Policy/Memo 73

Number: Policy Memo 73
Date Issued: July 20, 1994
Policy File Ref: A310

ISSUE:

Retention of the "actively at work" provision for new enrollments.

Background:

It has been a long-standing NYSHIP requirement to require new enrollees to be actively at work on the date their coverage becomes effective. "Actively at work" has been interpreted to mean that the employee is in paid status on the NYSHIP effective date. If the enrollee is in non-paid status, coverage doesn't become effective until the employee's return to the payroll. This is a common practice for larger group health plans and is used to defer liability for claims expense for individuals whose medical condition prevents them from working.

The actively at work provision could prove troublesome for local employers who wish to join NYSHIP since some employees could be denied coverage on the agency's charter enrollment date. A recent complaint from a prospective PA has caused us to reexamine this policy.

Although this has been a long-standing NYSHIP requirement, there is no provision of Civil Service Law or Regulation, Insurance Law or carrier contract that requires continuation of this policy.

Policy:

Continue the "actively at work" requirement for all (State, PE, PA) new enrollments when the enrollee is employed by an employer currently participating in NYSHIP.

Waive the provision for employees not on the payroll on the charter date of an employer's participation in NYSHIP to the extent benefits are not available from the previous plan, provided the enrollee otherwise meets the NYSHIP enrollment requirements and was covered under the employer's previous health plan.