{"id":8150,"date":"2025-12-02T12:11:35","date_gmt":"2025-12-02T17:11:35","guid":{"rendered":"https:\/\/communicator.pef.org\/?p=8150"},"modified":"2025-12-11T14:10:26","modified_gmt":"2025-12-11T19:10:26","slug":"telephone-town-hall-covers-health-insurance-increases-and-benefits-to-help-you-save-money-deadlines-are-december-8","status":"publish","type":"post","link":"https:\/\/communicator.pef.org\/issue\/volume-43-no-11\/telephone-town-hall-covers-health-insurance-increases-and-benefits-to-help-you-save-money-deadlines-are-december-8\/","title":{"rendered":"Telephone Town Hall covers health insurance increases"},"content":{"rendered":"

December 2, 2025 —<\/em> Just before Thanksgiving, PEF learned there would be a 9.6% increase in\u00a0New York State Health Insurance Program (NYSHIP)\u00a0premiums in\u00a02026,\u00a0and President Wayne Spence hosted a telephone town hall December 1 to address the increases and outline useful benefits that members can access.<\/span>\u00a0<\/span><\/p>\n

The union does not negotiate the premiums\u00a0themselves,\u00a0that 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%\u00a0and\u00a0the state pays 84%. For family coverage, the employee pays 31%\u00a0and\u00a0the state pays 69%. With health care costs increasing around the country,\u00a0insurers have increased their costs, which means the percentage paid by PEF members will also go up.<\/span>\u00a0<\/span><\/p>\n

\u201cThat number for the overall premium is based on usage, health care trends, costs,\u201d said Director of Contract Administration Deb Greenberg. \u201cHealth insurance costs have been going up a lot, but that is\u00a0a big increase, but\u00a0it’s\u00a0not unusual this year.\u00a0We had a government shutdown that was based in large part\u00a0about\u00a0a conflict about the Affordable Care Act and whether subsidies were going to be continued.\u00a0Medicare is going up about\u00a09.5%.\u00a0The Affordable Care Act is going\u00a0up\u00a0probably\u00a0over 20%.<\/span>\u00a0<\/span><\/p>\n

\u201cAll around the health insurance industry, including people who have insurance through private employers, it’s all going up,\u201d she said. \u201cIt’s\u00a0a 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\u00a0contained\u00a0things last year.\u201d<\/span>\u00a0<\/span><\/p>\n

President Spence said the premium increases are not unique to PEF.<\/span>\u00a0<\/span><\/p>\n

\u201cI want people to understand this is not a PEF specific thing,\u201d he said. \u201cThis increase\u00a0is for\u00a0pretty much everybody\u00a0who works for\u00a0New\u00a0York\u00a0State government and for some municipalities.\u00a0We\u00a0came up with\u00a0something to help offset that. And over the years,\u00a0we’ve\u00a0increased that benefit so that more people can get it.\u201d<\/span>\u00a0<\/span><\/p>\n

The\u00a0<\/span>Productivity Enhancement Program (PEP)<\/span><\/a>\u00a0allows eligible employees to exchange previously\u00a0accrued\u00a0annual leave and\/or personal leave in return for a biweekly credit to reduce their share of New York State Health Insurance Program (NYSHIP) premiums.<\/span>\u202fThe deadline to sign up for next year\u2019s program was December 8, 2025.<\/span><\/b>\u00a0<\/span><\/p>\n

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.\u00a0<\/span>\u00a0<\/span><\/p>\n

The dollar value of the increase for individual plans is around $200 for the year and about $806 annually for families.\u00a0<\/span>\u00a0<\/span><\/p>\n

\u201cPEP could really offset some of that cost and help you save some money,\u201d President Spence said. \u201cOver the years we have significantly increased the program. The contract team is going to be advocating very strongly for that again and we think\u00a0we’ll\u00a0have some compelling arguments to get higher salary grades\u00a0in light of\u00a0all this.\u201d<\/span>\u00a0<\/span><\/p>\n

You\u00a0mustobtain\u00a0PEP forms from the Health Benefits Administrator at\u00a0your\u00a0agency.\u00a0<\/span>\u00a0<\/span><\/p>\n

Flex\u00a0Spending\u00a0Accounts<\/span><\/b>\u00a0<\/span><\/p>\n

Members can also take advantage of health care spending accounts, to cover things that\u00a0aren’t\u00a0covered by insurance, such as co-pays;\u00a0the Dependent Care Advantage\u00a0Account;\u00a0and an adoption account. These are all pre-tax programs. Even if you\u00a0don\u2019t\u00a0put aside some of your own money, the state\u00a0makes a contribution\u00a0if you just enroll.\u00a0<\/span>\u00a0<\/span><\/p>\n

\u201cDon’t leave this money on the table,\u201d said President Spence. \u201cYou could get\u00a0between $600 and $800\u00a0from the state contribution.\u201d\u00a0<\/span>\u00a0<\/span><\/p>\n

The deadline to sign up for these 2026 programs was also December 8, 2025. Visit this <\/span>OER website<\/span><\/a> to learn more.\u00a0 <\/span>\u00a0<\/span><\/p>\n

Dental benefits<\/span><\/b>\u00a0<\/span><\/p>\n

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\u00a0Anthem\u00a0provider in your area.\u00a0<\/span>Call 833-821-1949 to speak to Anthem<\/span><\/b>. If you are approved you may have to pay some out-of-pocket costs, but\u00a0you’ll\u00a0be fully reimbursed as though they were in-network.<\/span>\u00a0<\/span><\/p>\n

For\u00a0complete\u00a0health benefits information, visit the\u00a0<\/span>PEF website<\/span><\/a>\u00a0or download the\u00a0<\/span>PEF App<\/span><\/a>.<\/span>\u00a0<\/span><\/p>\n