Young Adult Option Coverage

STATE EMPLOYEES • NYSHIP

Medical coverage for young adults, with a clear path to eligibility and enrollment.

New York State law (Chapter 240 of the Laws of 2009) allows an eligible young adult child aged 29 or younger to purchase coverage through their parent’s group health insurance policy. NYSHIP’s Young Adult Option complies with this law and is subject to all terms of the group policy.

Who is eligible?

An unmarried child, adopted child or stepchild of a NYSHIP enrollee, age 29 or younger, may qualify. All eligibility requirements must be met, including the rules for employer coverage, residence or employment and Medicare. Review the full checklist below.

When can you enroll?

Enroll within 60 days of aging out of a parent’s policy or becoming newly eligible, or during the annual 30-day open enrollment period. The young adult or parent may elect coverage and pay the premium. Review the enrollment steps and full timing details below.

Check eligibility

The young adult must meet all of these requirements:

• Be the child, adopted child or stepchild of a NYSHIP enrollee, including an enrollee with COBRA coverage.
• Be age 29 or younger.
• Be unmarried.
• Not be insured by, or eligible for, hospital and medical coverage through their own employer, whether insured or self-funded.
• Live, work or reside in New York State or the plan’s service area.
• Not be covered by Medicare.

Choose your enrollment window

• Within 60 days of aging out: Elect coverage within 60 days of losing eligibility under the parent’s policy.
• Within 60 days of becoming newly eligible: This may follow loss of employer coverage, relocation to or employment in New York State or the plan’s service area, or a change in circumstances such as divorce. Empire Plan coverage is available regardless of residence.
• During annual open enrollment: Enroll during the annual 30-day open enrollment period. Confirm the current dates with the Employee Benefits Division.

How to enroll

1. Complete and sign the enrollment form. The young adult or parent may elect coverage and pay the premium. Submit the Young Adult Option enrollment form and required documentation to the Employee Benefits Division.
2. Include the first month’s premium. Sending the first premium with the form helps coverage begin on the earliest possible date.
3. Authorize help from a parent, if needed. The young adult must complete the HIPAA authorization form if they want the Employee Benefits Division to discuss their protected health information with their parent.

Find enrollment forms and current plan documents   |   HIPAA authorization form (PDF)

When coverage ends

Young Adult Option coverage terminates when:

• The young adult voluntarily ends coverage.
• The parent is no longer a NYSHIP enrollee.
• The young adult no longer meets any eligibility requirement.
• The full premium is not paid within the 30-day grace period following the due date.

Termination is not a qualifying event for federal COBRA or State continuation coverage.

Questions? Get help with your next step.

Contact the Health Benefits Administrator at the parent’s employing agency or the Employee Benefits Division for help with eligibility, enrollment and premiums.

Employee Benefits Division: 518-457-5754 or 1-800-833-4344. The original notice lists telephone hours of 9 a.m.–3 p.m.; confirm current hours with the division.

Visit the Employee Benefits Division’s Young Adult Coverage information   |   Find your Health Benefits Administrator

NYSHIP coverage for young adults guide (PDF)