Nassau County, New York

Q: I am a new employee. When will my health insurance coverage begin?
A: The date your health insurance coverage starts depends on your collective bargaining agreement or, for non-union employees, the Ordinance covering your employment. Your department’s Human Resource Officer can tell you the coverage commencement date applicable to you.

Q: Will I have to contribute toward my health insurance coverage through a payroll deduction?
A: If you are an employee not covered by a collective bargaining agreement, and you were hired after January 1, 2002, you must contribute 5% of the cost of the premium toward individual coverage and 10% toward family coverage. If your employment began before January 1, 2002, you do not contribute to health insurance coverage.

Q: I am getting married and would like to know if my spouse will be eligible for coverage?
A: Yes, your spouse can be covered. If you are an active employee, contact your department’s Human Resource Officer in advance of the wedding to apply for family coverage in order to minimize your waiting period. If you are a retiree or other enrollee, you should provide this paperwork to the Comptroller’s Office.

Once you are married you must provide a copy of your new marriage certificate and your spouse’s social security number to your department’s Human Resource Officer. The effective date of the coverage for your spouse will be determined as outlined in the NYSHIP General Information Book.

Special eligibility rules apply to newborn and adopted children as outlined in the NYSHIP General Information Book here.

Q: My spouse and I are now both employed by the County. How will this affect our health coverage plans?
A: Spouses and domestic partners covered by the current CSEA contract and both employed by the County must choose either one family health coverage plan and one buyback, or choose one family and one individual health coverage plan. Both spouses may not be enrolled in a family health coverage plan.

Q: What is the Health Insurance Buyback program?
A: The Buyback program allows all active employees who have other health insurance coverage to receive a payment in exchange for disenrolling from individual and family health insurance through NYSHIP. Participants in the Buyback program receive one-twelfth of the annual buyback amount for each month of non-coverage within each calendar year as follows:

Payments will be made twice a year; on or about June 1 and December 1 of each year. To disenroll, you should obtain a New York State “Declination of Health Insurance” form PS-403 from your department’s Human Resource Officer. In addition, you are required to include a signed and notarized affidavit stating that you have insurance coverage other than that provided by the County, and proof of such insurance coverage must be attached.

Q: If my spouse works for another municipality that uses both Davis Vision and Healthplex for vision and dental coverage, can I use that optical or dental plan to co-ordinate benefits, so long as I am listed as a dependent?
A: The answer to this question depends on the contract that each municipality has in place with the insurance carriers. Speak with your department’s Human Resource Officer and the person in charge of health insurance benefits at your spouse’s employer.

Q: If I chose the Buyback program and have disenrolled from the County’s health insurance, may I re-enroll in the future?
A: Yes, an employee is entitled to re-enroll in the County’s health insurance program by applying through your department’s Human Resource Officer. The re-enrollment period starts no earlier than the first day of the third month after the return of the re-enrollment form (PS-501.3) to the Comptroller’s Health Benefits Unit.

An employee who has decided to re-enroll in the County’s health insurance program after having participated in the Buyback program may not participate in the Buyback program again for a minimum period of one year.

Q: How long will my dependent children be eligible for health benefits coverage?
A: Unmarried children, including natural children, legally adopted children, children in a waiting period prior to finalization of adoption, and dependent children are eligible for health benefits coverage until they reach age 19.

Children age 19 or over who are full-time students at an accredited secondary or preparatory school, college or other educational institution, and are otherwise not eligible for employer group coverage, continue to be eligible for health benefits coverage until the first of the following events occurs:

Q: I have a disabled child. Are there were any special provisions that would extend my child’s coverage after turning age 19?
A: Unmarried children age 19 or over who are incapable of supporting themselves because of a mental or physical disability acquired before termination of their eligibility for health insurance may be eligible for continued coverage. You must complete and file a Disability Form PS-451, which can also be obtained from your department’s Human Resource Officer or from the Comptroller’s Office.

If your child was not enrolled in NYSHIP because the child had other health insurance, but has lost the other coverage involuntarily, you may apply for disabled dependent child coverage. You must submit a Disability PS-451 form, along with proof that (a) the disability occurred prior to NYSHIP’s standard age disqualification date and (b) that the loss of the other coverage was involuntary.

If the child is age 19 or older, but younger than 25, and is covered as a full-time student, and is disabled, or becomes disabled while a full-time student, file a Disability PS-451 form as soon as possible.

Q: What are the requirements for obtaining coverage for my domestic partner?
A: You must be an active employee covered by the current CSEA contract in order to apply for domestic partnership coverage. You and your partner must also satisfy the requirements of a domestic partnership established by NYSHIP (The Empire Plan). NYSHIP defines a domestic partnership as a lifetime relationship in which you and your partner are 18 years of age or older, live together, are financially interdependent, unmarried and not related in a way that would bar marriage.

Q: How do I document that I have a domestic partner?
A: The current proof requirements are outlined in the domestic partner enrollment application packet available through your department’s Human Resource Officer. These forms (PS 428, 428.1, 428.2, 428.3, and 428.4) can also be downloaded from the NYSHIP Web site here.

Once completed, these forms should be given to your department’s Human Resource Officer for processing.

Q: Are there any income tax implications associated with domestic partnership coverage?
A: Yes. According to the Internal Revenue Service’s rules, if a domestic partner is not a “dependent” (as defined in Section 152 of the Internal Revenue Code), the “fair market value” of the partner’s coverage, less any contribution by the enrollee, is treated as income for federal tax purposes. Your department’s Human Resource Officer should be able to provide you with an approximation of the fair market value for The Empire Plan. This value, referred to as “imputed income,” will be added to your annual salary for income tax purposes and will apply even if you cover other dependents in addition to your partner.

If your partner does qualify as a dependent under the Internal Revenue Code, there will be no imputed income. You must, however, submit a completed “Dependent Tax Affidavit” with your other enrollment documents.

Q: If my domestic partner’s application is rejected, can I reapply?
A: Yes, you can reapply.

Q: Does domestic partner coverage extend to HMOs and dental/optical carriers?
A: Yes, the same NYSHIP eligibility and documentation requirements apply if you are seeking domestic partner coverage in an HMO and in dental/optical plans.

Q: If I predecease my domestic partner, is my domestic partner eligible for survivor coverage?
A: Yes, your unmarried domestic partner, who has not acquired another domestic partner, can continue coverage as a survivor.

Q: If the domestic partnership is terminated, how will this affect my partner’s health insurance?
A: If the partnership ends, you must notify your department’s Human Resource Officer and end coverage for the domestic partner. You must complete a “Termination of Domestic Partnership of Participating Agency Enrollee in NYSHIP” form for proper notification. Your domestic partner may be eligible to continue coverage under COBRA. Upon notification of termination of the partnership, a COBRA application will be provided to you and mailed to your former domestic partner at his or her last known address. The domestic partner must apply for COBRA coverage within 60 days of termination of their domestic partner coverage.

As of January 1, 2005, NYSHIP has imposed a one-year waiting period from the termination date of your previous domestic partner's coverage before you may again enroll a domestic partner.

Q: Will I continue to be eligible for benefits if I am temporarily not working and do not receive a pay check?
A: Coverage while you are on leave is not automatic and depends on the nature of the absence. You should speak with your department’s Human Resource Officer in order to determine your eligibility. In most cases, you must pay the health insurance premium to continue coverage during an unpaid absence. If you do not make your premium payment, coverage will terminate on the last day of the month for which payment was received.

Q: What happens if my coverage lapses when I am not working?
A: Canceling your coverage or letting it lapse due to non-payment has serious implications as you will have no rights to coverage as a former enrollee, nor will your dependents. If you let coverage lapse as a vestee, you risk losing health insurance coverage when you retire.

Q: I am on leave without pay and have recently become disabled. Can I have my health insurance contribution waived?
A: Yes, premium waivers are granted in certain instances. There are several criteria that must be met in order to qualify for a premium waiver:

If eligible, you should obtain a PS-452 Form from your department’s Human Resource Officer in order to apply for a waiver of premium. You may also download it here. This form should be completed by you, your agency, and your physician and sent to:

            United HealthCare
            Eligibility Unit 505
            Boices Lane
            Kingston, New York 12401

Q: If my employment with the county terminates, can I continue my health insurance coverage?
A: You will be able to continue your coverage under COBRA or if you meet certain requirements as a vestee or health insurance retiree. If you do not qualify as a retiree or do not chose to apply for COBRA or vestee coverage, then your health coverage with Nassau County will end on the last day of the month following your separation from service (i.e. if last day is April 30th, your coverage ends May 31st). Contact your department’s Human Resource Officer for the necessary forms.

Q: What is the federal Consolidated Omnibus Budget Reconciliation Act (COBRA)?
A: COBRA is a federal law which provides for the continuation of medical coverage in certain circumstances.

Q: Am I able to apply for COBRA coverage if I was fired for cause?
A: Yes, you may still apply for COBRA coverage even if you were fired for cause.

Q: Is there a deadline to apply for COBRA benefits?
A: You must apply no later than 60 days after your health insurance termination date, or within 60 days of the date you receive notification from your department’s Human Resource Officer informing you of your right to choose to continue coverage under your existing health insurance plan.

Q: How long can I receive COBRA benefits?
A: Former employees can be covered for a maximum of eighteen months. Special rules extending coverage to 29 months, referenced in the federal COBRA, may apply for disabled individuals and certain dependents.

Q: What is a “vestee” and how does vesting work?
A: A “vestee” is an employee with five or more years of service, or ten years or more of service for CSEA employees hired after August 22, 2003, whose employment terminates, and who continues his or her health insurance coverage with the county even if the employee has not yet reached retirement age. For more information on vesting please click here.

Q: Is there a cost to vesting?
A: Yes, if you choose to continue your coverage while in vested status, you are responsible for paying both the employer and employee share, if any, of the health insurance premium.

Q: What will happen if I stop paying the premium?
A: If you cease making the premium payments, your coverage will be canceled permanently and you will not be able to receive County-provided health insurance coverage when you reach retirement age, as outlined in the NYSHIP General Information Book.

Q: If I die, are my dependents eligible to continue to receive health insurance coverage?
A: Your dependents will continue to receive coverage without charge for 3 months beyond the end of the month in which you die. In addition, certain collective bargaining agreements may extend the period of time dependents may receive coverage at no charge. Active employees should contact their department’s Human Resource Officer for more information. Retirees may contact the Comptroller’s Office, Health Benefits Unit by email or by phone at 516-571-2679.

Q: Who should be notified upon my death?
A: Your dependent survivors should forward a copy of your death certificate to the Comptroller’s Office, Health Benefits Unit as soon as possible. In order to ensure your eligible dependents’ ability to elect survivor benefits, the County must receive notice within 90 days of your death.

Q: Under what circumstances might my dependents be eligible for coverage beyond the extended benefit period?
A: If you had at least 10 years of qualified service at the time of your death, your dependent survivors may continue their coverage but will be required to pay the full monthly premium. If you had not completed 10 years of qualified service prior to your death, your dependents may continue coverage for a maximum of 36 months under COBRA.

Q: How do I find out what month my premiums are paid up through?
A: Call the County Comptroller’s Office, Health Benefits Unit at 516-571-2679 for the details of your payment history.

Q: Why has my payment not been posted?
A: Checks are posted within ten days of receipt by the Comptroller’s Office. If there is a high volume of incoming checks, it may take slightly longer to post.

Q: Why am I receiving mail from the County at my old address?
A: The Comptroller's Office may not have received the required documentation to change your address in its records. If you are an employee, please notify your department’s Human Resource Officer of your new address and request that s/he notify the Comptroller’s Office. All other enrollees should contact the County Comptroller’s Office, Health Benefits Unit by e-mail or by phone at 516-571-2679.

Q: I lost my insurance card. How do I get a new one?
A: NYSHIP: If you are an employee, notify your department’s Human Resource Officer who will request a new insurance card for you. All other enrollees should contact the Comptroller’s Office, Health Benefits Unit by e-mail or by phone at 516-571-2679.

HMO: If enrolled in an HMO, you should contact your HMO directly for a replacement.

Q: Why haven't I received my insurance card yet?
A: NYSHIP: If enrolled in The Empire Plan, Empire processes and mails your card from 7-15 days from the time it receives a request to enroll you in the Plan. Until you receive your card, you can provide your Social Security number to the doctor or pharmacist for the processing of payments and prescriptions.

HMO: If enrolled in an HMO, you should contact your HMO directly.

Q: I recently tried using my insurance card but it was rejected. What can be wrong?
A: NYSHIP: Please call 1-877-7-NYSHIP if you think the card you received is defective. If you are an employee, your department’s Human Resource Officer can request a new insurance card for you. If you are not an employee, contact the County Comptroller’s Office, Health Benefits Unit by e-mail or by phone at 516-571-2679.

HMO: If enrolled in an HMO, please contact your HMO directly if you experience any difficulties with your insurance card.

Q: Should my dependents’ insurance cards have a different ID number than mine?
A: No. Cards used by you and your dependents will have the same ID number.

Q: Do county health insurers have to maintain the confidentiality of my medical records?
A: The Health Insurance Portability and Accountability Act of 1996 (HIPAA), applies to health plans such as The Empire Plan and the HMO options and imposes obligations to maintain the confidentiality of your medical records.

Q: Can I join an HMO if I am not a New York State resident?
A: No, you must be a New York State resident in order to be eligible for enrollment in an HMO for health benefit coverage.

Q: Will I have health insurance coverage while on vacation in another country?
A: NYSHIP: Yes, you will be covered for healthcare expenses incurred outside the United States.

HMO: As an HMO participant, only emergency healthcare expenses incurred outside of the United States will be covered.

Q: How do I get reimbursed for expenses incurred outside the United States?
A: The same reimbursement form that is used for domestic treatment is also used for treatment while abroad. Mail the completed form, along with the healthcare bills in question, directly to the health insurance carrier. You may obtain a claim form from the Comptroller’s Office, Health Benefit Unit.

General Questions About Your Health Insurance—NYSHIP: The Empire Plan and HMOs