Negotiated Changes to Health Benefits; Mental Health & Substance Abuse Parity Changes

As soon as the 2011-2015 PS&T contract was ratified, the state began implementing a number of changes to the health benefits provided to PEF-represented employees enrolled in the New York State Health Insurance Program (NYSHIP).  These changes, along with the effective date of the change, are summarized at the links below:

Changes affecting members enrolled in the Empire Plan or an HMO.

Changes only affecting members enrolled in the Empire Plan.

In addition to the negotiated health benefit changes, Empire Plan enrollees will see a change in the benefits provided for non-network care effective January 1, 2012 due to implementation of the remaining provisions of the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

This law requires the Empire Plan to provide benefits for the treatment of mental health and substance abuse disorders in full parity with the benefits for other medical services. In other words, the Empire Plan cannot impose financial requirements (co-pays, deductibles, etc.) or treatment limitations (frequency of treatment, number of visits, or days of coverage) on mental health or substance abuse disorder benefits that are more restrictive than those applied to other medical services.

As a result of implementation of the requirements set forth under the MHPAEA, effective January 1, 2012:

*The Medical/Surgical and Mental Health Substance Abuse (MHSA) Programs will have a shared annual non-network deductible. The shared annual non-network deductible will increase to $1000 for the enrollee, $1000 for the spouse/domestic partner and $1000 for all dependent children combined.

The shared annual non-network deductible will not include the Managed Physical Medicine Program (MPN) annual non-network deductible. The MPN Program will continue to have a separate annual non-network deductible of $250 for the enrollee, $250 for the spouse/domestic partner and $250 for all dependent children combined.

*The Hospital, Medical/Surgical, and MHSA Programs will have a shared annual coinsurance maximum. The annual coinsurance maximum will increase to $3000 for the enrollee, $3000 for the spouse/domestic partner and $3000 for all dependent children combined.

Under the terms of the 2011-2015 PS&T contract, there will no longer be an annual CPI-W adjustment to the shared annual non-network deductible and coinsurance maximum.  They will remain $1,000 and $3,000, respectively, for the term of the contract.