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§9.5 CSEA Empire Plan Enhancements

In addition to the basic Empire Plan benefits, the Empire Plan for

CSEA enrollees shall include:
(a) The annual basic medical component deductible shall equal $1,000

per enrollee, $1,000 per covered spouse/domestic partner and $1,000 for
one or all dependent children. Effective January 1, 2019, the annual basic

medical component deductible shall equal $1,250 per enrollee, $1,250 per
covered spouse/domestic partner and $1,250 for one or all dependent

children. The annual basic medical component deductible for employees
in a title Salary Grade 6 or below or an employee equated to a position title

Salary Grade 6 or below, shall equal $500 per enrollee, $500 per covered
spouse/domestic partner and $500 for one or all dependent children.

Effective January 1, 2019, the annual basic medical component deductible
for employees in a title Salary Grade 6 or below or an employee equated to

a position title Salary Grade 6 or below, shall equal $625 per enrollee, $625
per covered spouse/domestic partner and $625 for one or all dependent

children. Covered expenses for basic medical services, mental health
and/or substance abuse treatments and home care advocacy services will

be included in determining the basic medical component deductible. As
set forth in Section 9.9 of this Agreement, a separate deductible for

managed physical medicine services will continue.
(b) The annual maximum enrollee coinsurance out-of-pocket expense

under the basic medical component shall equal $3,000 for the enrollee,
$3,000 for the covered spouse/domestic partner and $3,000 for one or all

dependent children. Effective January 1, 2019, the annual maximum

enrollee coinsurance out-of-pocket expense under the basic medical
component shall equal $3,750 for the enrollee, $3,750 for the covered
spouse/domestic partner and $3,750 for one or all dependent children.

Employees in a title Salary Grade 6 or below or an employee equated to a

position title Salary Grade 6 or below, the annual maximum coinsurance
out-of-pocket expense shall equal $1,500 for the enrollee, $1,500 for the
covered spouse/domestic partner and $1,500 for one or all dependent

children. Effective January 1, 2019, the annual maximum coinsurance out

of pocket expense under the basic medical component for employees in a
title Salary Grade 6 or below or an employee equated to a position title

Salary Grade 6 or below will be $1,875 for the enrollee, $1,875 for the

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