Empire Plan Deductible and Coinsurance Maximum for '05

If you’re in the Empire Plan, you know that, with a few exceptions, you must first satisfy an annual deductible before you receive reimbursement for services performed by a non-participating (par) provider. You are also responsible for 20 percent of covered charges until you reach the annual coinsurance maximum. The amount of the deductible and coinsurance maximum increases on January 1st of each year.  Beginning  January 1, 2005, the deductible and coinsurance maximum will change as follows:

Basic Medical Deductible:  The Empire Plan Basic Medical Program annual deductible for medical services performed and supplies dispensed by non-par providers increases from $295 to $309.

Basic Medical Coinsurance Maximum:  The annual coinsurance maximum under the Empire Plan Basic Medical Program increases from $1,419 to $1,486. The 20 percent coinsurance you pay for covered services by non-par providers counts towards this $1,486 coinsurance maximum. Your copayments for services by par providers also count.

The changes to the deductible and coinsurance maximum are due to an increase of 4.7% in the medical component of the Consumer Price Index for Workers (CPI- W ) for the period 7/1/03 through 6/30/04.