RENSSELAER COUNTY

Health Insurance Costs - January 1, 2017

For Employees Hired Prior to 9/28/2006

Full Monthly Premium Rates

Coverage NYSHIP EMPIRE PLAN CDPHP HMO MVP HMO Empire Blue Cross Direct HMO
Single $947.53 $697.14 $724.05 $1,020.36
Two Person $2,168.60 $1,395.96 $1,666.05 $1,991.56
Family $2,168.60 $1,812.36 $1,774.19 $2,957.64

*** Employee Bi-Weekly Share of Premium Cost at 20% ***

Coverage NYSHIP EMPIRE PLAN CDPHP HMO MVP HMO Empire Blue Cross Direct HMO
Single $87.46 $64.35 $66.84 $94.19
Two Person $200.18 $128.86 $153.79 $183.84
Family $200.18 $167.29 $163.77 $273.01

If you have Family Dental Coverage the bi-weekly cost will be $24.86 for 2017. 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 Direct HMO
Single $2,274.07 $1,673.14 $1,737.72 $2,448.86
Two Person $5,204.64 $3,350.30 $3,998.52 $4,779.74
Family $5,204.64 $4,349.66 $4,258.06 $7,098.34

Plan Benefit Highlights

Coverage NYSHIP EMPIRE PLAN CDPHP HMO MVP HMO Empire Blue Cross Direct HMO
In Network  
Doctor Co-Pay $20.00 $25.00 $25.00 $25.00
Specialist Co-Pay $20.00 $25.00 $40.00 $25.00
Drug Co-Pay $5G/$25B/$45NF $10G/$25B/$40NF $10G/$30B/$50NF $10G/$25B/$50NF
Inpatient Co-Pay 0 0 $500 0
Out of Network  
Deductible $1,000 NA NA NA
Coinsurance 20% NA NA NA
Inpatient Co-Pay 10% NA $500 NA

*The payroll deduction for family dental coverage will remain at $24.86 for 2017. 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.

ONLY EMPLOYEES HIRED PRIOR TO 9/28/06 ARE ELIGIBLE TO ENROLL IN THE NYSHIP PLAN.

*** 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.