As required by the Patient Protection and Affordable Care Act (PPACA),
effective January 1, 2011, the eligibility rules for covering dependents
under the New York State Health Insurance Program (NYSHIP) will change to
allow an enrollee’s child to continue coverage as an eligible dependent up
to age 26. Please Note: The extension of coverage to age 26 under PPACA does
not apply to Dental and Vision coverage.
An enrollee’s natural, legally adopted, step and/or domestic partner child
is eligible for this coverage regardless of financial dependency, residency,
student status, employment and/or marital status. The extension of coverage
to age 26 applies also to “other” eligible dependent children upon
submission of an approved Statement of Dependence and supporting
documentation. An adult child under age 26 who is currently enrolled as a
dependent under their parent’s family coverage on January 1, 2011, will
continue to be covered to age 26; no action is required by the enrollee.
Also beginning January 1, 2011, dependent children will be eligible for
coverage under NYSHIP through the end of the month in which they reach age
The special enrollment period for eligible adult children not currently
covered under their parent’s family coverage begins 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 the age of
26 will be able to do so without a waiting period. Proper documentation must
be on file to add an eligible dependent back on to an enrollee’s coverage
(birth certificate and social security card.) The normal family premium
contribution will apply.
For enrollees requesting to add young adult dependents after the special
enrollment period has ended, normal waiting periods apply and the effective
date of coverage will be based upon date of first eligibility and date of
Adult children who are currently enrolled in either COBRA continuation
coverage or the Young Adult Option through NYSHIP will be required to
indicate on the enrollment form if they wish to cancel the current coverage.
Cancellation of coverage is not automatic.
A NYSHIP Special Report announcing the dependent coverage extension to age
26 will be mailed to all enrollee’s homes, which will include an
form for enrollees to complete and return to Human Resource Management.
The enrollment form is also available
online, and in Cleveland Hall 410.
For additional information, please review the
Young Adult Questions and
Please call Human Resource Management at ext. 4821 if you have any