Information about young adult coverage for the children of NYSHIP enrollees
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 eligible 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:
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, be financially dependent upon the parent, or be a student.
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 will be lower than the COBRA premium (COBRA includes a 2% administrative charge), 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. Can my child enroll for dental and vision coverage under the Young Adult Option?
A. Young Adult Option enrollees under SEHP are automatically enrolled in dental and vision coverage (these benefits are included in the medical plan).
Q. Which NYSHIP options are 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 SEHP coverage is not limited to a geographic service area, your eligible young adult child may enroll in SEHP regardless of where he/she resides.
Q. Where can I find information about the various health insurance plans offered under NYSHIP's Young Adult Option?
A. A summary of benefits for SEHP is available under the Health Plan Information link on this site.
Q. Where can I find a list of premiums for health insurance plans available under NYSHIP's Young Adult Option?
A. A list of premiums for NYSHIP's Young Adult Option is 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:
Q. How do I enroll for the Young Adult Option?
A. Either the parent enrollee or the young adult may complete the application form (YAO 30-01/10 SEHP). Proof of the parent/child relationship also must be provided, e.g. birth certificate, as indicated on the form. The first month's premium also must be remitted. Send the completed form, documents and payment to:
NYS Department of Civil Service
Employee Benefits Division - YAO
Alfred E. Smith State Office Building
Albany, NY 12239
Q. When will my Young Adult Option 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. A monthly bill will be mailed to the young adult or the parent enrollee, as designated on the application. Payments may be made by mailing a check or money order made payable to "NYS Employee Insurance Pending Account" to the Employee Benefits Division. 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 will end if: