RENSSELAER COUNTY HEALTH INSURANCE COSTS: January 1, 2021

NON-MEDICARE ELIGIBLE RETIREES

Rensselaer County 2021 Plan Options and Monthly Premiums

Coverage NYSHIP Empire Plan CDPHP HMO MVP HMO CO Plan 20 Empire BCBS EPO
Single $1,074.87 $835.51 $865.38 $1,165.63
Two Person $2,452.24 $1,671.02 $1,990.37 $2,272.98
Family $2,452.24 $2,172.33 $2,120.19 $3,380.54

Plan Benefit Highlights

Coverage NYSHIP Empire Plan CDPHP HMO MVP HMO CO Plan 20 Empire BCBS EPO
In Network  
Doctor Co-Pay $25 $25 $25 $25
Specialist Co-Pay $25 $25 $40 $25
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

Retiree Monthly Share of Premium

Coverage NYSHIP Empire Plan CDPHP HMO MVP HMO CO Plan 20 Empire BCBS EPO ***
Single $537.44 $417.76 $432.69 $582.82
Two Person $1,432.73 $960.84 $1,163.93 $1,302.59
Family $1,432.73 $1,286.69 $1,248.32 $2,022.51