Home » News » 2015 Empire Plan Rates

2015 Empire Plan Rates

The 2015 Empire Plan premium rates will increase as indicated in the tables below

Salary Grade 9 and Below:

Type of Coverage Current Biweekly Premium Deduction 2015 Biweekly Premium Deduction $ Change from 2014 to 2015 % Change from 2014 to 2015
Individual $34.11 $35.42 $1.31 +3.8%
Family $143.73 $149.56 $5.83 +4.1%

More detailed plan information for Salary Grade 9 and below is available HERE.

Salary Grade 10 and Above:

Type of Coverage Current Biweekly Premium Deduction 2015 Biweekly Premium Deduction $ Change from 2014 to 2015 % Change from 2014 to 2015
Individual $45.48 $47.23 $1.75 +3.8%
Family $171.34 $178.28 $6.94 +4.1%

More detailed plan information for Salary Grade 10 and above is available HERE.

To put these increases into perspective, the table below shows increases of other large employer health plans, comparing plans similar to the Empire Plan where possible.

 

Employer Group or Survey Percent Change*
Federal Employees Health Benefits Program (fee-for service) +3.2%
California State Employees – average Preferred Provider Organization (PPO) & HMO plans +3.3%
Segal Cost Trend Survey – Preferred Provider Organization (PPO) plans +7.9%

 

*The percentages shown represent an average of individual and family premium increases.  Separate percentage increases for individual and family coverage are not available.

The option transfer period will run through January 16, 2015. If anyone is considering changing health plans, or enrolling in the Opt-out Program for 2015, they should act quickly.  Deductions for the 2015 plan year will begin on December 31, 2014 for Administration Lag Payroll employees and on December 24, 2014 for Institution Lag Payroll employees.

The NYSHIP Rates and Deadlines for 2015 flyer will be mailed directly to employees’ homes. In the meantime, members can get option transfer information, including the premium rates, on the Department of Civil Service web site at https://cs.ny.gov/employee-benefits. Select your group if prompted, and then click on Health Benefits & Option Transfer. Choose Rates and Health Plan Choices. Employees can also download, print and complete the PS-404 form required to change health plan options, and then bring it to their HBA for processing on or before December 31, 2014. Or, employees can change their option online using MyNYSHIP.

According to the NYS Department of Civil Service, the HMO rates have increased an average of 6.8%. The actual percentage change varies by HMO and coverage type (Individual vs. Family). The change in the employee deduction for each HMO can vary due to the impact of the HMO premium “capping” formula. If a PS&T employee enrolls in an HMO, the State’s dollar contribution for the non-prescription drug components (i.e., hospital, medical/surgical and mental health and substance abuse components) of his or her HMO premium will not exceed the State’s dollar contribution for the non-prescription drug components of The Empire Plan premium.  The enrollee must pay 100% of the premium amount exceeding the cap.  For Salary Grade 10 and above, the 2015 premiums for 18 of the 20 HMO options exceeded the cap for Individual coverage and 17 of the 20 HMO options exceeded the cap for Family coverage.  The two below the cap for Individual coverage are Independent Health and MVP-Rochester and the three below the cap for Family coverage are Blue Choice, Independent Health and MVP-Rochester.

With more than 5,200 PS&T employees, the HMO option with the most members enrolled in it is CDPHP-Capital Region.  For Salary Grade 10 and above, the 2015 premiums are increasing from $45.28 to $58.72 (+29.7%) for Individual coverage and from $159.61 to $187.23 (+17.3%) for Family coverage.

Please review the NYSHIP Rates & Deadlines for 2015 flyer even if you don’t plan on changing your health plan option.

Neither PEF nor the state has the authority to negotiate HMO rates, which are community rated. Community rating means all enrollees in an HMO are pooled and charged the same premium for the same benefits. The HMO premium cap limits the state’s contribution to HMO premiums to an amount no greater than the cost of Empire Plan hospital/medical/mental health and substance abuse premiums. Any amount of HMO premium greater than the Empire Plan’s for these components must be paid in full by the enrollee.

It is important to look at more than premium contributions and copayments when selecting or remaining with an HMO. By now, all members enrolled in an HMO should have received side-by-side comparisons illustrating any benefit changes their HMOs will implement for plan year 2014. PEF does not negotiate the level of benefits provided by each HMO. HMOs can change their benefits from year to year and many do.

If you have any questions about the rates, please contact Deborah Stayman or Lorraine Simpkins in the Contract Administration Department at PEF headquarters.