GIS 12 MA/012: Premium Rates for Use with the Family Health Plus Premium Assistance Program Calculator

The purpose of this message is to provide local districts with updated Family Health Plus premium rates for adults, Medicaid Managed Care rates for children, and Medicaid wrap-around service rates to be used in cost effective determinations for the Family Health Plus Premium Assistance Program (FHP PAP). These rates are effective immediately. Please see the attached regional rates for the nine regions of the State.

The Family Health Plus rates represent the regional costs to enroll an individual into a Family Health Plus Plan and should be compared to the cost of paying for employer sponsored health insurance premiums. Refer to Administrative Directive 08 OHIP/ADM-01 for more FHP PAP and cost analysis instructions.

Central

Central	FHP	Children
Monthly Managed Care Premiums Effective 4/1/12	$436.39	$194.00
Cost of Wrap
Vision	$2.22	$1.14
DME	$2.12	$0.61
ER Trans	$2.39	$1.50
Non ER Trans ($0 for adults)	$0.00	$3.13
Dental	$21.47	$15.77
Pharmacy	$156.36	$43.98

Counties in region

• Cayuga
• Chenango
• Columbia
• Cortland
• Delaware
• Greene
• Madison
• Onondaga
• Otsego
• Schoharie
• Tompkins

Finger Lakes

Finger Lakes	FHP	Children
Monthly Managed Care Premiums Effective 4/1/12	$458.91	$230.03
Cost of Wrap
Vision	$2.89	$1.59
DME	$3.18	$0.84
ER Trans	$1.65	$1.29
Non ER Trans ($0 for adults & children)	$0.00	$2.46
Dental	$22.39	$12.47
Pharmacy	$156.36	$43.98

Counties in region

• Allegany
• Broome
• Cattaraugus
• Chautauqua
• Chemung
• Livingston
• Ontario
• Schuyler
• Seneca
• Steuben
• Tioga
• Wayne
• Yates

Long Island

Long Island	FHP	Children
Monthly Managed Care Premiums Effective 4/1/12	$431.79	$227.06
Cost of Wrap
Vision	$1.36	$0.82
DME	$1.13	$0.69
ER Trans	$0.35	$1.15
Non ER Trans ($0 for adults)	$0.00	$2.92
Dental	$21.51	$16.71
Pharmacy	$156.36	$43.98

Counties in region

• Nassau
• Suffolk

Mid-Hudson

Mid-Hudson	FHP	Children
Monthly Managed Care Premiums Effective 4/1/12	$466.75	$227.42
Cost of Wrap
Vision	$1.73	$1.36
DME	$2.62	$0.64
ER Trans	$1.63	$1.36
Non ER Trans ($0 for adults)	$0.00	$3.75
Dental	$21.53	$16.38
Pharmacy	$156.36	$43.98

Counties in region

• Dutchess
• Orange
• Sullivan
• Ulster

Northeast

Northeast	FHP	Children
Monthly Managed Care Premiums Effective 4/1/12	$417.46	$209.44
Cost of Wrap
Vision	$2.61	$1.58
DME	$2.96	$1.02
ER Trans	$1.82	$1.49
Non ER Trans ($0 for adults)	$0.00	$3.50
Dental	$21.63	$15.96
Pharmacy	$156.36	$43.98

Counties in region

• Albany
• Fulton
• Montgomery
• Rensselaer
• Saratoga
• Schenectady
• Warren
• Washington

Northern Metropolitan

Northern Metropolitan	FHP	Children
Monthly Managed Care Premiums Effective 4/1/12	$448.15	$220.98
Cost of Wrap
Vision	$1.99	$1.60
DME	$1.24	$0.74
ER Trans	$0.88	$1.20
Non ER Trans ($0 for adults)	$0.00	$3.20
Dental	$21.77	$17.54
Pharmacy	$156.36	$43.98

Counties in region

• Putnam
• Rockland
• Westchester

New York City

New York City	FHP	Children
Monthly Managed Care Premiums Effective 4/1/12	$383.42	$202.05
Cost of Wrap
Vision	$1.46	$0.99
DME	$0.91	$0.68
ER Trans	$0.66	$0.84
Non ER Trans ($0 for adults)	$0.00	$0.37
Dental	$16.13	$11.02
Pharmacy	$156.36	$43.98

Counties in region

• NYC

Utica-Adirondack

Utica-Adirondack	FHP	Children
Monthly Managed Care Premiums Effective 4/1/12	$461.00	$209.55
Cost of Wrap
Vision	$2.53	$1.36
DME	$2.06	$0.65
ER Trans	$1.62	$1.37
Non ER Trans ($0 for adults & children)	$0.00	$2.46
Dental	$23.13	$16.47
Pharmacy	$156.36	$43.98

Counties in region

• Clinton
• Essex
• Franklin
• Hamilton
• Herkimer
• Jefferson
• Lewis
• Oneida
• Oswego
• St. Lawrence

Western

Western	FHP	Children
Monthly Managed Care Premiums Effective 4/1/12	$422.76	$210.94
Cost of Wrap
Vision	$2.36	$1.38
DME	$2.81	$0.58
ER Trans	$2.86	$1.43
Non ER Trans ($0 for adults)	$0.00	$2.69
Dental	$21.11	$16.52
Pharmacy	$156.36	$43.98

Counties in region

• Erie
• Genesee
• Monroe
• Niagara
• Orleans
• Wyoming