The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. Empire Plan benefits include inpatient and outpatient hospital coverage, medical/surgical coverage, Centers of Excellence for transplants, infertility and cancer, home care services, equipment and supplies, mental health and substance abuse coverage and prescription drug coverage.
TO: Agency Health Benefits Administrators
FROM: Employee Benefits Division (EBD)
SUBJECT: Adding Dependents
DATE: September 13, 2016
Dependent Eligibility Proofs
The Employee Benefits Division has recently released Policy Memo #139r1. The purpose of this memo is to clarify the types of proofs required for dependents to be enrolled in NYSHIP. The policies contained in this memo are consistent with the documentation requested during the most recent Dependent Eligibility Verification Audit. Please refer to the attached PM #139r1for a complete list of acceptable forms of proof.
When re-enrolling a previously covered dependent, NYSHIP will continue to require current documentation to verify the dependent's eligibility. For example, if an enrollee wishes to add a previously covered spouse back on to his or her plan, the enrollee must provide current proof of joint financial obligation, such as the prior year's tax return, joint bank account statement, etc. Additionally, the enrollee must provide a copy of the marriage certificate, spouse’s birth certificate, and spouse’s social security number if they are not already on file.
If you have any questions regarding the contents of this memo, please contact EBD for assistance.
Adding Dependents to Existing Family Plans
The New York State Health Insurance Program (NYSHIP) has revised its policy regarding the addition of previously eligible dependents to existing family coverage.
In the past, when an enrollee with family coverage requested to add a previously eligible dependent to his or her plan, the dependent was added effective the date of request.
As of the release of this memo, a late enrollment period will be applied when an enrollee with family coverage requests to add a previously eligible dependent. The only exception is if the dependent has experienced a loss of other health insurance coverage. The late enrollment period should be equivalent to the waiting period applied when an enrollee changes from individual to family coverage.
This change in policy is intended to ensure consistent application of effective date rules, regardless of whether the enrollee is carrying individual or family coverage. NYBEAS programming will be updated to accommodate the change in policy.
Attachment:Policy Memo 139r1