New York Codes, Rules and Regulations › Title 4 - DEPARTMENT OF CIVIL SERVICE › Chapter V - Regulations Of The Department Of Civil Service (president's Regulations) › Part 73 - State Health Insurance Plan › Section 73.3 - Charges and contributions

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				Charges for coverage. Charges for coverage of employees of the State whose
				salaries are paid on a biweekly basis shall be payable to the respective
				insurers on a corresponding biweekly basis. Charges for coverage of all other
				employees and for coverage of all retired employees shall be payable to the
				respective insurers on a monthly basis. All such charges are subject to change
				from time to time in accordance with the provisions of the respective contracts
				or otherwise upon amendment of any such contract.
(b) Rate of contribution. The rate of
				contribution of New York State on account of the coverage of its employees,
				post retirees and their dependents shall be 100 percent of the charge on
				account of individual coverage and 75 percent of the charge on account of
				dependent coverage, except that for the health maintenance organization options
				the State's contribution shall not exceed the same dollar amount as is paid by
				the State under the basic benefit plan. Effective October 1, 2011, for those
				employees employed in a title allocated or equated to salary grade 9 or below,
				the State's rate of contribution for such employees and their dependents
				enrolled in the Empire Plan or a health maintenance organization shall be 88
				percent of the charge on account of individual coverage and 73 percent of the
				charge on account of dependent coverage; provided, however, that for
				hospital/medical/mental health and substance abuse coverage provided under a
				health maintenance organization, the State's rate of contribution shall not
				exceed 100 percent of its dollar contribution for such coverage under the
				Empire Plan. For employees employed in a title allocated or equated to salary
				grade 10 or above, the State's rate of contribution for such employees and
				their dependents enrolled in the Empire Plan or a health maintenance
				organization shall be 84 percent of the charge on account of individual
				coverage and 69 percent of the charge on account of dependent coverage,
				provided, however, that for hospital/medical/mental health and substance abuse
				coverage provided under a health maintenance organization, the State's rate of
				contribution shall not exceed 100 percent of its dollar contribution for such
				coverage under the Empire Plan. Effective October 1, 2011, the rate of
				contribution on account of the coverage of post retirees shall be as follows:
(1) for retirees who retired on or after
				January 1, 1983, and employees retiring prior to January 1, 2012, New York
				State shall contribute 88 percent of the charge on account of individual
				coverage and 73 percent of the charge on account of dependent coverage,
				provided, however, that for hospital/medical/mental health and substance abuse
				coverage provided under a health maintenance organization, the State's rate of
				contribution shall not exceed 100 percent of its dollar contribution for such
				coverage under the Empire Plan;
(2)
				for employees retiring on or after January 1, 2012, from a title allocated or
				equated to salary grade 9 or below, New York State shall contribute 88 percent
				of the charge on account of individual coverage and 73 percent of the charge on
				account of dependent coverage, provided, however, that for
				hospital/medical/mental health and substance abuse coverage provided under a
				health maintenance organization, the State's rate of contribution shall not
				exceed 100 percent of its dollar contribution for such coverage under the
				Empire Plan;
(3) for employees
				retiring on or after January 1, 2012, from a title allocated or equated to
				salary grade 10 or above, New York State shall contribute 84 percent of the
				charge on account of individual coverage and 69 percent of the charge on
				account of dependent coverage, provided, however, that for
				hospital/medical/mental health and substance abuse coverage provided under a
				health maintenance organization, the State's rate of contribution shall not
				exceed 100 percent of its dollar contribution for such coverage under the
				Empire Plan.
The rate of contribution of a participating employer on
				  account of the coverage of its employees, post retirees and their dependents
				  shall be not less than 50 percent of the charge on account of individual
				  coverage and 35 percent of the charge on account of dependent coverage. A
				  participating employer may elect to pay higher rates of contribution for the
				  coverage of its employees, retired employees and their dependents; provided,
				  however, that if a participating employer so elects to pay a higher or lower
				  rate of contribution for its retired employees or their dependents, or both,
				  than that paid by the State for its retired employees or their dependents, or
				  both, amounts withheld from the retirement allowances of its retired employees
				  for their share of premium or subscription charges, if any, shall, if the
				  president so requires, be paid to such participating employer which shall pay
				  into the health insurance fund the full cost of premium or subscription charges
				  for the coverage of such retired employees and their dependents; and provided
				  that notice of such election shall be furnished to the Department of Civil
				  Service not less than 60 days prior to the date on which it is proposed to make
				  such higher rate of contribution effective. The contributions payable by a
				  prior retiree shall be equal to the contributions payable by active employees
				  and post retirees having similar coverages; the employer's contributions shall
				  be the difference between the contributions of the prior retiree and the total
				  charges on account of coverage for such prior retiree. Notwithstanding the
				  foregoing provisions:
(i) An employee
				on leave without pay, an employee or former employee receiving long-term
				disability payments from a State income protection plan, or a vested employee
				whose coverage is continued pursuant to this Part shall be required to pay the
				entire charge (both employee's and employer's contributions) on account of such
				coverage for each full pay period of absence or while having the status of a
				vested employee, as the case may be. Provided, however, any vested employee who
				is currently entitled to, but defers receipt of, a retirement allowance or
				pension from a retirement or pension plan or system administered and operated
				by the State of New York, or a civil division thereof, including the New York
				State Teachers' Retirement System or under the optional retirement programs
				established under article 3, part V, and article 8-B of the Education Law shall
				pay only the employee share of the charge. In addition, an employer may elect
				to continue the employer share of health insurance premiums for employees in
				authorized leave without pay status for periods aggregating not more than two
				years provided such payment is available to all members of a class or category
				of employee, and the employer provides written notice of such election to the
				Department of Civil Service at least 60 days prior to the date on which it is
				proposed to make such payment available. Such payment may be extended an
				additional two years by the State Civil Service Commission for good cause shown
				and where the interests of the government would be served. Where payment has
				been made for a period which aggregates two years, or for an additional two
				year period where extended under this paragraph, no further extensions shall be
				granted unless the employee returns to his or her position and serves
				continuously therein for the six month period immediately preceding the
				subsequent leave of absence.
(ii) A
				covered prior retiree whose retirement allowance is suspended by virtue of his
				further government employment in a capacity other than as an officer or
				employee of the employer from whose service he retired shall be required to pay
				the entire charge on account of such coverage for the period during which his
				retirement allowance is suspended. If further government service is as an
				officer or employee of the employer from whose service he retired, such
				employer shall pay the required employer's contributions.
(iii) The employer shall pay the entire
				charge for the coverage of dependents of a deceased employee for the period of
				continued coverage provided in section
				73.2(b)(1) of this
				Part, following the period for which contributions for coverage of such
				dependents were made by the employee.
(iv) Dependents of a deceased employee for
				whom coverage is continued pursuant to section
				73.2(b)(2) of this
				Part, shall be required to pay the entire charge on account of such coverage.
				The initial payment shall be required in advance of such coverage and,
				thereafter, advance payments shall be required at such intervals as may be
				prescribed by the President of the Civil Service Commission.
(v) Dependents of deceased State correction
				officers or civilian employees of a correctional facility whose death occurred
				as the result of injuries sustained during the period from September 9, 1971 to
				September 13, 1971 whose coverage is continued pursuant to section
				73.2(b)(2) of this
				Part shall have the full cost of such coverage paid by the State; provided,
				however, that in the case of those enrolled in an optional benefit plan, the
				State shall contribute not more than the same dollar amount which would be paid
				if such unremarried spouse and dependents were enrolled in the basic Statewide
				health insurance plan and further provided that application for continuation of
				such coverage is made prior to September 1, 1972.
(vi) The employer shall pay an additional sum
				each month equal to the current monthly Federal Medicare charge as the
				employer's share of the cost of coverage for each employee and dependent
				covered under the health insurance plan who is 65 years of age or
				older.
(vii) The unremarried spouse
				and/or other dependents of a deceased employee who elect to continue coverage
				in the plan as provided in section
				73.2(b)(3) of this
				Part shall be required to pay the entire charge (both employee's and employer's
				contributions) on account of such coverage.
(viii) No participating employer shall be
				required to pay the cost of premium or subscription charges for the coverage of
				unpaid local elective officials or their dependents. Provided however, in
				instances where there is no statute, local law, or ordinance or resolution
				which expressly prohibits an unpaid local elective official from receiving
				compensation and the participating employer elects to contribute toward such
				premium or subscription charges, the participating employer's rate of
				contribution shall be not less than 50 percent of the charge on account of
				individual coverage and 35 percent of the charge on account of dependent
				coverage. Post-retirees who continue coverage in the plan by virtue of having
				served as unpaid local elective officials and who are expressly excluded from
				compensation by statute, local law, ordinance or resolution, shall be required
				to pay the entire charge (both the employee's and employer's contribution) on
				account of such coverage.
(ix) The
				post-retiree who continues coverage in the plan by virtue of 20 years' or more
				service as a publicly elected school board member with a participating employer
				shall be required to pay the entire charge (both employee's and employer' s
				contribution) on account of such coverage.