Department of Civil Service

NY07-20

TO: New York State Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: CSEA/PEF/NYSCOPBA Seasonal Employees
DATE: May 11, 2007

This is a reminder of New York State Health Insurance Program (NYSHIP) eligibility rules for Seasonal Employees.

CSEA - and PEF – Represented Employees

To be eligible for enrollment, an employee must be appointed or elected to a position in State service and:

• Seasonal employees must be expected to work at least six months. If the employee is anticipated to work at least on a half-time basic (50% or more) for six months, the employee is eligible to apply for NYSHIP coverage as of the date of employment. Coverage is subject to the 42 (CSEA) or 56 (PEF) day new employee waiting period, which starts on the first date of such employment, and benefits become available as of the 43rd or 57th date of employment, assuming a written application was submitted during the waiting period.
• If an employee is expected to work at least 6 months, but does not, the employee is still entitled to benefits based on “anticipated benefits eligible employment”. Employees so hired cannot be made to actually work 6 months before becoming eligible to enroll.
• Seasonal employees who are hired for an anticipated duration of less than 6 months are not benefits eligible at the time of hire. However, if they actually work for 6 months on a regularly scheduled basis of at least half time, they become benefits eligible upon the completion of such service.  Such employees must then be offered the opportunity to enroll for health benefits, and the 42 or 56 day new employee waiting period begins for them on the day immediately following the completion of six months of qualifying service.
• Seasonal employees must be on the payroll at the time of enrollment.

Seasonal Layoff

• A seasonal employee, who becomes enrolled and then leaves the payroll, may continue coverage by paying the full-share of premium (Leave without Pay).
• If a seasonal employee leaves the payroll for less than six months (CSEA) or three months (PEF) and returns to work, the employee need not satisfy the six months anticipated minimum employment requirement for benefits eligibility. Coverage begins on the first day of the second payroll period after the payroll period in which the employee returns to work.
• Coverage must be in effect before the employee leaves the payroll to be eligible for continued coverage at full share while on seasonal layoff and to be exempt from the six month duration requirement for reinstatement of coverage upon return to the payroll within 6 months (CSEA) or 3 months (PEF). Having coverage “in effect” means that if a claim were submitted, it would be paid.

NOTE:  If a seasonal employee, who is benefits eligible, elects not to enroll in benefits and returns the next year within 6 months, the employee will be subject to a late enrollment, unless there is a qualifying event that would entitle the enrollee to coverage without a late enrollment waiting period (e.g.; the enrollee marries or acquires a dependent child and requests coverage on a timely basis).

NYSCOPBA-Represented Seasonal Employees.

To be eligible for coverage, an employee must be appointed or elected to a position in State service and:

• Seasonal employees must be expected to work at least six months. If the employee is anticipated to work at least on a half-time basis (50% or more) for six months, the employee is eligible for NYSHIP coverage on the first day of employment, and the new employee waiting period begins on that day.
• If an employee is expected to work at least 6 months, but does not, the employee is still entitled to benefits based on “anticipated benefits eligible employment”. Employees so hired cannot be made to actually work 6 months before becoming eligible to enroll.
• Seasonal employees who are hired for an anticipated duration of less than 6 months are not benefits eligible at the time of hire. However, if they actually work for 6 months on a regularly scheduled basis of at least half time, they become benefits eligible upon the completion of such service.  Such employees must then be offered the opportunity to enroll for health benefits, and the 56 day new employee waiting period begins for them on the day immediately following the completion of six months of qualifying service.
• NYSCOPBA represented seasonal employees who are not working in benefits-eligible positions as described above may purchase coverage by paying both the employee and employer share of the coverage during the season.

Seasonal Layoff

Seasonal employees, who have completed at least six years of continuous service of six bi-weekly payroll periods on a scheduled 40 hours a pay period or greater basis in each of those six years and who are eligible for rehire, may continue their health insurance coverage on a full pay basis between seasons. If an employee fails to return in the following season, health insurance coverage must be terminated.

If the employee subsequently returns as a seasonal employee, coverage is again available during the season, but a new six years service requirement must be served to regain between season purchase eligibility.

If you have any questions about the seasonal employees or NYBEAS processing, please call your processor at the Employee Benefits Division.