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Want to change health plans for 2020? Do it before December 31

If you want to stay in the same health plan for 2020 that you are using in 2019, you do not need to re-enroll. But if you want to enroll in a different plan for 2020, you must change your enrollment by December 31. That’s also the deadline if you want to opt out of NYSHIP, unless you are currently opted out for 2019. Opt out enrollment for 2019 will continue into 2020, unless you change that option by the deadline.

BCBS dropping out

Please note that effective January 1, 2020, the Empire BlueCross BlueShield (BCBS) HMOs will no longer be offered through NYSHIP. If you are currently enrolled in that plan, you need to make another choice by December 20. If no request to change options is received by December 20, 2019, the employee will automatically be enrolled in The Empire Plan for plan year 2020 to ensure no interruption in coverage.

Rates for 2020 are up

The Empire Plan and HMO premium rates for 2020 have been approved by the state Division of Budget. Empire Plan premium rates are adjusted annually based on enrollee utilization and projected costs. These rates are not negotiated by PEF.

For 2020, there are two sets of premium rates for active employees enrolled in the NYS Health Insurance Program (NYSHIP): a slightly lower rate for the unions that have ratified contracts with the state (CSEA, UUP, NYSCOPBA, PBA, PIA and DC37) and Management/Confidential (M/C) employees, and a slightly higher rate for the unions that have not ratified contracts with the state (PEF, PBANYS, and AFSCME Council 82). The unions that settled contracts agreed to higher copayments and other benefit changes that reduced the cost of their premiums.

The 2020 Empire Plan premium rates for PEF-represented active employees will increase as indicated here: For employees in salary grade 9 and below with individual coverage, $45.94 will be deducted from your biweekly paycheck. That’s up from $43.71. For family coverage, $201.20 will be deducted, which is up from the 2019 rate of $192.68.

If you are in salary grade 10 or higher, the biweekly paycheck deduction will be $61.26 for individual coverage. That’s up by $2.97 from 2019. The deduction for family coverage will be $239.52, which is a $10.19 increase over 2019.

HMO rates for SG 9 and below and SG 10 and above are also available.

Plan starts just days away

The effective dates for Plan Year 2020 are:

• December 26, 2019 for employees on the Administration Lag-Payroll; and
• January 2, 2020 for employees on the Institution Lag-Payroll

The NYSHIP Rates and Deadlines for 2020 flyer was mailed directly to employees’ homes.

Find info, forms online

Not only are option transfer information and rates available online, employees also can download, print and complete the PS-404 Form to change their plan option. Go to the state Department of Civil Service web site at https://cs.ny.gov/employee-benefits. Select your group (PEF) and plan if prompted. Click on Health Benefits & Option Transfer and then on Rates and Health Plan Choices. When you’ve completed your form, submit it to your health benefits administrator (HBA) for processing by the designated deadline. Or change your option online using MyNYSHIP.

HMOs change rates & benefits

For HMOs, the rate increase or decrease varies by HMO and coverage type (individual vs. family). The change in the employee deduction for each HMO can vary because of the HMO premium “capping” formula.

If a PEF-represented state 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 percent of the premium amount that exceeds the cap.

Please review the NYSHIP Rates & Deadlines for 2020 flyer even if you don’t plan to change your health plan option. That’s the best way to avoid the potential of an unpleasant surprise in your first biweekly paycheck with the new deductions.

It is important to look at more than premium rates when selecting or remaining with an HMO. PEF (and the other state employee unions) only negotiate the benefits and other elements of plan design for the Empire Plan. PEF does not negotiate the benefits that HMOs provide.

HMOs are allowed to change benefit levels on an annual basis, independent of the negotiated Empire Plan benefits. That’s why HMO enrollees should review their plan options carefully each year during the Option Transfer Period. By now, all members enrolled in an HMO should have received side-by-side comparisons illustrating any benefit changes their current HMOs will implement for plan year 2020.

Got ??

If you have any questions about the rates, please contact Deborah Stayman, Lorraine Simpkins or Erika Frasier in the Contract Administration Department (x283) at PEF headquarters (800-342-4306).


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