Cornell University - Contract College Health Insurance Rates Effective 01/01/2021 Annualized Salary $47,741.00 or less Annualized Salary $47,741.00 or more BIWEEKLY SEMIMONTHLY BIWEEKLY SEMIMONTHLY CODE PLAN SERVICE AREA, ADDRESS AND TELEPHONE NUMBER IND. FAM. IND. FAM. IND. FAM. IND. FAM. 877-7NYSHIP (877-769-7447) The Empire Plan www.cs.ny.gov Empire BlueCross NYS Service Center, PO Box 1407, Church Street Station, NY 10008-1407 | TTY: 800-241-6894 (Hospitalization) Serving all counties. United HealthCare PO Box 1600, Kingston, NY 12402-1600 | TTY: 888-697-9054 (Medical) Serving all counties. 001 $ 46.30 $ 199.61 $ 50.16 $ 216.24 $ 61.73 $ 237.76 $ 66.87 $ 257.57 Beacon Health Options PO Box 1850, Hicksville, NY 11802 | TTY: 855-643-1476 (Mental Health/Substance Abuse) Serving all counties. CVS Caremark PO Box 6590, Lee's Summitt, MO 64064-6590 | TTY: 711 (Prescription Drug) Serving all counties. 165 Court Street, Rochester, NY 14647 Blue Choice 800-499-1275 | TTY: 800-662-1220 www.excellusbcbs.com 066 Blue Choice Serving Livingston, Monroe, Ontario, Seneca, Wayne and Yates Counties. $ 42.37 $ 181.98 $ 45.90 $ 197.15 $ 56.50 $ 216.79 $ 61.21 $ 234.86 PO Box 80, Buffalo, NY 14240 BlueCross BlueShield of Western NY 716-887-8840 or 877-576-6440 | TTY: 711 www.bcbswny.com/NYSHIP 067 BlueCross BlueShield of Western NY Serving Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming Counties. $ 39.20 $ 167.44 $ 42.47 $ 181.39 $ 52.27 $ 199.51 $ 56.63 $ 216.14 PO Box 15013, Albany, NY 12212 BlueShield of Northeastern New York 800-888-1238 | TTY: 711 www.bcbswny.com/nyship 069 BlueShield of Northeastern New York Serving Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Warren, and Washington Counties $ 43.36 $ 185.96 $ 46.97 $ 201.46 $ 57.81 $ 221.53 $ 62.63 $ 239.99 500 Patroon Creek Blvd., Albany, NY 12206-1057 Capital District PHP 518-641-3700 or 800-777-2273 | TTY: 711 www.cdphp.com Serving Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington 063 Capital $ 43.78 $ 185.67 $ 47.43 $ 201.14 $ 58.37 $ 221.28 $ 63.23 $ 239.72 Counties 300 Central Serving Broome, Chenango, Clinton, Essex, Franklin, Hamilton, Herkimer, Madison, Oneida, Otsego, and Tioga Counties $ 65.23 $ 197.25 $ 70.67 $ 213.69 $ 80.02 $ 234.99 $ 86.69 $ 254.57 310 Hudson Valley Serving Delaware, Dutchess, Orange, and Ulster Counties $ 148.20 $ 419.10 $ 160.55 $ 454.03 $ 163.13 $ 457.16 $ 176.72 $ 495.26 55 Water St., New York, NY 10041 HIP - Health Plan of New York 800-447-8255 | TTY: 888-447-4833 emblemhealth.com 050 Downstate Serving Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk and Westchester Counties. $ 117.20 $ 332.99 $ 126.97 $ 360.74 $ 133.98 $ 375.49 $ 145.15 $ 406.78 220 Capital Serving Albany, Columbia, Greene, Rensselaer, Saraoga, Schenectady, Warren and Washington Counties. $ 172.33 $ 472.07 $ 186.69 $ 511.41 $ 189.85 $ 516.36 $ 205.67 $ 559.39 350 Hudson Valley Serving Delaware, Dutchess, Orange, Putnam, Sullivan and Ulster Counties. $ 172.33 $ 472.07 $ 186.69 $ 511.41 $ 189.85 $ 516.36 $ 205.67 $ 559.39 333 Butternut Drive, Syracuse, NY 13214-1803 HMOBlue Excellus BlueCross BlueShield 800-499-1275 | TTY: 800-662-1220 www.excellusbcbs.com 072 Central New York Region Serving Broome, Cayuga, Chemung, Cortland, Onondaga, Oswego, Schuyler, Steuben, Tioga and Tompkins Counties. $ 44.77 $ 188.80 $ 48.50 $ 204.53 $ 59.69 $ 225.06 $ 64.66 $ 243.82 12 Rhoads Drive, Utica, NY 13502 HMOBlue Excellus BlueCross BlueShield 800-499-1275 | TTY: 800-662-1220 www.excellusbcbs.com Serving Chenango, Clinton, Delaware, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Lewis, Madison, Montgomery, Oneida, 160 Utica Region $ 46.31 $ 206.73 $ 50.17 $ 223.96 $ 61.75 $ 245.93 $ 66.90 $ 266.42 Otsego and St. Lawrence Counties 511 Farber Lakes Drive, Buffalo, NY 14221 Independent Health 800-501-3439 | TTY: 716-631-3108 www.independenthealth.com 059 Independent Health Serving Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming Counties $ 38.30 $ 161.90 $ 41.49 $ 175.39 $ 51.06 $ 192.98 $ 55.32 $ 209.06 PO Box 2207, 625 State St., Schenectady, NY 12301-2207 MVP Health Care 888-MVP-MBRS (888-687-6277) | TTY: 800-662-1220 www.mvphealthcare.com 058 Rochester Serving Chemung, Genesee, Livingston, Monroe, Ontario, Orleans, Schuyler, Seneca, Steuben, Wayne, Wyoming and Yates Counties $ 42.30 $ 165.91 $ 45.83 $ 179.74 $ 56.39 $ 198.32 $ 61.09 $ 214.85 Serving Albany, Columbia, Fulton, Greene, Hamilton, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and 060 East $ 43.49 $ 170.74 $ 47.11 $ 184.97 $ 57.98 $ 204.09 $ 62.81 $ 221.10 Washington Counties Serving Broome, Cayuga, Chenango, Cortland, Delaware, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, Otsego, 330 Central $ 74.28 $ 194.97 $ 80.47 $ 211.22 $ 89.56 $ 232.97 $ 97.02 $ 252.38 Tioga and Tompkins Counties 340 Mid-Hudson Serving Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester Counties $ 73.36 $ 192.35 $ 79.47 $ 208.38 $ 88.41 $ 229.83 $ 95.78 $ 248.98 360 North Serving Clinton, Essex, Franklin and St. Lawrence Counties. $ 152.36 $ 372.70 $ 165.06 $ 403.76 $ 168.17 $ 412.46 $ 182.18 $ 446.83 12/1/2020.