EMPIRE PLAN (NYSHIP)

Q: I currently have individual coverage and would like to add a dependent. When will the coverage be effective?

A: By adding a dependent your coverage will be changed to a family plan. The effective date for your dependent's coverage depends on when you applied and when the dependent was first eligible. A dependent become first eligible on the day of birth for a newborn child, the date of marriage, or loss of other coverage for any eligible dependent. 

E.g. (1), An employee will be married on June 10 and applies for a change from Individual to Family coverage on or before June 10th. Family coverage will become effective June 10 (the "date of event" is the date of marriage).

If the request is made within 30 days after the event date, then coverage becomes effective on the first day of the month following the request.

If the request is made after 30 days after the event, then coverage becomes effective the first day of the third month following the month of the request. E.g., an employee gets married on June 10th, and applies for family coverage on July 11, then coverage for the spouse will become effective on October 1st.

E.g. (2), you are requesting a change of coverage to family due to the birth of a child. If the request is made within 30 days of the birth of the child, the coverage for the newborn will become effective on the day of birth. If the request is done later than 30 days, then the three month wait applies.

Please note that you are required to submit along with the request the birth certificate, social security card as proof of eligibility. However, for a newborn you may submit the request along with a letter from the hospital documenting the birth of the child and a letter from the Social Security Administration indicating that you have applied for the social security number. We will enroll the child pending the actual documents.

Enrollment for any other dependent not specified above will be subject to a late enrollment period regardless of whether the employee has an individual or family plan. The late enrollment period is a three month wait from the date of the request. Please note that the request is not considered complete until you have submitted all the necessary forms and documents to your Human Resouces representative or the Comptroller Health Benefits Unit.