2013 Empire Plan & HMO Rates Released

The Empire Plan and HMO premium rates for the year 2013 have been approved and were distributed to state agencies on Thursday, November 29, 2012. Pursuant to the authority established in NYS Insurance Law Section 4235 (j) (1), (2) and (3), Empire Plan premiums are adjusted annually based on plan experience. The PEF/NYS contract does not give PEF authority to negotiate premium rates.

The 2013 Empire Plan premium rates will increase as indicated in the tables here.

HMO rates for SG10 and above are attached here; rates for SG9 and below are attached here.

The option transfer period will run through December 31, 2012. If anyone is considering changing health plans, they should act quickly.  Deductions for the 2013 plan year will begin on January 2, 2013 for Administration Lag Payroll employees and on December 27, 2012 for Institution Lag Payroll employees.

The NYSHIP Rates and Deadlines for 2013 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 www.cs.state.ny.us. Scroll down sidebar on the left, click on “Benefit Programs” and follow the instructions to access “NYSHIP Online.” Then, click on “Health Benefits and Option Transfer.” 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, 2012. Or, employees can change their option online using MyNYSHIP.

For employees in titles salary grade 10 and above, thirteen (13) of the twenty (20) HMO options have biweekly premium deductions over $200 for family coverage.  Six (6) of these HMO options (Aetna, Empire BCBS Downstate and Mid-Hudson, HMO Blue – CNY and Utica-Watertown, and MVP-North) will have a biweekly deduction over $300 for family coverage. We ask that you remind members to check their health plan rates now to avoid an unpleasant surprise in their first biweekly paycheck with the new deductions.

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 2013. 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.