Frequently Asked Questions
The New York State Health Insurance Program (NYSHIP) and The Young Adult Option
Information about young adult coverage for the children of NYSHIP enrollees
On July 29, 2009, Governor David A. Paterson signed into law Chapter 240 of the Laws of 2009, which extends the availability of health insurance coverage to young adults up to age 30. This expansion will assist young adults who do not have access to employer-sponsored health insurance. This law is sometimes referred to as the "Age 29" law, because it permits young adults to continue or obtain coverage through a parent's policy until the young adult's 30th birthday. For general information about this law go to the NYS Department of Financial Services web site at http://www.dfs.ny.gov/insurance/health/S6030_Age29_young.htm.
The following FAQs address this law and how it affects the young adult children of NYSHIP enrollees.
Q. I am enrolled in NYSHIP with family coverage. Am I able to add my young adult child to my family coverage at no additional cost to me?
A. You may add your young adult child up to age 26 to your family coverage at no additional cost under the federal Patient Protection and Affordable Care Act (PPACA). Under the Young Adult Option, you or your eligible young adult child up to age 30 must pay the premium for the full cost of individual coverage for the NYSHIP option selected.
Q. Who is eligible for young adult coverage under NYSHIP?
A. The Young Adult Option is available to young adults who meet all of the following eligibility requirements:
- Be a child, adopted child, or stepchild of a NYSHIP enrollee (including those enrolled under COBRA)
- Be age 29 or younger
- Be unmarried
- Not be insured by or eligible for coverage through the young adult's own employer sponsored health plan, whether insured or self-funded, provided that the health plan includes both hospital and medical benefits
- Live, work or reside in New York State or the plan's service area
- Not be covered under Medicare
Q. Does my child have to be financially dependent on me or reside with me to be eligible for the Young Adult Option?
A. No. The young adult does not need to live with the parent, be financially dependent upon the parent, or be a student.
Q. My 26 year old daughter is currently enrolled for COBRA coverage under NYSHIP. Is she eligible for the Young Adult Option?
A. Yes. However, while the premium for the Young Adult Option will be lower than the COBRA premium (COBRA includes a two percent administrative charge), your daughter should consider that if you (the parent enrollee) lose coverage under NYSHIP, her eligibility for the Young Adult Option will end and she will not be eligible for COBRA coverage when coverage under the Young Adult Option ends.
Q. Can my child enroll for dental and vision coverage under the Young Adult Option?
A. No. This law applies only to health insurance coverage.
Q. Which NYSHIP options are available to my young adult child?
A. A young adult is entitled to the same health insurance coverage as his/her parent provided the young adult lives, works or resides in New York State or the insurer's service area. Additionally, NYSHIP will permit a young adult to enroll in any other NYSHIP option that is available to the parent and for which the Young Adult otherwise qualifies for enrollment under NYSHIP rules. This means that a young adult may:
- Enroll in The Empire Plan regardless of the parent's option;
- Enroll in the same HMO as the parent if the young adult lives, works or resides in the HMO's service area or in New York State; or
- Enroll in a NYSHIP HMO that the parent is not enrolled in if the young adult lives or works within the HMO service area.
Q. Where can I find information about the various health insurance plans offered under NYSHIP's Young Adult Option?
A. Materials that summarize the benefits for the various health insurance plans offered under NYSHIP's Young Adult Option are available under the Health Plan Choices link on this site.
Q. Where can I find a list of premiums for health insurance plans available under NYSHIP's Young Adult Option?
A. A list of premiums for NYSHIP's Young Adult Option is available under the Rates link on this site.
Q. When can I enroll in the Young Adult Option?
A. A young adult may enroll at the following times:
- Within 60 days of when the young adult would lose coverage due to age under the parent's policy.
- Within 60 days of when the young adult becomes eligible due to: a loss of his/her employer coverage; relocation of residence or employment into New York State or the service area (please note that NYSHIP's HMOs have specific, geographically limited service areas while The Empire Plan does not); or otherwise becomes newly eligible due to a change in circumstances (such as divorce).
- During the annual 30-day open enrollment period.
Q. How do I enroll in the Young Adult Option?
A. Either the parent enrollee or the young adult may complete the application form (YAO 30-01/10 NYPE). Proof of the parent/child relationship also must be provided, e.g. birth certificate, as indicated on the form. The first month's premium also must be remitted. Send the completed form, documents and payment to:
NYS Department of Civil Service
Employee Benefits Division - YAO
Alfred E. Smith State Office Building
Albany, NY 12239
Q. When will my Young Adult Option coverage be in effect?
A. If coverage is elected within 60 days of the date that the young adult otherwise would lose eligibility for coverage as his/her parent's dependent due to age, coverage is retroactive to the date that the young adult lost coverage. This is the only circumstance in which the Young Adult Option will be effective on a retroactive basis.
For prospective Young Adult Option elections, coverage may be elected during the annual 30-day Young Adult Option Open Enrollment Period or within 60 days of the date that a Young Adult is newly qualified due to a change in circumstances. (Examples include loss of coverage through employer, moving residence into New York State, or divorce.) Coverage will be available no later than 30 days after NYSHIP receives written notice of the election and payment of the first monthly premium.
Q. How will I be billed?
A. A monthly bill will be mailed to the young adult or the parent enrollee, as designated on the application. Payments may be made by mailing a check or money order made payable to "NYS Employee Insurance Pending Account" to the Employee Benefits Division. Payment is due prior to the first of the month for which premium is being paid. If payment is not received within the 30-day grace period, coverage will be cancelled.
Q. If I voluntarily cancel my coverage or am cancelled for non-payment can I reenroll for the Young Adult Option?
A. You may not reenroll until the next open enrollment period unless you become eligible again because of a qualifying event, e.g. you obtain other employer-sponsored coverage and subsequently lose that coverage.
Q. When will my Young Adult Option coverage end?
A. Your coverage will end if:
- You voluntarily terminate coverage;
- Your parent is no longer enrolled in NYSHIP;
- You no longer meet all of the eligibility requirements; or
- Your NYSHIP premium is not paid in full within the 30-day grace period, following the premium payment due date.