Department of Civil Service

SEHP10-12

TO: Student Employee Health Plan Agency Health Benefits Administrators
FROM: Employee Benefits Division (EBD)
SUBJECT: Federal Health Care Reform and NYSHIP Coverage of Children to Age 26
DATE: October 19, 2010

As required by the Patient Protection and Affordable Care Act (PPACA), effective January 1, 2011, the eligibility rules for covering dependents under the New York State Health Insurance Program (NYSHIP) will change to allow an enrollee’s child to continue coverage as an eligible dependent up to age 26. 

An enrollee’s natural, legally adopted, step and/or domestic partner child is eligible for this coverage regardless of financial dependency, residency, student status, employment and/or marital status. The extension of coverage to age 26 applies also to “other” eligible dependent children upon submission of an approved PS 457 Statement of Dependence and supporting documentation. An adult child under age 26 who is currently enrolled as a dependent under their parent’s family coverage on January 1, 2011 will continue to be covered to age 26; no action is required by the enrollee or the HBA.  Also beginning January 1, 2011, dependent children will be eligible for coverage under NYSHIP through the end of the month in which they reach age 26.

Special Enrollment Period

The special enrollment period for eligible adult children not currently covered under their parent’s family coverage begins November 1, 2010 and continues through the end of the option transfer period, for coverage effective January 1, 2011. During this period, enrollees who currently have individual coverage and want to add a young adult dependent under the age of 26 will be able to do so without a waiting period.  The normal family premium contribution will apply.  NYBEAS transaction processing guidelines for the open enrollment period are attached.

Employees will be instructed to contact their agency HBA to have their eligible adult dependent(s) added to their NYSHIP coverage.  A NYSHIP Special Report announcing the dependent coverage extension to age 26 will be mailed to all enrollees next week. This report will include an enrollment form (enclosed) for enrollees to complete.

HBAs must process the appropriate transaction on NYBEAS to enroll the dependent on the employee’s record.  Adult children who are also currently enrolled in either COBRA continuation coverage or the Young Adult Option through NYSHIP will be required to indicate on the enrollment form if they wish to cancel the current coverage.  If an adult child indicates they wish to cancel the current COBRA or Young Adult Option coverage, the HBA must forward a copy of the enrollment form to EBD to process the cancellation.

NYBEAS Processing

Through the end of the option transfer period, use the dates and transactions below when adding young adult dependents to NYBEAS:

For enrollees requesting to add young adult dependents after the Special Enrollment Period has ended, normal waiting periods resume and will be based on date of first eligibility and date of request.

Military Service 

Dependents age 26 and over will continue to be credited with up to 48 months of benefits eligibility for time served in the military, as long as they remain in full-time student status.

Automated Dependent Deletions and Reports

Beginning January 1, 2011, NYBEAS programming will be adjusted to automatically remove dependents at the end of the month in which the dependent turns 26.  You will continue receiving the Automated Dependent Delete Report notifying you when a change to individual coverage is necessary due to the last dependent on file reaching age 26.

COBRA/New York State Continuation Coverage

Young adult dependents under the age of 26 being re-added to an enrollee’s file will be offered another 36-month period of COBRA  or New York State Continuation Coverage when they reach age 26 or otherwise become ineligible.

New York State Young Adult Option (Implemented 01/01/2010)

Young Adult Dependents that reach age 26 or otherwise become ineligible may choose to enroll in the Young Adult Option.  The availability of the Young Adult Option coverage is based on the parent’s eligibility for NYSHIP.     Termination of coverage under the Young Adult Option does not cause a “qualifying event;” therefore, the Young Adult has no right to federal COBRA or State continuation coverage when the Young Adult Option coverage ends.

Enclosed is a copy of the dependent enrollment form, and the list of frequently asked questions that is included in the Special Report being mailed to all enrollees.

If you have any questions, please contact your processor.

SEHP Young Adult Q&A

Q1. My 20-year-old daughter is going back to school full-time in January. What do I need to do to enroll her as a dependent on my SEHP coverage?

A. As of January 1, 2011, your daughter will be eligible as a dependent on your family coverage up to age 26. To add her to your plan, complete the form on page 6 and return it to your HBA.

Q2. My 22-year-old daughter is enrolled in NYSHIP under the Young Adult Option. Will she be eligible to be covered as a dependent on my plan? If so, will she automatically be enrolled in my plan?

A. Effective January 1, 2011, your daughter, up to age 26, may be eligible for SEHP coverage as your dependent, but she will not be automatically enrolled. To enroll her as a dependent, fill out the attached Young Adult Dependent form on page 6 making sure to check box 8 to cancel her enrollment in the Young Adult Option and then return it to your agency HBA. You and your daughter must both sign and date the form. For eligibility requirements, please refer to the PPACA article.

Q3. My daughter’s birthday is at the beginning of the month. When she turns 26, will she lose coverage on her birthday or at the end of that month?

A. Effective January 1, 2011, your daughter’s coverage as a dependent will end on the last day of the month in which she turns 26-years-old.When she is no longer a dependent, she may be eligible for NYSHIP coverage under the Young Adult Option or continuation coverage under COBRA or New York State law. For eligibility requirements, please refer to the Young Adult Option and Continuation of Coverage articles.

Q4. I have two young adult children; my son is 27 and my daughter is 23. Can I cover them as dependents on my plan or will they be enrolled in a policy of their own and billed separately?

A. Since your son is over the age of 26, he may be eligible for coverage under the Young Adult Option, which is billed separately from your plan. The premium will be the full cost of individual coverage. If your daughter is eligible, she can be added as a dependent on your SEHP coverage up to age 26. If your daughter enrolls in your plan, you will pay the premium for family coverage. For eligibility requirements, please refer to the PPACA and Young Adult Option articles.

Q5. My daughter is enrolled in SEHP under the Young Adult Option. Will she be eligible to enroll in continuation coverage if I lose my SEHP eligibility?

A. No. If your daughter enrolls in SEHP under the Young Adult Option, she will no longer be eligible for continuation coverage under COBRA or New York State law. Additionally, if you lose your SEHP eligibility, your daughter will lose her eligibility for the Young Adult Option.

Q5. I plan to enroll my 24-year-old son as a dependent; will there be an extra charge to cover him?

A. Your premiums will not increase if you already have family coverage, because under the PPACA, eligible young adult children will be included as dependents on your family policy. However, if you are currently enrolled with individual coverage, you will need to change to family coverage and may see an increase in your premium costs.

Q6. My son is about to turn 26 and he lost SEHP coverage when he turned 19. His employer does not offer health insurance. Will he have any options for health insurance coverage under SEHP?

A. After your son’s 26th birthday, he may be eligible for coverage under the Young Adult Option. For eligibility requirements, please refer to the Young Adult Option article.

Q7. When my son lost eligibility as my dependent, he enrolled in continuation coverage. I plan to reenroll him as my dependent for January 2011. If I lose my SEHP eligibility, will he be eligible for the full length of continuation coverage again?

A. Yes. If you lose SEHP eligibility, your son will be eligible for the full length of continuation coverage.

Q8. If I add my son as a young adult dependent, can I also cover his daughter?

A. No. Under the PPACA, coverage does not apply to the spouse or children of your young adult dependent. However, if your son’s daughter is financially dependent on you and lives with you, she may be eligible to be covered on your health insurance as an “other eligible dependent.” Click here for more information.

Q9. My 23-year-old son is currently enrolled as a temporarily disabled dependent on my SEHP coverage. He has been approved to remain on my plan through December 31, 2011. If my son is still disabled on December 31, 2011, will I need to apply for an extension of his disabled dependent status for him to remain covered?

A. No. Effective January 1, 2011, your son will continue to be a dependent on your coverage up to age 26. If your son is still disabled when he approaches his 26th birthday, another disabled dependent application must be completed and approved prior to his 26th birthday for him to remain covered after age 26.

If You Are Adding a Young Adult Child as a Dependent

1. Complete the Young Adult Dependent form on the back of this page:

   • Enrollee Information section (boxes: 1-8)
   • Adult Child Dependent Information section
   • Enrollee must sign and date form
   • Dependent’s signature and date is required when the dependent being added is electing to cancel their other NYSHIP coverage under COBRA or the Young Adult Option

2. Submit Required Proofs:

   • Dependent’s birth certificate (photocopies only, no original documents)
   • Dependent’s Social Security Card (photocopies only, no original documents)

3. Bring the signed and completed Young Adult Dependent form with photocopies of the required proofs to your agency Health Benefits Administrator.

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