2018 NYSHIP State Premium Rates

Please be advised that the NYS Division of Budget has approved the Empire Plan’s premium rates for the year 2018.  The approval of these rates signals the beginning of the option transfer period for the New York State Health Insurance Program.

The Option Transfer Period and the Opt-Out enrollment period for State employees will run until December 15, 2017.

NYSHIP will again offer the Opt-Out Program in 2018, which will allow eligible employees who have employer sponsored group health insurance, to opt out of their NYSHIP coverage in exchange for an incentive payment.  NYS employees who currently participate in the Opt-Out Program will receive a notice advising that the PS-404 and PS-409 forms MUST be submitted during the Annual Option Transfer Period to continue participation in 2018.

In 2012 and 2013, CSEA had a special arrangement with New York State which allowed a CSEA enrollee covered as a dependent through their spouse/domestic partner, who is also a State employee, to opt out of their coverage in return for a $1,000 payment.  This arrangement has not been made available to CSEA since 2013.  CSEA’s ongoing grievance regarding the “State on State” Opt-Out Program continues to move forward in arbitration.  We will keep you advised of any developments.

Here is the link for the 2018 NYSHIP Biweekly Rates  rates for CSEA active State Executive Branch employees (and Unified Court System).  Please note there are two sets of rates.  The first set reflects 2018 biweekly rates for CSEA represented State employees who are Grade 9 and below.  The second set reflects 2018 biweekly rates for CSEA represented State employees who are Grade 10 and above.

Please note some of the HMOs saw a significant change in health insurance premiums for 2018.

Empire Plan rates for Local Government (municipalities and school districts) will be sent under separate cover.  Please contact our office at 1-800-286-5242 if you have any questions.


    Plans to Help Save on 2018 Health Insurance Expenses

    Enrollees should start thinking about their expenses for next year.  Do you currently participate in the Flex Spending Account?  Do you currently participate in the Productivity Enhancement Program (PEP)?   If you don’t, now is the ideal time to obtain additional information about these cost-saving benefits as enrollment begins October 2, 2017.

    The Flex Spending Account is a negotiated employee benefit for State employees.  There are two parts to the FSA; the Health Care Spending Account (HCSAccount) (medical, hospital, laboratory, prescription, dental, vision, hearing expenses, etc. not reimbursed by insurance or benefit plan) and the Dependent Care Advantage Account (DCAAccount) (childcare, eldercare or disabled dependent care, required for an employee or spouse to work).  Both are types of flexible spending accounts that give you a way to pay for your health care expenses or dependent care with pre-tax dollars.  Enrollment in the flexible spending account is voluntary – you decide how much to have taken out of your paycheck.

    For more detailed information regarding the Flexible Spending Account programs, including eligibility, enrolling online and calculating your out-of-pocket expenses, please visit www.flexspend.ny.gov or call 1-800-358-7202.

    Another program that helps to save enrollees money is the Productivity Enhancement Program (PEP).  PEP allows eligible full and part-time State employees to exchange previously accrued vacation leave and/or personal leave, in return for a biweekly credit, which reduces their share of the New York State Health Insurance Program (NYSHIP) premium.

    Eligible CSEA active State members can receive up to a $500 credit ($19.23 biweekly) or $1,000 credit ($38.46 biweekly), determined by salary grade and number of days forfeited.

    Review the Planning for Option Transfer documentation and contact your Health Benefits Administrator, usually located in your personnel office, or, if applicable, the Business Service Center if you have questions or to confirm your eligibility for this benefit.

      Choosing Your Health Insurance Option for 2018

      New York State Active Employees:  It’s that time of year to start thinking about your 2018 health insurance options.

      New York State typically mails the Planning for Option Transfer flyers to enrollees in late September.  The flyer describes the requirements and enrollment procedures for several benefits and programs, including NYSHIP health benefits, the Pre-Tax Contribution Program (PTCP) and the Opt-Out Program, if applicable.  This document is an important reminder and contains benefit and program deadlines.

      If you are thinking of changing health insurance plans during the Open Enrollment Period, the NYSHIP Plan Comparison tool, available on NYSHIP online, generates an actual side-by-side comparison of Empire Plan and HMO benefits.  This tool can help you easily compare and contrast services, copayments, coinsurance amounts and special programs for The Empire Plan and NYSHIP HMOs.

      The Comparison tool will be updated with 2018 benefits this fall, at the same time the 2018 Option Transfer Period begins.  To access this tool, visit the NYSHIP Online homepage at www.cs.ny.gov/employee-benefits.  Select your group and plan, if prompted, and then choose Health Benefits & Option Transfer; click on Rates and Health Plan Choices and the NYSHIP Plan Comparison.  Select your group (CSEA) and the counties in which you live and work.  Check the box next to the plans you want to compare, and click on Compare Plans to generate the comparison table.

      Please watch for additional information in the Work Force as the option transfer period draws near.

        Obtaining Access to the Empire Plan Participating Provider Directory

        The Empire Plan Participating Provider Program offers a network of over 275,000 physicians, laboratories and other providers located throughout New York and in many other states.

        Each year the Empire Plan sends postcards to all Empire Plan enrollees across the United States and Puerto Rico so that the enrollee may elect to have a printed directory for The Empire Plan Medical/Surgical Program mailed to them.

        You can obtain a printed directory by returning the participating provider request postcard you receive in the mail.  If you would like to receive a directory from a different state or region than your home zip code, simply write the name of the version you would like on the line provided on the postcard.  You can also get a copy of the directory by calling The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and using option 1 for the Medical Program.  A directory will be mailed within 4-6 weeks of your request.  In addition, customer service representatives can provide a personalized directory.

        To find an Empire Plan participating provider online, go to www.cs.ny.gov/employee-benefits. If prompted, choose your group and plan, and select Find a Provider.  You can choose from one of the following programs:  Hospital, Medical/Surgical, Mental Health and Substance Abuse or Prescription Drug.

        Both Enrollees and the Plan save when participating providers are used.  You pay only the applicable copayment for most covered services.

          Tentative Agreement Reached

          HealthAlliance of Hudson Valley and Empire BlueCross BlueShield

          Westchester Medical Center and Empire BlueCross BlueShield announced today that Empire BlueCross BlueShield has reached a tentative multi-year agreement with the HealthAlliance of the Hudson Valley, which operates the hospitals on Broadway and Mary’s Avenue in midtown Kingston.

          It is expected that HealthAlliance will rejoin Empire’s networks as a participating provider starting September 1, 2017.  Covered services provided by the hospitals to Empire members will resume on an in-network basis.


            Empire Plan to Cover 3D Mammograms

            Effective February 20, 2017, the Empire Plan carriers, United HealthCare and Empire BlueCross, will cover services for 3D mammograms. Until recently, 3D mammogram tomography has been considered an unproven technology by many insurance plans, including the Empire Plan. Consistent with a recent Circular Letter by the NYS Department of Financial Services, the Empire Plan will cover in-network 3D mammogram services with no copayment and non-network 3D mammogram services will be covered, subject to deductible and coinsurance. Claims for 3D mammogram services rendered on or after February 20, 2017 which were previously processed and denied by Empire Blue Cross and/or United HealthCare will be readjusted as a covered service.


              On March 31, 2017, the United States Food and Drug Administration issued a notice regarding a voluntary recall of the EpiPen and EpiPen Jr as a result of a potential defect that could make the device difficult to activate in an emergency.  While the incidence of defect is extremely rare; the recall was expanded as a measure of caution since it may represent a potential health hazard or safety risk to enrollees.

              For more information regarding the affected products, call Mylan Customer Relations at 1-800-796-9526 or visit www.mylan.com/EpiPenRecall. You may also call the FDA consumer inquiry line at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov.

              Additional information

                Update to Free Identity Protection Services for Empire Plan Enrollees

                As noted in previous articles in the Workforce, Anthem BlueCross BlueShield, the parent company of The Empire Plan Hospital Program administrator, offers free identity protection services to all current Empire Plan enrollees through AllClear ID.    For more information, call 1-855-227-9830 or go to https://anthemcares.allclearid.com.

                The National Association of Insurance Commissioners (NAIC) has also asked Anthem to provide additional credit protection to minors under the age of 18 as of January 27, 2015 in the form of credit freezes.

                Credit Freeze for Minors

                Anthem has partnered with the three major credit bureaus (Equifax, Experian, and Transunion) and will cover the cost of a one-time freeze and one-time removal at each of these credit bureaus.

                Highlights:  The Program offers a one-time credit freeze and one-time credit freeze removal at each of the three major credit reporting bureaus for children affected by the cyber-attack to:

                • Parents or legal guardians of children under the age of 18 as of January 27, 2015 who are not yet 18 as of February 24, 2017
                • Minors who are now adults – children under 18 on January 27, 2015 who are 18 or older as of February 24, 2017

                Anthem will begin mailing letters to parents or legal guardians and adult children on February 24, 2017 and expects all letters to be mailed by the end of May.

                  Important Information CarePoint Health Termination Notice

                  Empire BlueCross BlueShield is committed to providing Empire Plan members with quality service at affordable rates. One way we do this is by negotiating competitive reimbursement rates with participating hospitals.  Unfortunately, an agreement has not been met with CarePoint Health and as a result, effective January 1, 2017 they will no longer be participating in Empire BlueCross Blue Shield hospital network.


                  Terminating Hospitals:


                  Bayonne Medical Center 29 E 29th Street Bayonne, NJ 07002

                  Christ Hospital 176 Palisade Avenue Jersey City, NJ 07306

                  Hoboken University Medical Center 308 Willow Avenue Hoboken, NJ 07030


                  That means if you choose to use CarePoint Health, except for the special circumstances, services will be covered on an out-of-network basis.


                  Alternative Hospitals:


                  Englewood Hospital & Medical Center 350 Engle Street Englewood, NJ 07631

                  Jersey City Medical Center 355 Grand Street Jersey City, NJ 07304

                  Valley Hospital 223 N Van Dien Street Ridgewood, NJ 07450


                  Enrollees who have questions regarding how this may impact them are encouraged to call Empire BlueCross BlueShield toll free at 1-877-769-7447, Monday-Friday 8:30 a.m.-5:00 p.m. or visit www.empireblue.com to avoid potential difficulties and unnecessary medical expenses.

                    2017 Health Programs Important Dates to Remember

                    Now is the time for New York State employees (including the Unified Court System) to think about health insurance options for 2017.  Watch your mailbox for important information, including the 2017 health insurance premium rates, option transfer information and deadlines.  Other important benefits and dates to remember are:

                    Pre-Tax Contribution Program (PTCP) 

                    Open Enrollment November 1st through November 30, 2016

                    Your share of health insurance premium is deducted from wages before taxes are withheld, which may lower your taxes. Under Internal Revenue Service (IRS) rules, if you are enrolled in PTCP, you may change your health insurance deduction during the tax year ONLY after a qualifying PTCP event.  If you wish to change your pre-tax selection for 2017, see your agency Health Benefits Administrator and complete a health insurance transaction form (PS-404) by November 30, 2016.

                    Productivity Enhancement Program 

                    Open Enrollment November 1, 2016- December 2, 2016

                    Exchange previously accrued annual and/or personal leave in return for a credit to be applied toward the employee share of your New York State Health Insurance Program (NYSHIP) premium.  The credit will be included in biweekly paychecks and divided evenly during the plan year.  To elect PEP for 2017, you must apply between November 1, 2016 and December 2, 2016.  Please see your Agency Health Benefits Administrator for additional information and an application.  If you are currently enrolled in PEP, you must re-enroll to continue your benefits in 2017.

                    NYSHIP Annual Option Transfer Period – Dates to be Determined

                    The annual Option Transfer Period will begin once the 2017 New York State Health Insurance Program (NYSHIP) premium rates are approved.  During the Option Transfer Period, you may change your health insurance option for the next plan year;

                    • from a NYSHIP HMO to The Empire Plan
                    • from The Empire Plan to a NYSHIP HMO
                    • from one NYSHIP HMO to another NYSHIP HMO that has a NYSHIP service area where you live or work
                    • from a NYSHIP health plan to the Opt-out Program, or
                    • from the Opt-out Program to a NYSHIP health plan

                    NYSHIP Health Insurance Opt Out – Dates to be Determined

                    NYSHIP will continue to offer the Opt-out Program, which allows eligible employees who have other employer-sponsored group health insurance to opt out of their NYSHIP coverage in exchange for an incentive payment.  If you currently participate in the Opt-out Program for 2016 and wish to continue to receive incentive payments, you MUST elect to opt out for 2017 by submitting a completed Opt-Out Attestation Form (PS-409) during the Option Transfer Period.

                    We anticipate that the open enrollment dates for the opt-out will coincide with the Annual Option Transfer Period (dates not yet available).  Please watch your mail and the Work Force for additional information.