Two options available, but you must act quickly
Act now to continue health benefits for student dependents
By LORRAINE SIMPKINS
and DEBORAH STAYMAN
May and June are traditionally the months in which most full-time students complete their studies. If you have a child who is age 19 or older and enrolled in the NYS Health Insurance Program (NYSHIP), it is important to determine if he or she remains eligible for coverage.
Graduating students
The 1999-2003 PS&T contract includes an enhancement for graduating students that will extend coverage for health, dental and vision benefits for three months following completion of a qualified course of study. The extension will begin on the first day of the month following the month in which coursework is completed.
After the three-month extension, coverage can be continued up to 36 months by paying rates authorized under COBRA (the federal Consolidated Omnibus Budget Reconciliation Act). Or you can buy a direct-pay policy.
Continuing students
Your unmarried dependent children who are age 19 or older, but under age 25, are eligible for coverage if they are full-time students at an accredited educational institution.
Dependent-student coverage continues over the summer months only if your child is enrolled in school for the fall semester and was enrolled in the previous spring semester as a full-time student.
If your child is not enrolled in school for the fall semester, NYSHIP coverage will end on the last day of the month in which your child completed his or her course requirements.
If you want your child to continue to be covered without interruption, you must act quickly to either:
• Continue coverage in NYSHIP under COBRA, or
• Convert to a direct-pay contract.
COBRA continuation
Under provisions of COBRA, the employee or a family member is responsible for informing the Employee Benefits Division (EBD) of the state Department of Civil Service of a child’s losing NYSHIP eligibility within 60 days from the date coverage ends.
To obtain a COBRA election form, send a written request to:
NYS Department of Civil Service
Employee Benefits Division
Attn: COBRA Unit
State Office Building Campus
Albany, NY 12239
Please include the employee’s Social Security number, the dependent’s name, the reason for the request, the date coverage ended, and a telephone number where you can be reached during the workday.
If you do not notify EBD within the required 60-day period, regardless of the reason, the dependent will not be entitled to COBRA continuation coverage.
The health-care benefits your child may continue under COBRA are the same benefits you receive as an active employee enrolled in NYSHIP.
The cost of COBRA coverage is the full premium (both the employer and employee share) plus a 2 percent administrative fee.
If your child is seeking admission to a school over the summer, but has not yet been accepted, coverage should be continued through COBRA. After your child is enrolled for the fall semester, his or her dependent-student status will be reinstated back to the date he or she lost eligibility and the COBRA premium paid during the interim will be refunded.
Convert to direct-pay
In addition to continuation through COBRA, children losing eligibility are entitled to convert to direct-pay contracts after their NYSHIP coverage ends. Notification procedures and deadlines for applying for conversion coverage vary among the NYSHIP health-care plans.
The benefit package for direct-pay conversion contracts may differ from what your child had under NYSHIP. To obtain premium information, contact the carrier or HMO directly.
Additional information concerning COBRA and direct-pay conversion contracts can be found in the January 1, 1996 NYSHIP General Information Book.
You may also contact your agency’s health-benefits administrator, who is usually located in your personnel office, for assistance.