RENSSELAER COUNTY

Health Insurance Costs - January 1, 2017

For Employees Hired On or After 11/13/2014

Full Monthly Premium Rates

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

** Employee Bi-Weekly Share of Premium Cost at 25% **

Coverage CDPHP HMO MVP HMO Empire Blue Cross Direct HMO
Single $80.44 $83.54 $117.73
Two Person $161.07 $192.24 $229.80
Family $209.12 $204.71 $341.27

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 25% **

Coverage CDPHP HMO MVP HMO Empire Blue Cross Direct HMO
Single $2,091.42 $2,172.15 $3,061.08
Two Person $4,187.88 $4,998.15 $5,974.68
Family $5,437.08 $5,322.57 $8,872.92

Plan Benefit Highlights

Benefit CDPHP HMO MVP HMO Empire Blue Cross Direct HMO
In Network  
Doctor Co-Pay $25.00 $25.00 $25.00
Specialist Co-Pay Same as above $40.00 $25.00
Drug Co-Pay $10G/$25B/$40NF $10G/$30B/$50NF $10G/$25B/$50NF
Inpatient Co-Pay 0 $500 0
Out of Network  
Deductible NA NA NA
Coinsurance NA NA NA
Inpatient Co-Pay 0 $500 0

*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.

*** 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.