Dec. 14 deadline to switch health plans
By LORRAINE SIMPKINS
The state has approved the 2008 Empire Plan and HMO premium rates, which
means you have until December 14 to change your health plan option for next
year.
If you change your health plan, coverage for the new plan will begin January
3 if you are on the state’s institution payroll, or December 27 if you are
on the administration payroll.
Institution-payroll employees will not see a deduction change before their
January 3 paycheck.
Administration-payroll employees will not see a deduction change before
their December 26 check.
You should have received your 2008 rate flyer in your mail at home by now.
In addition to the new rate schedule, the flyer gives the deadline for
changing options and other important dates, such as payroll deduction dates.
The rates are also posted online at www.pef.org
.
The three state agencies responsible for administering the state Health
Insurance Program (NYSHIP) – the state Department of Civil Service,
Governor’s Office of Employee Relations and Division of Budget – negotiated
the Empire Plan premium rates with the insurers.
PEF and the other state-employee unions do not have authority to negotiate
premium rates or reject the rates negotiated 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
Empire Plan premium rates for both individual and family coverage are
increasing.
The biweekly paycheck deduction for individual coverage is increasing by 4.2
percent, from $21.30 to $22.19. The biweekly paycheck deduction for family
coverage is increasing by 6.2 percent, from $89.59 to $95.10.
HMO rates vary by plan
Some PEF members who enroll in an HMO will see an increase in their biweekly
premium deduction for their coverage in 2008, while others will pay less
than they did this year. Check the new rates for your plan now to avoid
“sticker shock” when they take effect.
One HMO, Aetna, will have a biweekly deduction of more than $300 for family
coverage.
Three HMO options – Empire BCBS HMO in both the Mid-Hudson and Downstate
Regions, and Univera – will have a biweekly deduction topping $200 for
family coverage.
Fourteen of the 20 HMO options will have biweekly premium deductions of more
than $100 for family coverage.
On the flip side, six of the HMO options have lowered their premiums for
individual coverage and seven have lowered premiums for family coverage.
Neither PEF nor the state has the authority to negotiate HMO premiums, which
are community rated.
Community rating means all enrollees (including those who don’t work for the
state) 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.
