Policy/Memo 102r3

Number: Policy Memo 102r3
Date Issued: July 18, 1997
Date Revised: July 22, 2026
Policy File Ref: A1130
Subject: Reinstatement of Coverage After Disability Retirement has been Approved

PURPOSE:

Determine if health insurance can be reinstated for individuals who lose coverage due to non-payment of premium and are subsequently granted a retroactive disability retirement by the New York State and Local Retirement System (NYSLRS) or the New York State Teachers' Retirement System (NYSTRS).

BACKGROUND:

Section 73.1(e) of the President’s Regulations states that a retiree is "a person who has become enrolled in the plan as an employee and whose coverage is being continued after his withdrawal from the active service of the employer under the eligibility privileges of the plan." This has always been interpreted to mean that an employee must be enrolled in the New York State Health Insurance Program (NYSHIP) on the date of retirement to be eligible for retiree coverage. Informational materials and procedures manuals all clearly state this as a requirement.

Occasionally, an illness or injury will necessitate an employee be placed on leave or separate from State service. If the employee does not make timely NYSHIP premium payments their health insurance is canceled. The employee may have filed for retirement with NYSLRS or NYSTRS, but in some cases the Retirement System’s decision is delayed. Retirement may be granted retroactively to the beginning of the leave, or sometimes to a later date depending on when the application was filed. In either case, the fact of retirement is not known until after the employee’s NYSHIP coverage has been terminated.

POLICY:

When an employee is approved for a disability retirement* after their health insurance has terminated, the employee will be granted the opportunity to reenroll in NYSHIP if all other retiree eligibility requirements are met. For purposes of NYSHIP retiree eligiblity, EBD will permit an individual to enroll in NYSHIP retiree coverage once they have been medically approved for disability retirement by NYSLRS or NYSTRS. In accordance with NYSLRS procedures, the individual’s effective date of retirement will be the later of the individual’s last date on the payroll or the date they submitted their disability retirement application to NYSLRS.

If the termination of coverage is earlier than the effective date of the retirement, the employee will be given the opportunity to pay retroactive premium to ensure they are enrolled in NYSHIP as of the date of retirement. The employee may elect family or individual coverage for the retroactive enrollment period and must pay all outstanding premium up to the effective date of the disability retirement. For EBD to reinstate coverage as a retiree, all payment of premium must be made within 60 days of EBD’s notice of eligibility to the enrollee. Failure to pay the premium within 60 days of notice to the enrollee will result in the enrollee’s ineligibility for retiree coverage.

Once all outstanding premiums have been paid, the retiree has the option to enroll in coverage retroactively to the date of retirement or effective the first day of the month following EBD’s receipt of acceptable disability retirement documentation. The retiree may choose any coverage and/or plan option at the time of enrollment in retiree coverage.

If an enrollee was previously awarded a waiver of premium, the waiver ends on the effective date of the disability retirement. In the event the enrollee is responsible for payment of premiums incurred after the retirement date, as in the case of a previously awarded waiver of premium that was reversed as a result of the retirement, the enrollee will be permitted 60 days to remit full payment of retroactive retiree premiums. If the enrollee does not remit full payment of the retiree premium within the allotted timeframe, they will be subject to a three-month late enrollment waiting period upon re-enrollment in NYSHIP.

Reinstatement of coverage for former New York State or Participating Employer (PE) employees granted a disability retirement will only be available through application to EBD. Participating Agency (PA) employees must submit their request for disability retiree coverage to their PA, and the PA is responsible for making a determination of eligiblity.

*Social Security Disability Insurance (SSDI) award will be accepted in place of a NYSLRS disability retirement for members of the State University of New York (SUNY) Optional Retirement Program (ORP). ORP is typically administered by a plan sponsor such as Teachers’ Insurance and Annuity Association (TIAA).