2027 NYSHIP Information Coming Soon!
This page reflects information for the 2026 calendar year.
Information for the 2027 calendar year will be provided once it is released.
Compare Plans
Save money by generating a comparison of the benefits provided by the NYSHIP plans in your area.
Coverage Options
The Empire Plan vs. NYSHIP HMOs
NYSHIP offers two types of health insurance options: The Empire Plan and NYSHIP-approved Health Maintenance Organizations (HMOs).
The Empire Plan provides worldwide coverage and access to a broad network of providers. HMOs provide regional coverage and typically require you to use network providers.
Changing Your Plan
Once in a 12-month period, you may change to any NYSHIP option for which you are eligible for any reason. You must wait a full twelve months after you change your plan before you are eligible to change your plan again.
You can change your NYSHIP option more than once during the 12-month period only if you have a qualifying life event.
Changing More Than Once Per Twelve Months
Retirees may change health plans once at any time during a 12-month period. Additional plan changes cannot be made except under certain circumstances (see your General Information Book for details).
Some common circumstances that may allow you to change plans include:
- Making a permanent move
- Adding a newly eligible dependent
Changing Your Option
Before you make a change, consider:
- Confirm that your plan is available where you live or work
- HMO availability varies by county
- Changes can be made once in a 12-month period. Mail the necessary form(s) to EBD as early as possible prior to the coverage effective date you are requesting. (The effective date must be the first of a month.)
- Changes due to a qualifying life event follow specific effective date rules
- Covered services
- Provider networks
- Your out-of-pocket costs
Forms You'll Need:
Health Insurance Transaction Form (PS-404R)
Use this form to:
- Enroll in NYSHIP
- Change your health insurance option
- Add or remove dependents
- Change to Individual or Family coverage
Cost of Coverage
Costs to Consider
New York State helps to pay for your health insurance coverage. After the State's contribution, you are responsible for paying the balance of your premium, usually through deductions from your monthly pension check or by paying EBD directly (speak with EBD for more information). Whether you enroll in The Empire Plan or a NYSHIP HMO, the State's share and your share of the cost of coverage are based on the following:
If you are a Grade 9 and below in 2026 or Grade 13 and below in 2027 (or salary equivalent):
Your Individual Coverage State Share is 88%, Employee Share is 12%
Your Dependent Coverage State Share is 73%, Employee Share is 27%
If you were a Grade 10 and above in 2026 or Grade 13 and below in 2027 (or salary equivalent):
Your Individual Coverage State Share is 84%, Employee Share is 16%
Your Dependent Coverage State Share is 69%, Employee Share is 31%
If you enroll in a NYSHIP HMO, the State's dollar contribution for the hospital, medical/surgical and mental health and substance use components of your HMO premium will not exceed its dollar contribution for those components of The Empire Plan premium. For the prescription drug component of your HMO premium, the State pays the share noted in the table; the dollar amount is not limited by the cost of Empire Plan drug coverage.
This information does not apply to vestees, COBRA enrollees or Young Adult Option enrollees (who pay the full cost of coverage).
What They Are
The amount of money you are expected to pay upon receiving covered services under your health insurance plan is referred to as either a copayment or coinsurance.
A copayment is a fixed dollar amount that has been set for the service being received, regardless of the total cost of the service.
Coinsurance is a fixed percentage of the cost of the service being received.
Copayment and coinsurance amounts for The Empire Plan and all NYSHIP HMOs may be viewed in Health Insurance Choices.
What It Is
The dollar amount you are required to pay before a health plan begins to reimburse for covered services received from non-network providers.
2026 Deductible Amounts
The 2026 Empire Plan deductible amounts may be viewed in Health Insurance Choices.
NYSHIP HMOs do not have annual deductibles.
What It Is
The maximum out-of-pocket (OOP) limit is the most you will pay out of your own pocket in a given plan year for covered health care services delivered by in-network providers under your plan. Once you reach this limit, your copayments will be reimbursed by your plan for the remainder of the plan year. Additional information about the annual maximum OOP limit can be found in Health Insurance Choices.
Medicare
Medicare and NYSHIP Coordination
When you are no longer an active employee and become eligible for Medicare, it is the combination of your health insurance benefits under Medicare and NYSHIP that provides you with the most complete coverage.