend of $135.7 million, 3.2% of premium. This report presents the basis for these projections and future reports will include revisions based on additional claims experience.

The projected 2006 premium rates are presented in Exhibit III and reflect a “best estimated” net increase of 10.4%. The report also presents a range of the potential 2006 rate increase for your budget development considerations.

Also, please note that we have replaced the “Keeping You Informed” section of the report with a new feature – NYSHIP News. We sending this quarterly newsletter to keep you and your agency better informed about NYSHIP issues and changes.

I hope this report is informative and useful to you. If you have any questions, comments or suggestions, please doni??t hesitate to contact me.

Sincerely,

Robert W. DuBois, CEBS
Director
Employee Benefits Division


PARTICIPATING AGENCIES

EMPIRE PLAN
2005 First Quarter
Experience Report

 

Prepared by the State of New York
Department of Civil Service

 

EMPIRE PLAN EXPERIENCE REPORT

JANUARY – MARCH 2005

Produced for

PARTICIPATING AGENCIES IN THE
NEW YORK STATE
HEALTH INSURANCE PROGRAM

by

the Employee Benefits Division

New York State Department of Civil Service

Daniel E. Wall

President, New York State Civil Service Commission

Exhibits

I. Actual 2004 Empire Plan Experience

II. Projected 2005 Empire Plan Experience

III. 2006 Projected PA Premium Rates

IV. Empire Plan PA 5-Tier Group Rates 1996-2006

V. Empire Plan PA 2-Tier Group Rates 1996-2006


NYS HEALTH INSURANCE PROGRAM
PARTICIPATING AGENCY GROUP
EMPIRE PLAN EXPERIENCE REPORT
1st QUARTER REPORT

ACTUAL 2004 EMPIRE PLAN EXPERIENCE

The Empire Plan carriers declared a composite dividend of $163.8 million (4.1% of premium), or $68.8 million more than the margin loaded in the 2004 rates. The 2004 annual experience is reported in Exhibit I.

Cigna declared a $60.7 million dividend (5.0% of premium) for the Prescription Drug Program. The dividend is $2.5 million less than the 4th Quarter projection and $26.1 million greater than what was projected at the 2004 rate renewal. This increase is reflective of an improvement in the 2004 trend of 17.9% estimated at rate development, to the actual trend of 12.7%.

UnitedHealthcare declared a $66.8 million dividend (4.6% of premium), $3.1 million less than the 4th Quarter projection and $29.1 million greater than what was projected at the 2004 rate renewal. This experience improvement is attributable to a modest reduction in the 2003 estimated claim base as well as a reduction in the 2004 trend from 10.8% projected at the time of the 2004 rate development to the current projected trend of 8.6%.

Group Health Incorporated declared a $7.8 million dividend (8.6% of premium) for the Mental Health and Substance Abuse Program, $0.07 million less than the 4th Quarter projection and $5.4 million more than the margin loaded in the 2004 rates. This improvement is largely attributable to a reduction in 2003 and 2004 trend to 3.0% and 3.5% respectively, from the trends (5% for both 2003 and 2004) used in the development of the 2004 rates.

Empire BlueCross BlueShield (EBCBS) declared a $28.5 million gain (2.4% of premium). This amount represents a $6.5 million improvement from the fourth quarter dividend projection and is consistent with the margin level used in the rate development.

PROJECTED 2005 EMPIRE PLAN EXPERIENCE

The Empire Plan carriers project a composite dividend of $135.7 million (3.2% of premium), or $32.3 million more than the margin loaded in the 2005 rates. The 2005 annual experience projected by the insurance carriers is reported in Exhibit II.

This projection is based on only three months of 2005 paid claim data. The following chart presents the percentage of the projected incurred claims actually paid as well as the current 2005 trend as compared to the trend assumed during the 2005 rate development:

  % of Paid Claims to Projected Incurred Claims 2004 % of Paid Claims to Projected Incurred Claims 2005 Projected 2005 Trend at Renewal Projected 2005 Trend at 1st Quarter
Blue Cross 95.6% 13.4% 13.6% 13.8%
UnitedHealthcare 98.2% 16.1% 10.7% 10.5%
GHI 97.7% 12.3% 4.5% 3.7%
Cigna 99.9% 21.0% 17.6% 16.8%

The 2005 projected dividend for each carrier as compared to the margin level used in the 2005 premium development is as follows:

  Margin 2005 Projected Dividend/(Loss)
Increase/(Decrease)
Blue Cross $23,043,000 $29,548,000 $6,505,000
UnitedHealthcare $40,834,000 $22,156,000 $(18,678,000)
GHI $2,423,000 $2,811,000 $388,000
Cigna $37,107,000 $81,205,000 $44,098,000
Total $103,407,000 $135,720,000 $32,313,000

The increase in the dividend projection is primarily attributable to a modest reduction in the projected prescription drug trend coupled with an increase in savings attributable to the plan changes made effective January 1, 2005. While modestly higher dividends are projected for the Blue Cross and GHI components, a decrease in the projected UnitedHealthcare dividend is projected. The majority of this projected dividend decrease/claim increase is attributable to a ten million dollar increase in the projected 2004 claims and an increase in the 2005 projected claim costs associated with the revised cost/savings estimates for certain plan design changes implemented on January 1, 2005.

2006 PROJECTED PREMIUM RATES

Exhibit III presents the projected 2006 Empire Plan gross and net premium rates assuming the application of $125.0 million in dividend to all payors. In aggregate, the Empire Plan gross premium is projected to increase approximately 11.1% while the net premium is projected to increase 10.4%

A range of projected gross and net premium rates is also included (7.1%-13.6%). Carrier rate projections made at this time of the year have been historically conservative with the rates ultimately approved and implemented being significantly less than the projections contained in 1st Quarter Reports. In developing the projected 2006 rates, the Department of Civil Service reduced the carrier projections by approximately 1.7% to remove the a level of excess conservatism specifically observed in the carrier rate estimates. Each agency should assess its budgetary environment in using the enclosed projections.

Exhibit IV presents the individual and family rate history for the Core Plus Medical and Psychiatric Enhancements option based on the 5-tier Empire Plan billing rate history in effect since January 1, 1996. Exhibit V presents, for illustrative purposes only, the 2-tier rate history from 1996 to 2006.


Exhibit I

2004 EMPIRE PLAN EXPERIENCE
In (000’s)

  EMPIRE BLUE CROSS UnitedHealthcare MEDICAL Core UnitedHealthcare MEDICAL NY Enhancement UnitedHealthcare MEDICAL PA Enhancement UnitedHealthcare MEDICAL Combined GHI MHSA Core GHI MHSA NY Enhancement GHI MHSA PA Enhancement GHI MHSA Combined CIGNA TOTAL
(A) Premium (1) 1,170,852 1,235,005 123,297 106,837 1,465,139 73,182 9,906 7,677 90,765 1,222,536 3,949,292
(B) Incurred Claims (2) 1,046,221 1,057,347 108,624 92,159 1,258,130 54,303 7,131 5,612 67,046 1,119,580 3,490,977
(C) Administrative Expense (3) 96,170 122,406 9,615 8,208 140,229 12,805 1,727 1,341 15,873 42,243 294,515
(D) Gain/(Loss) (A-B-C) 28,461 55,252 5,058 6,470 66,780 6,074 1,048 724 7,846 60,713 163,800

(1)Earned Premium - Premium which 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.i?? Includes carrier’s cost to administer the program, interest charges, and other retention.

Source: 2004 Annual Financial Statements


Exhibit II

2005 PROJECTED EMPIRE PLAN EXPERIENCE
In (000’s)

  EMPIRE BLUE CROSS UnitedHealthcare MEDICAL Core UnitedHealthcare MEDICAL NY Enhancement UnitedHealthcare MEDICAL PA Enhancement UnitedHealthcare MEDICAL Combined GHI MHSA Core GHI MHSA NY Enhancement GHI MHSA PA Enhancement GHI MHSA Combined CIGNA TOTAL
(A) Premium (1) 1,332,956 1,362,171 128,503 111,922 1,602,596 71,976 10,604 7,316 89,896 1,271,992 4,297,440
(B) Incurred Claims (2) 1,198,897 1,252,228 98,321 81,180 1,431,729 57,928 7,885 5,735 71,548 1,142,325 3,844,499
(C) Administrative Expense (3) 104,511 132,454 8,790 7,467 148,711 12,456 1,819 1,262 15,537 48,462 317,221
(D) Gain/(Loss) (A-B-C) 29,548 (22,511) 21,392 23,275 22,156 1,592 900 319 2,811 81,205 135,720

(1)Earned Premium - Premium which 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.i?? Includes carrier’s cost to administer the program, interest charges, and other retention.

Source: Carrier 2005 1st Quarter Report


Exhibit III

EMPIRE PLAN
Participating Agency Premium Rates
Comparison of 2005 and Projected 2006 rates
CORE ONLY

Plan Prime - Individual

 

Gross Rates(1)
2005

Gross Rates(1)
2006 (3)

Gross Rates(1)
% Change

Net Rates(2)
2005

Net Rates(2)
2006 (3)

Net Rates(2)
% Change

Optimistic
453.01
485.57
7.2%
446.36
474.40
6.3%
Best Estimate
453.01
500.33
10.4%
446.36
489.16
9.6%
Pessimistic
453.01
514.54
13.6%
446.36
503.37
12.8%

Plan Prime - Family

 

Gross Rates(1)
2005

Gross Rates(1)
2006 (3)

Gross Rates(1)
% Change

Net Rates(2)
2005

Net Rates(2)
2006 (3)

Net Rates(2)
% Change

Optimistic
957.03
1,025.74
7.2%
942.99
1,002.36
6.3%
Best Estimate
957.03
1,056.88
10.4%
942.99
1,033.50
9.6%
Pessimistic
957.03
1,086.86
13.6%
942.99
1,063.48
12.8%

MediPrime - Individual

 

Gross Rates(1)
2005

Gross Rates(1)
2006 (3)

Gross Rates(1)
% Change

Net Rates(2)
2005

Net Rates(2)
2006 (3)

Net Rates(2)
% Change

Optimistic
329.75
360.33
9.3%
322.87
348.20
7.8%
Best Estimate
329.75
367.49
11.4%
322.87
355.36
10.1%
Pessimistic
329.75
374.46
13.6%
322.87
362.33
12.2%

MediPrime - Family 1

 

Gross Rates(1)
2005

Gross Rates(1)
2006 (3)

Gross Rates(1)
% Change

Net Rates(2)
2005

Net Rates(2)
2006 (3)

Net Rates(2)
% Change

Optimistic
833.76
900.50
8.0%
819.48
876.19
6.9%
Best Estimate
833.76
924.05
10.8%
819.48
899.74
9.8%
Pessimistic
833.76
946.78
13.6%
819.48
922.47
12.6%

MediPrime - Family 2

 

Gross Rates(1)
2005

Gross Rates(1)
2006 (3)

Gross Rates(1)
% Change

Net Rates(2)
2005

Net Rates(2)
2006 (3)

Net Rates(2)
% Change

Optimistic
710.49
775.25
9.1%
696.00
749.98
7.8%
Best Estimate
710.49
791.22
11.4%
696.00
765.95
10.1%
Pessimistic
710.49
806.71
13.5%
696.00
781.44
12.3%

(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating employer.
(3) Projected Rates.

EMPIRE PLAN
Participating Agency Premium Rates
Comparison of 2005 and Projected 2006 rates
CORE PLUS MEDICAL & PSYCHIATRIC ENHANCEMENTS

Plan Prime - Individual

 

Gross Rates(1)
2005

Gross Rates(1)
2006 (3)

Gross Rates(1)
% Change

Net Rates(2)
2005

Net Rates(2)
2006 (3)

Net Rates(2)
% Change

Optimistic
490.41
526.31
7.3%
478.49
515.10
7.7%
Best Estimate
490.41
543.20
10.8%
478.49
527.26
10.2%
Pessimistic
490.41
559.56
14.1%
478.49
548.35
14.6%

Plan Prime - Family

 

Gross Rates(1)
2005

Gross Rates(1)
2006 (3)

Gross Rates(1)
% Change

Net Rates(2)
2005

Net Rates(2)
2006 (3)

Net Rates(2)
% Change

Optimistic
1,038.64
1,114.57
7.3%
1,013.68
1,091.06
7.6%
Best Estimate
1,038.64
1,150.38
10.8%
1,013.68
1,116.79
10.2%
Pessimistic
1,038.64
1,185.03
14.1%
1,013.68
1,013.52
14.6%

MediPrime - Individual

 

Gross Rates(1)
2005

Gross Rates(1)
2006 (3)

Gross Rates(1)
% Change

Net Rates(2)
2005

Net Rates(2)
2006 (3)

Net Rates(2)
% Change

Optimistic
340.50
372.08
9.3%
331.93
359.93
8.4%
Best Estimate
340.50
379.86
11.6%
331.93
366.16
10.3%
Pessimistic
340.50
387.44
13.8%
331.93
375.29
13.1%

MediPrime - Family 1

 

Gross Rates(1)
2005

Gross Rates(1)
2006 (3)

Gross Rates(1)
% Change

Net Rates(2)
2005

Net Rates(2)
2006 (3)

Net Rates(2)
% Change

Optimistic
888.71
960.35
8.1%
867.09
935.97
7.9%
Best Estimate
888.71
987.05
11.1%
867.09
955.76
10.2%
Pessimistic
888.71
1,012.93
14.0%
867.09
988.55
14.0%

MediPrime - Family 2

 

Gross Rates(1)
2005

Gross Rates(1)
2006 (3)

Gross Rates(1)
% Change

Net Rates(2)
2005

Net Rates(2)
2006 (3)

Net Rates(2)
% Change

Optimistic
738.79
806.11
9.1%
720.53
780.79
8.4%
Best Estimate
738.79
823.71
11.5%
720.53
794.65
10.3%
Pessimistic
738.79
840.82
13.8%
720.53
815.50
13.2%

(1) Represents premiums charged by the carriers.
(2) Represents cost to a participating employer.
(3) Projected Rates.


Exhibit IV

PA 5 TIER GROUP RATES
1996-2006 MONTHLY RATES
Core Plus Med. & Psych. Enhancement

Individual Planprime

Individual Gross Rate (1) % Change Net Rate (2) % Change
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 325.23 10.3% 314.26 9.7%
2002 353.81 8.8% 344.66 9.7%
2003 400.00 13.1% 384.89 11.7%
2004 448.00 12.0% 438.15 13.8%
2005 490.41 9.5% 478.49 9.2%
2006 Projected 543.20 10.8% 527.26 10.2%

Average Percent Increase

From Inception of 5 Tier Structure (1996)   8.9%   9.6%
Most Recent 5 Years   10.8%   10.9%

 

Family Planprime

Family Gross Rate (1) % Change Net Rate (2) % Change
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 673.67 10.9% 651.09 10.3%
2002 742.98 10.3% 723.97 11.2%
2003 842.38 13.4% 811.41 12.1%
2004 945.29 12.2% 924.74 14.0%
2005 1,038.64 9.9% 1,013.68 9.6%
2006 Projected 1,150.38 10.8% 1,116.79 10.2%

Average Percent Increase

From Inception of 5 Tier Structure (1996)   8.2%   8.9%
Most Recent 5 Years   11.3%   11.4%

 

Individual Medprime

Individual Gross Rate (1) % Change Net Rate (2) % 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 245.64 12.7% 239.94 12.0%
2002 259.96 5.8% 253.82 5.8%
2003 307.02 18.1% 297.50 17.2%
2004 341.87 11.4% 334.22 12.3%
2005 340.50 -0.4% 331.93 -0.7%
2006 Projected 379.86 11.6% 366.16

10.3%

Average Percent Increase

From Inception of 5 Tier Structure (1996)   6.1%   7.1%
Most Recent 5 Years   9.3%   9.0%

 

Family - 1 Medprime

Family Gross Rate (1) % Change Net Rate (2) % 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%
1998 452.73 6.0% 409.76 8.2%
1999 480.95 6.2% 447.05 9.1%
2000 530.97 10.4% 518.52 16.0%
2001 595.25 12.1% 577.95 11.5%
2002 649.14 9.1% 633.13 9.5%
2003 749.40 15.4% 724.05 14.4%
2004 839.18 12.0% 820.82 13.4%
2005 888.71 5.9% 857.09 5.5%
2006 Projected 987.05 11.1% 955.76 10.2%

Average Percent Increase

From Inception of 5 Tier Structure (1996)   6.9%   7.6%
Most Recent 5 Years   10.7%   10.6%

 

Family - 2 or More Medprime

Family Gross Rate (1) % Change Net Rate (2) % Change
1995 486.99   440.35  
1996 (3) 369.87 -24.0% 307.07 -30.3%
1997 315.24 -14.8% 267.15 -13.0%
1998 351.98 11.7% 314.25 17.6%
1999 387.05 10.0% 360.66 14.8%
2000 453.22 17.1% 445.51 23.5%
2001 514.40 13.5% 502.37 12.8%
2002 555.29 7.9% 542.29 7.9%
2003 656.42 18.2% 636.67 17.4%
2004 733.05 11.7% 716.88 12.6%
2005 738.79 0.8% 720.53 0.5%
2006 Projected 823.71 11.5% 794.65 10.3%

Average Percent Increase

From Inception of 5 Tier Structure (1996)   5.8%   6.7%
Most Recent 5 Years   10.0%   9.7%

(1) Represents the premiums charged by the carriers.
(2) Represents the premium charged to a participating employer.
(3) Includes the impact of benefit changes effective 1/1/05.


Exhibit V

EMPIRE PLAN
PA 2 TIER GROUP RATES
1996-2006 MONTHLY RATES
(FOR ILLUSTRATIVE PURPOSES ONLY)
Core Plus Med. & Psych. Enhancement

Individual

Individual Gross Rate % Change Net Rate % Change
1996 (1) 219.20 2.1% 192.27 -0.7%
1997 219.87 0.3% 198.37 13.2%
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 289.41 11.0% 280.25 10.3%
2002 313.58 8.4% 305.67 9.1%
2003 357.44 14.0% 345.36 13.0%
2004 402.70 12.7% 394.31 14.2%
2005 433.70 7.7% 423.31 7.4%
2006 Projected 481.97 11.1% 467.36 10.4%

Average Percent Increase

From Inception (1986)   8.3%   8.4%
Most Recent 5 Years   8.3%   9.4%
Most Recent 5 Years   10.8%   10.8%

 

Family

Individual Gross Rate % Change Net Rate % Change
1996 (1) 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 640.64 10.8% 619.28 10.0%
2002 703.61 9.8% 685.83 10.7%
2003 805.64 14.5% 778.82 13.6%
2004 899.98 11.7% 881.48 13.2%
2005 968.40 7.6% 945.11 7.2%
2006 Projected 1,075.39 11.0% 1,043.33 10.4%

Average Percent Increase

From Inception (1986)   8.7%   8.7%
Most Recent 5 Years   8.2%   9.4%
Most Recent 5 Years   10.9%   11.0%

(1) Represents 2 tier Empire Plan Rates; See 5 tier rate schedule effective 1/1/96.

 

Report - PDF Version

Exhibit I - PDF Version

Exhibit II - PDF Version

Exhibit III - PDF Version

Exhibit IV - PDF Version

Exhibit IV - PDF Version