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Deadline
December 12 for switching plans
Empire
Plan, many HMOs raising rates for ’04
By LORRAINE SIMPKINS
The 2004 Empire Plan and HMO premium rates were
distributed to state agencies on November 3. That opens
the 30-day window for members to change health plans. The
option-transfer period ends December 12.
If you change your health plan option, coverage and
premium rates for the new plan will begin December 24 for
institution-payroll employees, or December 31 for
administration-lag-payroll employees.
Civil Service began mailing the 2004 rate flyer directly
to employees’ homes on November 17. In addition to
the new rate schedule, the flyer indicates the deadline
for changing options and other important times, such as
payroll-deduction dates. The rates are also posted in the “Health Benefits” section of the PEF Web site at www.pef.org.
The three state agencies responsible for administering
the state Health Insurance Program (NYSHIP) — the
Department of Civil Service, the Governor’s Office
of Employee Relations, and the Division of Budget —
negotiated the Empire Plan premium rates with the
insurers.
PEF and the other state employee unions do not have the
authority to negotiate premium rates or reject the rates
set by the state.
Empire Plan premiums are adjusted annually based on plan
experience, which is the actual cost of providing health
care to individuals enrolled in the Empire Plan for a
given period of time. As health care costs rise, so do
the premiums.
Empire Plan
rates going up
For the fourth consecutive year, Empire Plan premium
rates for both individual and family coverage are
increasing by double-digits.
The biweekly paycheck deduction for individual coverage
is increasing by 13.9 percent, from $15.57 to $17.74. The
biweekly paycheck deduction for family coverage is
increasing by 12.5 percent, from $64.68 to $72.79. The
increase is due primarily to increased costs for hospital
and prescription drug benefits.
The Empire Plan premium increases are in line with the
rates of many other large employee health plans.
Nationally, what employers and their employees pay in
health insurance premiums jumped 13.9 percent this year,
according to a survey by the Kaiser Family Foundation and
the Health Research and Educational Trust.
HMO rates up and
down
As reported previously, some of the health plans chose to
lower their premiums by reducing their benefits and
increasing enrollees’ out-of-pocket costs for
services
Therefore, some PEF members enrolled in health
maintenance organizations (HMOs) will see a decrease in
their biweekly premium deduction for their coverage in
2004, while others will be paying more.
Check the new rates for your plan now to avoid
“sticker shock” when they take effect.
Ten of the HMO options have biweekly premium deductions
of more than $100 for family coverage, including HMO
Blue-Utica/Watertown which will have a biweekly deduction
of more than $200.
Eight of the HMO options have lowered their premiums for
family coverage and eight have lowered premiums for
individual coverage. The rates for individual coverage
are going up for 12 other HMO options.
Neither PEF nor the state has the authority to negotiate
HMO premiums, which are community rated. Community rating
means premiums are set according to the HMO’s
expected costs of providing medical benefits to the
community as a whole, rather than to NYSHIP enrollees
only.
The HMO premium cap may significantly affect what you pay
for your HMO coverage.
For HMO enrollees, the state’s dollar contribution
for the non-prescription drug components of the HMO
premium will not exceed its dollar contribution for the
non-prescription drug components of the Empire Plan
premium. Any amount exceeding this limit must be paid in
full by the enrollee.
 GO TO HEALTH BENEFITS WEBSITE
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