New coverage for dependents to age 26

Thanks to the new national health reform legislation, PEF members enrolled in the Empire Plan or an HMO through the New York State Health Insurance Program (NYSHIP), can enroll their young adult children up to age 26 as dependents on their health insurance. There is no additional cost, although if you currently have individual coverage you will need to change to family coverage.

This change will become effective on January 1, 2011. The extension of coverage applies only to medical benefits, and does not apply to dental or vision benefits. (Note: If the young adult is a full-time student under age 25 or disabled, he/she can continue to receive dental and vision benefits at no cost upon verification of eligibility.)

Financial dependency, student status, marital status, employment and residency can no longer be used to determine eligibility. Contrary to earlier reports, a young adult can be eligible for, or enrolled in, his/her own employer-sponsored plan and still enroll as a dependent in a NYSHIP family plan. Although the new law extends coverage to married children, it does not apply to their spouse or children.

The dependent coverage extension is different from NYSHIP’s currently available Young Adult Option, which requires a young adult to enroll in a separate individual plan and pay the full share (employee and employer contributions) of premium. The Young Adult Option, which will continue to be available, can cover an eligible dependent from age 26 up to 30. It is for medical benefits only, and does not include dental or vision benefits.

A special enrollment period for eligible adult children began November 1, 2010 and continues through the end of the option transfer period, for coverage effective January 1, 2011. During this period, enrollees who currently have individual coverage and want to add a young adult dependent under age 26 will be able to do so without a waiting period. The normal family premium will apply.

A NYSHIP Special Report announcing the dependent coverage extension to age 26 was mailed to all enrollees in mid-October. The Report can also be downloaded from the Civil Service web site at www.cs.state.ny.us. From the home page select Benefit Programs, then NYSHIP Online, then Using Your Benefits, then Publications. Scroll down to All NYSHIP, then scroll down to the bottom of the page and you’ll find “NYSHIP Special Report: Covering Your Young Adult Children, October 2010”.

The Special Report contains an enrollment form to fill out for eligible adult dependent(s). Employees should bring the form to their agency Health Benefits Administrator (HBA), usually located in the Personnel Office, to have their adult dependent(s) added to their NYSHIP coverage. HBAs must ensure that proper documentation, e.g., birth certificate and Social Security card, is on file for any young adult dependent added back on to coverage.

If you have additional questions, contact your agency Health Benefits Administrator in the Personnel Office.