N.Y. Comp. Codes R. & Regs. tit. 4 § 73.3

Current through Register Vol. 46, No. 45, November 2, 2024

Section 73.3 - Charges and contributions

(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.

(c) Deduction of contributions.

(1) The contributions required to be paid by an employee on account of coverage for himself and his dependents shall be deducted from his salary or wages by the chief fiscal officer of the employer. In the case of a retired employee his required contributions shall be deducted from his retirement allowance by the fiscal officer responsible for the payment of such allowance, but in the event that his retirement allowance is suspended by virtue of his further government employment as an officer or employee of the employer from whose service he retired his required contributions shall be deducted from his salary or wages. In the case of a retired employee of a participating agency which has elected to pay a higher rate of contribution for its retired employees or their dependents than is paid by the State for its retired employees and their dependents pursuant to subdivision (b) of this section, the amount deducted from his retirement allowance as his required contribution shall be paid by the fiscal officer responsible for the payment of such allowance to the chief fiscal officer of the participating employer. During any period when an employee or retired employee is not receiving a salary, wages or a retirement allowance and his coverage is continued pursuant to this Part, he shall make the payments required of him on account of such coverage directly to the chief fiscal officer of the participating employer or in the case of a State employee to the health insurance pending account.

(2) The sums to be deducted from salaries, wages or retirement allowances or otherwise paid by direct payment shall be as determined by the president or in the case of a participating employer by the appropriate fiscal officer, and shall be in sufficient amounts so that the full contributions of employees and retired employees due and payable to the health insurance fund as provided in section 73.8 of this Part will have been so deducted or otherwise paid on or before the appropriate due date.

(3) Payments required on account of coverage of surviving dependents, for whom coverage is continued pursuant to section 73.2(b)(2) of this Part, shall be made directly to the health insurance pending account or, upon written request of the surviving dependent, such contribution shall be deducted from any retirement allowance to which such survivor is entitled. In the case of surviving dependents of a deceased employee of a participating employer, such payments shall be made to the chief fiscal officer of such participating employer.

(4) Payments required on account of coverage of the unremarried surviving spouse and/or other dependents for whom coverage is continued pursuant to section 73.2(b)(3) of this Part shall be made on a quarterly basis directly to the health insurance pending account or, upon written request of the surviving dependent, such contribution shall be deducted from any retirement allowance to which such survivor is entitled. In the case of a surviving unremarried spouse and/or other dependents of a deceased employee or retired employee of a participating employer, such payments shall be made to the chief fiscal officer of such participating employer.

N.Y. Comp. Codes R. & Regs. Tit. 4 § 73.3