RENSSELAER COUNTY

Health Insurance Costs - January 1, 2021

For Employees Hired Prior to 9/28/2006

Full Monthly Premium Rates
Coverage NYSHIP EMPIRE PLAN CDPHP HMO MVP HMO Empire Blue Cross EPO
Single $1,078.01 $838.65 $868.52 $1,168.77
Two Person $2,460.20 $1,678.98 $1,998.33 $2,280.94
Family $2,460.20 $2,180.29 $2,128.15 $3,388.50

*** Full-Time Employee Bi-Weekly Share of Premium Cost at 20% ***
Coverage NYSHIP EMPIRE PLAN CDPHP HMO MVP HMO Empire Blue Cross EPO
Single $99.51 $77.41 $80.17 $107.89
Two Person $227.10 $154.98 $184.46 $210.55
Family $227.10 $201.26 $196.44 $312.78

If you have Family Dental Coverage the bi-weekly cost will be $24.86 for 2021. There is no payroll deduction for individual dental coverage.

Employee Annual Share of Premium Cost at 20%
Coverage NYSHIP EMPIRE PLAN CDPHP HMO MVP HMO Empire Blue Cross EPO
Single $2,587.22 $2,012.76 $2,084.45 $2,805.05
Two Person $5,904.48 $4,029.55 $4,795.99 $5,474.26
Family $5,904.48 $5,232.70 $5,107.56 $8,132.40

Plan Benefit Highlights
Coverage NYSHIP EMPIRE PLAN CDPHP HMO MVP HMO Empire Blue Cross EPO
In Network  
Doctor Co-Pay $25.00 $25.00 $25.00 $25.00
Specialist Co-Pay $25.00 $25.00 $40.00 $25.00
Drug Co-Pay $5G/$30B/$60NF $10G/$25B/$40NF $10G/$30B/$50NF $10G/$25B/$50NF
Inpatient Co-Pay 0 0 $500 $100
Out of Network  
Deductible $1,250.00 NA NA NA
Coinsurance 20% NA NA NA
Inpatient Co-Pay 10% 0 $500 0

*The payroll deduction for family dental coverage will be $24.86 for 2021. There is no payroll deduction for individual dental coverage.*

NOTE-THE EMPLOYEE SHARE LISTED ABOVE IS FOR FULL-TIME EMPLOYEES. IF YOU ARE NOT A FULL-TIME EMPLOYEE, THE HEALTH INSURANCE COVERAGE WILL COST YOU MORE, DEPENDING UPON THE NUMBER OF HOURS WORKED PER WEEK.

Plan information, including summaries of benefits and coverage (SBC) and links to health plan websites, can be found here.

*** ANY PAYROLL DEDUCTIONS THAT ARE REQUIRED FOR ANY COVERAGE YOU ELECT WILL COME OUT OF YOUR PAYCHECK THE PAY-PERIOD BEFORE THE COVERAGE IS EFFECTIVE.