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Effective Date of Coverage –NYSHIP rules not applicable to HMOs


Q: I am getting married, and would like to add my spouse to my insurance. When will my spouse coverage become effective?


A: If an employee currently enrolled with Individual coverage applies for Family coverage prior to the date of first eligibility for Family coverage, coverage becomes effective on the “date of event”
Example: An employee will be married on June 10 and applies for a change from Individual to Family coverage on May 31. Family coverage will become effective June 10 (the “date of event” is the date of marriage).
If the employee applies for family coverage within one month of the date of the marriage, coverage becomes effective on the first day of the month following the marriage in which the coverage was requested.
Example: An employee is married on June 10 and applies for a change from Individual to Family coverage on June 25. Family coverage will become effective on July 1.
Example: An employee is married on June 10 and applies for a change from Individual to Family coverage on July 3. Family coverage would become effective August 1.
If an employee currently enrolled for Individual coverage applies for Family coverage more than one month after the date of first eligibility for Family coverage, the effective date for Family coverage is the first day of the third month following the month in which the employee requests Family coverage.
Example: An employee is married on June 10 and applies for a change from Individual to Family coverage on September 5. Family coverage will become effective December 1.
Once coverage is changed to Family coverage due to the addition of a family member, any other eligible dependent can be added.