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Contract College Health Insurance Rates Effective 01/01/2016

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Contract College Health Insurance Rates Effective 01/01/2016 Annual Salary up to & Including $41,756 Annual Salary over $41,756 Cornell University - Contract College Health Insurance Rates Effective 01/01/2016 BIWEEKLY SEMIMONTHLY BIWEEKLY SEMIMONTHLY EMPLOYEE COSTS EMPLOYEE COSTS EMPLOYEE COSTS EMPLOYEE COSTS CODE PLAN SERVICE AREA, ADDRESS AND TELEPHONE NUMBER IND. FAM. IND. FAM. IND. FAM. IND. FAM. 001 The Empire Plan [www.cs.ny.gov] Empire Blue Cross and Blue Shield NYS Service Center, P.O. Box 1407, Church Street Station, NY, NY 10008-1407 1-877-7NYSHIP United HealthCare P.O. Box 1600, Kingston, NY 12402-1600 37.50 161.62 40.63 175.09 50.01 192.52 54.18 208.56 1-877-7NYSHIP United Health Care/Medco Health Solutions P.O. Box 5900, Kingston,NY 12402-5900 1-877-7NYSHIP United Healthcasre/OptumHealth P.O. Box 5190, Kingston,NY 12402-5190 1-800-855-1089 066 Blue Choice 165 Court Street, Rochester, NY 14647 (585) 454-4810 or 1-800-462-0108 www.excellusbcbs.com Serving Livingston,Monroe,Ontario,Seneca,Wayne & Yates counties 43.11 144.80 46.70 156.87 53.85 172.46 58.34 186.83 280 Empire BlueCross BlueShield HMO (Upstate) 11 Corporate Woods Blvd., P.O. Box 11800, Albany, NY 12211-0800 1-800-453-0113 [www.empireblue.com] 105.29 333.46 114.06 361.25 117.28 364.66 127.05 395.05 Serving Albany,Clinton,Columbia,Deleware,Essex,Fulton,Greene, Montgomery, Rensselaer,Saratoga,Schenectady,Schoharie,Warren, and Washington Counties 290 Empire BlueCross BlueShield HMO (Downstate) Serving Bronx, Kings, Nassau, New York, 207.79 603.33 225.11 653.61 220.12 635.41 238.46 688.36 Queens, Richmond, Rockland, Suffolk, and Westchester Counties 320 Empire BlueCross BlueShield HMO (Mid-Hudson) Serving Dutchess, Orange, Putnam, Sullivan and Ulster Counties 198.70 578.93 215.26 627.17 210.92 610.73 228.50 661.62 063 Capital District PHP (Capital Area) 500 Patroon Creek Blvd., Albany, NY 12206-1057 [www.cdphp.com] (518)641-3700 or 1-800-777-2273 52.29 162.78 56.65 176.35 63.48 191.67 68.77 207.64 Serving Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington counties 300 Capital District PHP (Central) Serving Broome, Chenango, Essex, Hamilton,Herkimer, Madison, Oneida, 89.09 271.50 96.51 294.13 100.57 301.18 108.95 326.28 Otsego, and Tioga Counties 310 Capital District PHP (W. Hudson Valley) Serving Delaware, Dutchess, Orange, and Ulster Counties 122.58 342.01 132.80 370.51 134.39 372.45 145.59 403.49 067 BlueCross BlueShield of Western NY P.O. Box 80, Buffalo, NY 14240 [www.bcbswny.com] (716) 887-8840 or 1-877-576-6440 33.94 146.25 36.77 158.44 45.26 174.21 49.03 188.73 Serving Allegany,Cattaraugus,Chautauqua,Erie,Genesee,Niagara,Orleans & Wyoming counties 220 HIP - Health Plan of New York 55 Water St., New York, NY 10041 [emblemhealth.com] 1-877-861-0175 Serving Albany,Columbia,Greene,Rensselaer,Saraoga,Schenectady,Warren 105.88 285.05 114.70 308.80 117.65 315.26 127.45 341.53 & Washington counties 350 HIP - Health Plan of New York Serving Delaware,Dutchess,Orange,Putnam,Sullivan & Ulster counties 105.88 285.05 114.70 308.80 117.65 315.26 127.45 341.53 050 HIP - Health Plan of New York 55 Water St., New York, NY 10041 [emblemhealth.com] 1-877-861-0175 99.55 269.03 107.85 291.45 111.22 299.01 120.49 323.93 Serving Bronx,Kings,Nassau,New York,Queens,Richmond,Suffolk & Westchester counties 160 HMOBlue Excellus BlueCross BlueShield, Utica Business Park, 12 Rhoads Drive, Utica, NY 13502 [www.excellusbcbs.com] Utica Region 1-800-722-7884 122.42 367.13 132.62 397.72 133.65 396.11 144.79 429.12 Serving Chenango,Clinton,Delaware,Essex,Franklin,Fulton,Hamilton,Herkimer,Jefferson, Lewis,Madison,Montgomery,Oneida.Otsego & St Lawrence counties 072 HMOBlue Excellus BlueCross BlueShield, 333 Butternut Drive, Syracuse, NY 13214 [www.excellusbcbs.com] Central New York Region 1-800-447-6269 102.16 281.78 110.67 305.26 113.48 310.73 122.94 336.62 Serving Broome,Cayuga,Chemung,Cortland,Onondaga,Oswego,Schuyler,Steuben,Tioga & Tompkins counties 059 Independent Health 511 Farber Lakes Drive, Buffalo, NY 14221 [www.independenthealth.com] 1-800-501-3439 38.43 147.07 41.63 159.33 49.73 175.24 53.87 189.84 Serving Allegany,Cattaraugus,Chautauqua,Erie,Genesee,Niagara,Orleans & Wyoming counties 060 MVP Health Care (East) P.O. Box 2207, 625 State St., Schenectady, NY 12301-2207 [www.joinmvp.com] 1-800-MVP-MBRS [1-888-687-6277] 48.74 132.40 52.80 143.43 59.23 158.22 64.17 171.41 Serving Albany, Columbia, Fulton, Greene, Hamilton, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington Counties 330 MVP Health Care (Central ) Serving Broome, Cayuga, Chenango, Cortland, Delaware, Herkimer, Jefferson, Lewis, 81.34 191.93 88.12 207.92 92.12 219.57 99.80 237.87 Madison, Oneida, Onondaga, Otsego, Oswego, Tioga and Tompkins Counties 340 MVP Health Care (Mid-Hudson) Serving Dutchess, Orange, Putnam, Rockland, Sullivan,Ulster and Westchester Counties 89.47 210.07 96.93 227.58 99.78 236.74 108.10 256.47 360 MVP Health Plan (North Region) Serving Clinton, Essex, Franklin and St. Lawrence Counties 143.83 341.32 155.82 369.76 155.02 369.88 167.94 400.70 058 MVP Health Care (Rochester) Serving Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Steuben, Wayne, 34.67 130.57 37.56 141.45 45.64 156.05 49.44 169.05 Wyoming and Yates Counties 11/17/2015.
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