New York State Health Insurance Program (NYSHIP) Frequently Asked Questions
Active Employees
Rates | Address Change | Medicare: Turning 65 | Planning for Retirement (NYS Employee) | Planning for Retirement (PA or PE Employee) | Electronic Payments | Drug Coverage | Providers | Health and Wellness Benefits | Dependent Survivor
Retirees
Rates | Address Change | Recent Retiree | Medicare: Turning 65 Soon | Medicare Part B Reimbursement | Income-Related Monthly Adjustment Amount (IRMAA) | Dental and Vision Coverage for Retirees | Electronic Payments | Pension Questions | Drug Coverage | Providers | Health and Wellness Benefits | Dependent Survivor
Active Employees
Rates
Q: Where can I find current NYSHIP health insurance premium rates for active employees?
A: If you are an active Participating Agency (PA) or Participating Employer (PE) employee, please contact your agency's health benefits administrator (HBA) directly for information.
You can find current NYSHIP health insurance premium rates for NYS active employees in the NYSHIP Rates Flyer for active employees. To view the NYS active employee rates flyer on NYSHIP Online, go to www.cs.ny.gov/employee-benefits. Select your group and plan, if prompted, then click on Health Benefits & Option Transfer.Address Change
Q: I am moving. How can I update my address?
A: If you are an active New York State employee, an active employee of a NYSHIP Participating Agency (PA), such as an employee of a County, City, or other municipal entity, or an active employee of a Participating Employer (PE), such as the Thruway Authority or Bridge Authority, please contact your HBA to change your address on file.
If you have a MyNYSHIP account, you can logon and update your address through the Employee Self Portal.
Medicare: Turning 65
Q: I am an active employee and turning 65 soon. How will this affect my NYSHIP medical coverage?
A: You become eligible to enroll in Medicare on the first of the month in which you turn 65, or earlier if you are awarded Medicare due to a disability. While you are still actively working, your NYSHIP coverage remains the primary insurer for you and your covered dependents. Exceptions may apply for individuals enrolled in Medicare due to End-Stage Renal Disease (ESRD).
Once you retire, Medicare becomes the primary insurer and NYSHIP becomes the secondary insurer, meaning Medicare will pay claims first before NYSHIP. You can find more information in the NYSHIP publication General Information Book. Visit www.cs.ny.gov/employee-benefits, select your group and plan, then click on Using Your Benefits and select Current Publications.
You are not required to enroll in Medicare Part A and Part B until you are no longer actively working, but you may wish to contact the Social Security Administration to enroll in Medicare Part A as there is no premium charge for Part A for most people.
When you are preparing to retire, work with your health benefits administrator (HBA) to determine the date Medicare will become the primary insurer for you and any Medicare-eligible dependents, and contact the Social Security Administration three months before you turn 65 to enroll in Medicare Part B. You can enroll online, visit your local Social Security office, or call Social Security at 1-800-772-1213.
When Medicare is your primary insurer, your employer will reimburse you for the Medicare Part B premium you and any Medicare-primary dependents pay to the Social Security Administration, including an Income Related Monthly Adjustment Amount (IRMAA) if applicable. This is provided that you or your dependent are not reimbursed by another source and the premium is not paid for by another entity, such as Medicaid. IRMAA reimbursement is not automatic; you must apply each year.
If you are an employee of a NYSHIP Participating Agency (PA), please contact your agency directly for reimbursement information. If you are an employee of the State or a NYSHIP Participating Employer (PE), please fax a copy of your Medicare card to (518) 485-5590 or mail a copy to:
New York State Department of Civil Service Employee Benefits Division Albany, NY 12239
You can find additional information in the NYSHIP publication Medicare & NYSHIP. Visit www.cs.ny.gov/employee-benefits, select your group and plan, then click on Using Your Benefits and select Current Publications.
Planning for Retirement (NYS Employee)
Q: I am a New York State employee planning to retire and hoping for assistance with this process. Can EBD assist?
A: You must contact your health benefits administrator (HBA) before retiring to inform them that you wish to continue NYSHIP coverage as a retiree. They will assist you with the process and offer guidance on completing documentation.
To be eligible to enroll in retiree coverage through the NYSHIP, you must satisfy three eligibility requirements at the time you separate from NYS service:
- Complete the minimum service requirement of 10 years of service in a position eligible for NYSHIP benefits.
- Satisfy the requirements for retiring as a member of a retirement system; you do not need to collect your pension at this time but need to be eligible for them.
- Be enrolled in NYSHIP. This includes enrollment in the Opt-out Program.
If you qualify for NYSHIP benefits in retirement, your retiree health benefits will be effective after a two-pay-period of active benefits following your last day on the payroll. It can take several months for your pension to be finalized by the Retirement System, which affects how quickly the Employee Benefits Division (EBD) can deduct premiums from your pension check. Please be prepared for a potentially lengthy process. During this time, your coverage will be active with no break, provided you meet the eligibility requirements above. You can continue using the same insurance card and ID number. You will receive a "Dear Retiree" letter once EBD has confirmed your eligibility for retiree coverage. EBD will bill you for the retiree health insurance premium from the date your retiree health benefits went into effect through the current billing period. Once your pension has been finalized, EBD will deduct premiums directly from your pension. If your account balance includes any outstanding premiums, deductions will be taken at a maximum of $999 per month until all outstanding premiums have been recouped.
You have the option to have your NYSHIP premium deducted from your pension or be billed directly for your coverage. If you do not make an election, you will be set up for pension deduction. If you wish to be billed directly for your premium, please submit a signed written request to EBD. The request may be securely faxed to (518) 485-5590, or mail it to:
New York State Department of Civil Service Employee Benefits Division Albany, NY 12239
If you earn sick leave, you may be able to use the value of your unused sick leave to pay for all or part of the premium cost of your NYSHIP coverage during retirement. To estimate the value of your monthly Sick Leave Credit, visit www.cs.ny.gov/employee-benefits and choose your group and plan if prompted. From the NYSHIP Online homepage, select Planning to Retire? and choose Sick Leave Credit Calculator.
You may also find helpful information in Planning for Retirement, the Planning for Retirement Benefit Checklist, and the NYSHIP General Information Book. To view these publications on NYSHIP Online, visit www.cs.ny.gov/employee-benefits, select your group and plan, then click on Using Your Benefits and select Current Publications.
For more information about NYSHIP coverage and the transition from an active employee to a retiree, please contact your HBA.
Planning for Retirement (PA or PE Employee)
Q: I am a Participating Agency (PA) or Participating Employer (PE) employee planning to retire and hoping for assistance with this process. Can EBD assist?
A: You must contact your HBA before retiring and inform them you wish to continue NYSHIP coverage as a retiree. They will assist you with the process and offer guidance on completing any documentation.
To be eligible to enroll in retiree coverage through the NYSHIP, you must satisfy four eligibility requirements at the time you separate from NYS service:
- Be in a class or category of employee eligible for coverage in retirement.
- Complete your employer's minimum service requirement.
- Satisfy requirements for retiring as a member of a retirement system; you do not need to collect your pension at this time, but you must be eligible to do so.
- Be enrolled in NYSHIP; this includes enrollment in an employerr's buyout program.
If you are a PE employee, more information can be found in Planning for Retirement and the NYSHIP General Information Book. To view these publications, visit www.cs.ny.gov/employee-benefits, select your group and plan, then click on Using Your Benefits and select Current Publications.
For more information about NYSHIP coverage and the transition from an active employee to a retiree, please contact your HBA.
Electronic Payments
Q: Can I make health insurance premium payments electronically?
A: NYSHIP does not currently offer an electronic payment option. You may request a recurring payment plan with your financial institution to issue checks on your behalf for health insurance premiums. Please contact your financial institution for more details.
If you are planning to travel, you may pay in advance for the months you will be away. Please notify the Employee Benefits Division prior to sending an advance payment so we can hold refunds to be applied toward future premiums.
Drug Coverage
Q. Where can I find a comprehensive listing of drugs covered by my plan?
A. If you are enrolled in The Empire Plan, please refer to the prescription drug formulary for your group. Visit www.cs.ny.gov/employee-benefits, select your group and plan, then click on Using Your Benefits and select Empire Plan Formulary Drug Lists.
If you are enrolled in a NYSHIP HMO, please contact your HMO directly. You can find contact information for your HMO in the NYSHIP publication Health Insurance Choices. Visit www.cs.ny.gov/employee-benefits, select your group and plan, then click on Health Benefits & Option Transfer.
Providers
Q. Where can I find a listing of participating providers for my plan?
A. If you are an Empire Plan enrollee, please refer to the participating provider listing on NYSHIP Online: www.cs.ny.gov/employee-benefits/nyship/shared/providers/index.cfm.
If you are enrolled in a NYSHIP HMO, please contact your HMO directly. You can find contact information for your HMO in the NYSHIP publication Health Insurance Choices. Visit www.cs.ny.gov/employee-benefits, select your group and plan, then click on Health Benefits & Option Transfer.
Health and Wellness Benefits
Q: Does NYSHIP offer Silver Sneakers or a similar gym membership benefit?
A: The Empire Plan does not offer Silver Sneakers or a similar gym reimbursement program. However, some NYSHIP HMO plans available for NYS and PE employees may offer health and wellness benefits such as gym memberships as part of their NYSHIP Medicare Advantage Plan.
You can find information about the NYSHIP plans available to you and the benefits they offer in the NYSHIP publication Health Insurance Choices. To view Choices, go to www.cs.ny.gov/employee-benefits. Select your group and plan, then click on Health Benefits & Option Transfer.
Dependent Survivor
Q: If I pass away, will my spouse or other dependents be able to continue their coverage?
A: Should you predecease them, your enrolled dependents may be eligible to continue their NYSHIP coverage.
Eligible dependents covered at the time of the enrollee's death will continue to receive the same coverage without charge for three months beyond the month in which the enrollee passes, known as an extended benefits period.
After the extended benefits period ends, your dependents may elect to continue in NYSHIP with Dependent Survivor coverage if they are eligible. You can find more information on eligibility for Dependent Survivor coverage in the NYSHIP General Information Book for your group. Visit www.cs.ny.gov/employee-benefits, select your group and plan, then click on Using Your Benefits and select Current Publications.
You can reach the Employee Benefits Division by calling 1-800-833-4344, Monday through Friday between 9:00 am and 4:00 pm.
Retirees
Rates
Q: Where can I find the current NYSHIP health insurance premium rates for retirees?
A: If you are a Participating Agency (PA) retiree, please contact your agency's HBA directly.
You can find the current NYSHIP health insurance premium rates for NYS retirees in the NYSHIP Rates Flyer for Retirees. Visit www.cs.ny.gov and select Retirees and then Health Benefits. Select your group and plan, then click on Health Benefits & Option Transfer.
You may also find the full-share rates for COBRA medical, dental, and vision coverage in the NYSHIP Rates Flyer for direct pay enrollees. Visit www.cs.ny.gov/employee-benefits and select NYSHIP Online for Retirees. Select your group and plan, then click on Health Benefits & Option Transfer.
If you are a Participating Employer (PE) retiree, you can find the current NYSHIP health insurance premium rates for Participating Employer (PE) retirees in the NYSHIP Rates Flyer for PE Retirees. Visit www.cs.ny.gov/employee-benefits and select NYSHIP Online for Retirees. Select your group and plan, then click on Health Benefits & Option Transfer. The PE Retiree Rates flyer contains the most commonly used rate shares, but this is not a comprehensive list of actual premium rates for all retirees. Please contact your former employer directly for your exact rate.
Address Change
Q: I am moving. How can I update my address on file?
A: If you are a retired employee of a NYSHIP Participating Agency (PA) such as a retiree of a County, City, or other municipal entity, please contact your health benefits administrator (HBA) to change your address on file.
If you have a MyNYSHIP account, you can logon and update your address through the Employee Self Portal.
If you are a retired New York State employee or a retired employee of a NYSHIP Participating Employer (PE), please complete a PS-850 form and return it to the Employee Benefits Division to process this change. The completed form may be securely faxed to (518) 485-5590, or you may mail it to:
New York State Department of Civil Service
Employee Benefits Division
Albany, NY 12239
To view this form and other forms on NYSHIP Online, go to www.cs.ny.gov and select Retirees and then Health Benefits. Select your group and plan, if prompted, then click on Forms. If you have additional questions, please feel free to contact the Employee Benefits Division at 1-800-833-4344; representatives are available from 9:00 am to 4:00 pm, Monday through Friday.
Recent Retiree
Q: I recently retired and have not heard anything regarding my health insurance coverage. Can you please assist?
A: If you are a Participating Agency (PA) or Participating Employer (PE) retiree, please contact your agency's HBA directly. The following information applies for NYS retirees only.
If you are a NYS retiree, your NYSHIP health benefits will remain in effect during a two pay-period runout of your active health benefits following your last day on the payroll. Provided you have met all of the eligibility requirements to retire from NYS employment as outlined on pages 28-29 of the NYSHIP General Information Book (Active Employees), you may continue using your insurance card and ID number after the runout. To view the NYSHIP General Information Book (Active Employees) on NYSHIP Online, visitwww.cs.ny.gov/employee-benefits, select New York State Active Employee (NY) and then your group and plan, then click on Using Your Benefits and select Current Publications.
You will receive a confirmation letter once the Employee Benefits Division (EBD) has completed its review of your eligibility for NYSHIP retiree coverage, outlining your monthly health insurance premium amount, minus any applicable sick leave credit. You will be billed for your health insurance premium monthly, either through a direct billing statement mailed to your home or through deductions from your New York State and Local Retirement System (NYSLRS) or Teachers Retirement System (TRS) pension. Be advised, it can take some time for your pension to be finalized by your Retirement System. You must pay all premiums billed directly to you. If your account balance includes any outstanding premiums, deductions will be taken at a maximum of $999 per month until all outstanding premiums have been recouped.
If you would like an update on the status of your retiree benefits, contact the EBD at 1-800-833-4344; representatives are available from 9:00 am to 4:00 pm, Monday through Friday.
EBD will become your health benefits administrator when you are a retiree. The Welcome to EBD publication is a useful resource for contact information. Visit www.cs.ny.gov and select Retirees and then Health Benefits. Select your group and plan, then click Health Benefits & Option Transfer.
Medicare: Turning 65 Soon
Q: I am a retiree and turning 65 soon. How will this affect my NYSHIP medical coverage?
A: You will become eligible for primary Medicare coverage (meaning that Medicare will pay first on health insurance claims before NYSHIP) on the first of the month in which you turn 65, or earlier if you are awarded Medicare due to a disability. Exceptions may apply for individuals enrolled in Medicare due to End-Stage Renal Disease (ESRD).
You need to enroll in Medicare Part A and Part B to maintain your NYSHIP coverage. Contact the Social Security Administration (SSA) three months before you turn 65 to enroll in Medicare. You can enroll online, visit your local Social Security office, or call Social Security at 1-800-772-1213.
When Medicare is your primary insurer, your former employer will reimburse you for the Medicare Part B premium you and any Medicare-primary dependents pay to the Social Security Administration, including an Income Related Monthly Adjustment Amount (IRMAA), if applicable. This is provided that you or your dependent are not reimbursed by another source and the premium is not paid for by another entity, such as Medicaid. IRMAA reimbursement is not automatic. You must apply for it each year.
If you are a former employee of a NYSHIP Participating Agency (PA), please contact your agency directly for reimbursement information. If you are a former employee of the State or a NYSHIP Participating Employer (PE), please fax a copy of your Medicare card to (518) 485-5590 or mail a copy to:
New York State Department of Civil Service
Employee Benefits Division
Albany, NY 12239
You can find additional information in the NYSHIP publication Medicare & NYSHIP. Visit www.cs.ny.gov and select Retirees and then Health Benefits. Select your group and plan, then click on Using Your Benefits and select Current Publications.
Medicare Part B Reimbursement
Q: I am a retiree with NYSHIP coverage and enrolled in Medicare. Am I eligible for the Medicare Part B Reimbursement?
A: When Medicare is your primary insurer, your former employer will reimburse you for the Medicare Part B premium you and any Medicare-primary dependents pay to the Social Security Administration (SSA), including an Income Related Monthly Adjustment Amount (IRMAA), if applicable. This is provided that you or your dependent are not reimbursed by another source and the premium is not paid for by another entity, such as Medicaid. IRMAA reimbursement is not automatic; you must apply for it each year.
The Employee Benefits Division (EBD) distributes Medicare Part B reimbursements to NYS and Participating Employer (PE) enrollees through quarterly checks or as a credit to your New York State & Local Retirement System (NYSLRS) or Teachers'# Retirement System (TRS) pension.
If you are a Participating Agency (PA) enrollee, please contact your former employer directly for information on how the Medicare Part B premium is reimbursed.
You can find additional information in the NYSHIP publication Medicare & NYSHIP. Visit www.cs.ny.gov and select Retirees and then Health Benefits. Select your group and plan, then click on Using Your Benefits and select Current Publications.
Income-Related Monthly Adjustment Amount (IRMAA)
Q: What is IRMAA and am I eligible for an IRMAA reimbursement?
A: If you are a Participating Agency (PA) retiree, please contact your agency's HBA directly for information regarding IRMAA reimbursement.
For NYS and Participating Employer (PE) retirees, NYSHIP fully reimburses Part B premiums for any Medicare-primary enrollees or dependents. You are automatically reimbursed the standard premium through your pension check, a credit towards your monthly bill, or a quarterly reimbursement check. This is different from the premium for your health insurance under NYSHIP which is paid to the Employee Benefits Division.
For Medicare enrollees with a higher Modified Adjusted Gross Income (MAGI), the Social Security Administration (SSA) will assess a higher premium for Medicare Part B above the standard premium. This is known as the Income-Related Monthly Adjustment Amount (IRMAA). You must apply to be reimbursed for the additional IRMAA premium for Medicare Part B.
The IRMAA Reimbursement form, along with an instructional letter, is available on NYSHIP Online. To view the IRMAA reimbursement form and letter, go to www.cs.ny.gov and select Retirees and then Health Benefits. Select your group and plan, if prompted, then click on Forms.
If you have any questions about completing the form, please contact the Employee Benefits Division (EBD) at 1-800-833-4344 or visit the IRMAA FAQs page. To visit the IRMAA FAQs page, go to www.cs.ny.gov and select Retirees and then Health Benefits. Select your group and plan, if prompted, then select Medicare and scroll down and click on IRMAA FAQs.
Dental and Vision Coverage for Retirees
Q: I am a retiree and I have NYSHIP medical coverage. Am I eligible for vision or dental coverage?
A: If you are a retiree of a NYSHIP Participating Agency or Participating Employer, please contact your former employer directly for information regarding retiree dental and vision coverage and/or COBRA.
If you are a recent retiree, you may be within the 60-day timeframe during which you are eligible to apply for an extension of your active dental and vision coverage through COBRA. If you are a New York State retiree, please refer to page 42 of the NYSHIP General Information Book for more information. Visit www.cs.ny.gov/employee-benefits. Select New York State Active Employee (NY) and then your group and plan, then click on Using Your Benefits and select Current Publications. You may also contact your former employer union for information on possible dental or vision benefits for retirees offered by the union.
NYSHIP does not offer a retiree Dental or Vision plan. You may be eligible to enroll in a direct-pay plan for dental coverage through Anthem. Contact Anthem for more information at 1-800-947-0101. There is no direct-pay conversion plan available for vision benefits from Davis Vision.
Electronic Payments
Q: Is there a method for me to make health insurance premium payments electronically?
A: If you are a NYS retiree, you may enroll in pension deduction status to have health insurance premium payments deducted from your monthly pension in lieu of direct billing by mail. There are no other electronic payment options currently available. To enroll in pension deduction status, please send a signed, written request to EBD by fax at (518) 485-5590 or by mail to:
New York State Department of Civil Service
Employee Benefits Division
Albany, NY 12239
Pension Questions
Q: I have questions about my NYSLRS pension, can EBD assist?
A: The New York State Department of Civil Service does not administer retiree pensions. If you are looking for information about your pension, please contact the New York State & Local Retirement System (NYSLRS) or Teachers Retirement System (TRS).
If you have questions about continuing your health insurance in retirement, please contact the Employee Benefits Division at 1-800-833-4344, from 9:00 am to 4:00 pm, Monday through Friday.
Drug Coverage
Q. Where can I find a comprehensive listing of drugs covered by my plan?
A. If you are enrolled in The Empire Plan, please refer to the prescription drug formulary for your group. To view the prescription drug formulary on NYSHIP Online, go to www.cs.ny.gov/employee-benefits. Select your group and plan, if prompted, then click on Using Your Benefits and select Empire Plan Formulary Drug Lists.
If you are enrolled in a NYSHIP HMO, please contact your HMO directly. You can find contact information for your HMO in the NYSHIP publication Health Insurance Choices. To view Choices, go to www.cs.ny.gov/employee-benefits, select your group and plan, then click on Health Benefits & Option Transfer.
Providers
Q. Where can I find a listing of participating providers for my plan?
A. If you are an Empire Plan enrollee, please refer to the participating provider listing on NYSHIP Online: www.cs.ny.gov/employee-benefits/nyship/shared/providers/index.cfm.
If you are enrolled in a NYSHIP HMO, please contact your HMO directly. You can find contact information for your HMO in the NYSHIP publication Health Insurance Choices. To view Choices, go to www.cs.ny.gov/employee-benefits, select your group and plan, then click on Health Benefits & Option Transfer.
Health and Wellness Benefits
Q: Does NYSHIP offer Silver Sneakers or a similar gym membership benefit?
A: The Empire Plan does not offer Silver Sneakers or a similar gym reimbursement program. However, some of the NYSHIP HMO plans available to NYS and PE retirees may offer health and wellness benefits such as gym memberships as part of their NYSHIP Medicare Advantage Plan.
You can find information about the NYSHIP plans available to you and the benefits they offer in the NYSHIP publication Health Insurance Choices. To view Choices on NYSHIP Online, go to www.cs.ny.gov and select Retirees and then Health Benefits. Select your group and plan, if prompted, then click on Health Benefits & Option Transfer.
Dependent Survivor
Q: If I pass away, will my spouse or other dependents be able to continue their coverage?
A: Should you predecease them, your enrolled dependents may be eligible to continue their NYSHIP coverage.
Eligible dependents who are covered at the time of the enrollee's death will continue to receive the same coverage without charge for three months beyond the month in which the enrollee passes, known as an extended benefits period.
After the extended benefits period ends, your dependents may elect to continue in NYSHIP with Dependent Survivor coverage if they are eligible. You can find more information on eligibility for Dependent Survivor coverage in the NYSHIP General Information Book for your group. Visit www.cs.ny.gov and select Retirees and then Health Benefits, select your group and plan, then click on Using Your Benefits and select Current Publications.
You can reach the Employee Benefits Division by calling 1-800-833-4344, Monday through Friday between 9:00 am and 4:00 pm.