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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
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transfer period. The enrollee must be enrolled in NYSHIP prior to April 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

• $25 Preferred-Brand/Level Two ($30 effective 1/1/19)

• $45 Non-Preferred Brand/Level Three ($60 effective 1/1/19)
When a brand-name prescription drug is dispensed and an FDA-approved

generic equivalent is available, the member will be responsible for the

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