Young Adult Option Coverage for Employees and Retirees of Participating Agencies

Frequently Asked Questions

The New York State Health Insurance Program (NYSHIP) and The Young Adult Option

Information about young adult coverage for the children of NYSHIP enrollees covered through Participating Agencies (municipalities, school districts and other local governmental entities that have elected to participate in NYSHIP)

On July 29, 2009, Governor David A. Paterson signed into law Chapter 240 of the Laws of 2009, which extends the availability of health insurance coverage to young adults up to age 30. This expansion will assist young adults who do not have access to employer-sponsored health insurance. This law is sometimes referred to as the "Age 29" law, because it permits young adults to continue or obtain coverage through a parent's policy until the young adult's 30th birthday. For general information about this law go to the NYS Department of Financial services web site at http://www.dfs.ny.gov/consumer/S6030_Age29_young.htm.

The following FAQs address this law and how it affects the young adult children of NYSHIP enrollees.

Q. I am enrolled in NYSHIP with family coverage. Am I able to add my young adult child to my family coverage at no additional cost to me?

A. You may add your young adult child up to age 26 to your family coverage at no additional cost under the federal Patient Protection and Affordable Care Act (PPACA). Under the Young Adult Option, you or your young adult child up to age 30 must pay the premium for the full cost of individual coverage.

Q. Who is eligible for young adult coverage under NYSHIP?

A. The Young Adult Option is available to young adults who meet all of the following eligibility requirements:

  1. Be a child, adopted child, or stepchild of a NYSHIP enrollee (including those enrolled under COBRA)
  2. Be age 29 or younger
  3. Be unmarried
  4. Not be insured by or eligible for coverage through the young adult's own employer sponsored health plan, whether insured or self-funded, provided that the health plan includes both hospital and medical benefits
  5. Live, work or reside in New York State or the plan's service area
  6. Not be covered under Medicare

Q. Does my child have to be financially dependent on me or reside with me to be eligible for the Young Adult Option?

A. No. The young adult does not need to live with the parent or be financially dependent upon the parent.

Q. My 26 year old daughter is currently enrolled for COBRA coverage under NYSHIP. Is she eligible for the Young Adult Option?

A. Yes. However, while the premium for the Young Adult Option may be lower than the COBRA premium (your employer can charge a two percent administrative fee for COBRA), your daughter should consider that if you (the parent enrollee) lose coverage under NYSHIP, her eligibility for the Young Adult Option will end and she will not be eligible for COBRA coverage when coverage under the Young Adult Option ends.

Q. What coverage is available to my young adult child?

A. A young adult is entitled to the same health insurance coverage as his/her parent provided the young adult lives, works or resides in New York State or the insurer's service area. Since Empire Plan and Excelsior Plan coverage is not limited to a geographic service area, your eligible young adult child may enroll in the same plan as you regardless of where he/she resides.

Q. My employer is a Participating Agency with NYSHIP, but I am enrolled in another plan offered by my employer. Can my young adult child enroll in The Empire Plan?

A. No. You (the parent enrollee) must be enrolled in NYSHIP's Empire Plan in order for your child to be eligible to enroll in The Empire Plan under the Young Adult Option.

Q. Where can I find information about the benefits offered under NYSHIP's Young Adult Option?

A. A summary of benefits for The Empire Plan and Excelsior Plan is available under the Health Plan Choices section of this site.

Q. Where can I find a list of premiums for NYSHIP's Young Adult Option?

A. A list of premiums for NYSHIP's Young Adult Option is available under the Rates section of this site.

Q. When can I enroll in the Young Adult Option?

A. A young adult may enroll at the following times:

  1. Within 60 days of when the young adult would lose coverage due to age under the parent's policy.
  2. Within 60 days of when the young adult becomes eligible due to a loss of his/her employer coverage or otherwise becomes newly eligible due to a change in circumstances (such as divorce).
  3. During the annual 30-day open enrollment period.

Q. How do I enroll in the Young Adult Option?

A. Either the parent enrollee or the young adult may complete the application form (YAO 30-01/10 PA). Proof of the parent/child relationship also must be provided, e.g. birth certificate, as indicated on the application. The first month's premium also must be remitted. Send the completed application, documents and payment to the Health Benefits Administrator (HBA) for the Participating Agency through which the parent is enrolled in NYSHIP.

Q. When will my Young Adult Coverage be in effect?

A. If coverage is elected within 60 days of the date that the young adult otherwise would lose eligibility for coverage as his/her parent's dependent due to age, coverage is retroactive to the date that the young adult lost coverage. This is the only circumstance in which the Young Adult Option will be effective on a retroactive basis.

For prospective Young Adult Option elections, coverage may be elected during the annual 30-day Young Adult Option Open Enrollment Period or within 60 days of the date that a Young Adult is newly qualified due to a change in circumstances. (Examples include loss of coverage through employer, moving residence into New York State, or divorce.) Coverage will be available no later than 30 days after NYSHIP receives written notice of the election and payment of the first monthly premium.

Q. How will I be billed?

A. Check with the HBA at the Participating Agency regarding billing and payment details. Payment is due prior to the first of the month for which premium is being paid. If payment is not received within the 30-day grace period, coverage will be cancelled.

Q. If I voluntarily cancel my coverage or am cancelled for non-payment can I reenroll for the Young Adult Option?

A. You may not reenroll until the next open enrollment period unless you become eligible again because of a qualifying event, e.g. you obtain other employer-sponsored coverage and subsequently lose that coverage.

Q. When will my Young Adult Option coverage end?

A. Your coverage ends if:

  1. You voluntarily terminate coverage;
  2. Your parent is no longer enrolled in NYSHIP;
  3. You no longer meet all of the eligibility requirements; or
  4. Your NYSHIP premium is not paid in full within the 30-day grace period, following the premium payment due date.