December 2, 2025 — Just before Thanksgiving, PEF learned there would be a 9.6% increase in New York State Health Insurance Program (NYSHIP) premiums in 2026, and President Wayne Spence hosted a telephone town hall December 1 to address the increases and outline useful benefits that members can access.
The union does not negotiate the premiums themselves, that number is set by the Department of Civil Service. Unions negotiate the percentage of that premium that members pay. For individual coverage, members pay 16% and the state pays 84%. For family coverage, the employee pays 31% and the state pays 69%. With health care costs increasing around the country, insurers have increased their costs, which means the percentage paid by PEF members will also go up.
“That number for the overall premium is based on usage, health care trends, costs,” said Director of Contract Administration Deb Greenberg. “Health insurance costs have been going up a lot, but that is a big increase, but it’s not unusual this year. We had a government shutdown that was based in large part about a conflict about the Affordable Care Act and whether subsidies were going to be continued. Medicare is going up about 9.5%. The Affordable Care Act is going up probably over 20%.
“All around the health insurance industry, including people who have insurance through private employers, it’s all going up,” she said. “It’s a tough year. Last year we had an increase that was significantly less than 1%. We had less than 1% because of some commonsense cost containment measures that we had negotiated about how out-of-network providers were reimbursed and so that really contained things last year.”
President Spence said the premium increases are not unique to PEF.
“I want people to understand this is not a PEF specific thing,” he said. “This increase is for pretty much everybody who works for New York State government and for some municipalities. We came up with something to help offset that. And over the years, we’ve increased that benefit so that more people can get it.”
The Productivity Enhancement Program (PEP) allows eligible employees to exchange previously accrued annual leave and/or personal leave in return for a biweekly credit to reduce their share of New York State Health Insurance Program (NYSHIP) premiums. The deadline to sign up for next year’s program is December 8, 2025.
For those in salary grade 17 and below, they can trade in four days for $800 credit or eight days for a $1,600 credit. For those in salary grade 18 to 24, members can trade in two and a half days for a $750 credit or five days for a $1,500 credit. There is a separate program for teachers.
The dollar value of the increase for individual plans is around $200 for the year and about $806 annually for families.
“PEP could really offset some of that cost and help you save some money,” President Spence said. “Over the years we have significantly increased the program. The contract team is going to be advocating very strongly for that again and we think we’ll have some compelling arguments to get higher salary grades in light of all this.”
You mustobtain PEP forms from the Health Benefits Administrator at your agency.
Flex Spending Accounts
Members can also take advantage of health care spending accounts, to cover things that aren’t covered by insurance, such as co-pays; the Dependent Care Advantage Account; and an adoption account. These are all pre-tax programs. Even if you don’t put aside some of your own money, the state makes a contribution if you just enroll.
“Don’t leave this money on the table,” said President Spence. “You could get between $600 and $800 from the state contribution.”
The deadline to sign up for these 2026 programs is also December 8, 2025. Visit this OER website to learn more and enroll.
Dental benefits
Members living in areas with few dental providers can take advantage of the Limited Access Program, which allows you to see an out-of-network provider when there is no Anthem provider in your area. Call 833-821-1949 to speak to Anthem. If you are approved you may have to pay some out-of-pocket costs, but you’ll be fully reimbursed as though they were in-network.
For complete health benefits information, visit the PEF website or download the PEF App.