A. Changes in Family Status - Adding or Dropping Dependents
Participants should report all changes in family status to their personnel or payroll office (for employees) or the Health Benefits Program (for retirees). Use the Health Benefits Application to add dependents due to marriage, domestic partnership, birth or adoption of a child, and to drop dependents due to death, divorce, termination of domestic partnership, or a child reaching an ineligible age or losing full-time student status. Forms must be submitted within 31 days of the event (see Late Enrollment). If a covered dependent loses eligibility, that person may obtain benefits through the COBRA Continuation of Benefits provisions.
B. Change in Plan
Health Benefits Transfer Periods are usually scheduled once each year. During these periods, all employees may transfer from their current health plan to any other plan for which they are eligible, or they may add or drop Optional Rider coverage to their present plan. Retirees may only participate in Transfer Periods that occur in even-numbered years.
If you do not apply for an Optional Rider when you first enroll, you may add these additional benefits only during a Transfer Period, upon retirement, or if there is a change in your union or welfare fund coverage.
Annual Transfer Period
Procedures for Employee Health Plan Transfers — In order to transfer from one plan to another or to add Optional Rider coverage, you must complete a Health Benefits Application, which is available from your agency payroll or personnel office. This form must be completed and returned to your payroll or personnel office during the annual Transfer Period.
See your agency payroll or personnel office for the effective date of the change. Once you submit an Application, the Transfer Period is over for you and your transfer is irrevocable.
Appropriate documentation of marital status, domestic partnership, or birth or adoption of a child is required. This documentation may consist of marriage or birth certificate; adoption or guardianship papers; or copies of tax returns indicating a child is claimed as a dependent. Domestic partner documentation must consist of a copy of the Certificate of Domestic Partnership and a completed Declaration of Financial Interdependence accompanied by two items of proof evidencing financial interdependence (non-New York City residents must complete an “Alternative Affidavit of Domestic Partner”).
Retiree Transfer Opportunities
Retirees may transfer or add an Optional Rider during the even-numbered year Transfer Periods. Additionally, retirees who have been retired for at least one year can take advantage of a once-in-a-lifetime provision to transfer or add an optional rider at any time. Once-in-a-lifetime transfers become effective on the first of the month following the date that the Health Benefits Application is processed.**
C. Transfer into or out of Your Plan's Service Area
If you permanently move outside of your plan's service area, you may transfer within 31 days to another plan without waiting for the next Transfer Period. Also, if you move into the service area of a plan, you may transfer within 31 days to that plan.**
** Exception: When transferring into a Medicare HMO plan other than during Transfer Periods, transfers will become effective on the first day of the month following the processing of the special health plan application.
D. Leave of Absence Coverage
Special Leave of Absence Coverage (SLOAC): SLOAC may provide continued City health coverage for specified periods of time to certain employees who are on authorized leave without pay as a result of temporary disability or illness, or who are receiving Workers' Compensation. Contact your payroll or personnel office for details.
Family and Medical Leave Act: The Federal Family and Medical Leave Act of 1993 ("FMLA") entitles eligible City employees to twelve weeks of family leave in a 12-month period to care for a dependent child or covered family member, and for the serious illness of the employee. Employees using this leave may be able to continue their City health coverage through the FMLA provisions. Contact your payroll or personnel office for details.
E. Change of Address
If you change your address be sure to notify your health plan and your agency so that your records can be kept up-to-date. Always provide your certificate or identification number when communicating with health plans.
Retirees should notify the Health Benefits Program of any address change.
F. Transfer from One City Agency to Another
If you leave the employment of one City agency at which you are covered under the City's Health Benefits Program, and subsequently become employed by another City agency at which you are eligible to enroll for health coverage, your coverage will become effective on your appointment date at the new agency, provided that no more than 90 days have elapsed since your coverage terminated at the first agency. Your new agency should reinstate your coverage by submitting a completed Health Benefits Application (See Termination and Reinstatement, B.) You may only change health plans during the annual Transfer Period.
If more than 90 days have elapsed, the Effective Dates of Coverage rules apply. You must complete a new Health Benefits Application.
G. Change of Union or Welfare Fund Membership
Title changes that result in a change of union or welfare fund membership may require a change in payroll deductions for any Optional Rider coverage. You must contact your agency benefits representative within 31 days if you have changed unions or welfare funds.