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coverage either through the Empire Plan Prescription Drug Program or a

Health Maintenance Organization. For employees in a title Salary Grade 9

or below or an employee equated to a position title Salary Grade 9 or
below, the State agrees to pay 88 percent of the cost of individual coverage

and 73 percent of the cost of dependent coverage toward the prescription
drug component provided under the Empire Plan or each HMO. For

employees in a title Salary Grade 10 and above or an employee equated to
a position title Salary Grade 10 and above, the State agrees to pay 84

percent of the cost of individual coverage and 69 percent of the cost of
dependent coverage toward the prescription drug component provided

under the Empire Plan or each HMO.
§9.16 Health Insurance Enrollment Opt-out

NYSHIP enrollees who can demonstrate and attest to having other
coverage may annually elect to opt-out of NYSHIP’s Empire Plan or

Health Maintenance Organizations. Employees who choose not to enroll
in NYSHIP will receive an annual payment of $1,000 for not electing

individual coverage and $3,000 for not electing family coverage. The Opt-
out program will allow for re-entry to NYSHIP during the calendar year

subject to a Federally Qualifying Event and during the annual option
transfer period. The enrollee must be enrolled in NYSHIP prior to April

st
1 of the previous plan year in order to be eligible to opt out, unless newly
eligible to enroll. The Opt-out payment will be prorated over the twenty-

six (26) payroll cycles and appear as a credit to the employee’s wages for
each biweekly payroll period the eligible individual is qualified.

§9.17 Prescription Drug Benefit Structure

The Empire Plan Prescription Drug Program benefits shall consist of the
following: Prescription Drug Program will cover medically necessary
drugs, including vitamins and contraceptive drugs and devices, requiring a

physician's prescription and dispensed by a licensed pharmacist.

Mandatory Generic Substitution will be required for all brand-name
multisource prescription drugs (a brand-name drug with a generic
equivalent) covered by the Prescription Drug Program. The three-level

prescription drug benefit will continue. The copayment for prescription

drugs purchased at a retail pharmacy or the mail service pharmacy for up
to a 30-day supply shall be as follows:

• $5 Generic/Level One

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