Human Resource Management

The annual option transfer period is the time in which you can make certain limited changes to your NYSHIP health insurance options. Any changes that are made during this period will be effective with the following calendar year.  The types of changes that are allowed during this option transfer period are:

• change from one NYSHIP plan to another, e.g., the Empire Plan to a NYSHIP approved HMO or vice versa;

• voluntarily cancel your insurance without a qualifying event;

• remove otherwise eligible dependents from your plan without a qualifying event, resulting in a change from family to individual coverage.

No action is required to keep your current health insurance option.

Are you considering changing your NYSHIP health insurance option in 2025?
Click here for quick access to information and tools to help you prepare for the upcoming Option Transfer Period: https://www.cs.ny.gov/employee-benefits/nyship/shared/option-transfer/guide/index.cfm

• change in family status (e.g., marriage, birth, death, legal separation, divorce, only dependent child attains the maximum age for coverage);

• you no longer live or work within your HMO's NYSHIP service area and therefore you choose another NYSHIP HMO or the Empire Plan;

• your spouse loses coverage due to termination of employment and you apply for coverage for your spouse under NYSHIP;

• your spouse has a change in employment status, which results in acquiring or losing eligibility for health insurance coverage;

• you first become eligible for health insurance coverage after the beginning of the tax year.

• your employment with the State terminates or you retire.

The New York State Health Insurance Program allows a young adult child up to age 30 to purchase coverage through his or her parent's group health insurance policy. The Young Adult Option is for medical coverage only; dental and vision coverage is not included. Under the law, the young adult's coverage is subject to all terms of the group policy; however, premiums are to be paid by the young adult or his or her parent, not the employer. The premium is the full cost of individual coverage for the NYSHIP option selected.

Eligibility Criteria
The Young Adult Option is available to young adults who meet all of the following eligibility requirements:

• Be a child, adopted child, or stepchild of a NYSHIP enrollee (including those enrolled under COBRA)
• Be age 29 or younger
• Be unmarried
• Not be insured by or eligible for coverage through the young adult's own employer-sponsored health plan.
• Live, work, or reside in New York State or the plan's service area
• Not be covered under Medicare

In addition, the young adult does not need to live with the parent, be financially dependent on the parent, or be a student. A young adult's eligibility for health insurance coverage through a former employer under federal COBRA or state continuation coverage does not disqualify the young adult from electing this option under NYSHIP. Children of the young adult are not eligible for coverage under this option but may be eligible for health insurance coverage under other programs, such as the Child Health Plus Program. The young adult's parent does not need to have family coverage, nor is the young adult required to have been previously covered as a dependent under NYSHIP, to be eligible to enroll.

For more information or to enroll a young adult child, visit the Department of Civil Service website.

Q. Do I need to enroll in Medicare Part A and B once I turn 65?

A. If you continue to be an active employee in a "benefits eligible" position and you have New York State Health Insurance Program (NYSHIP) coverage either under your own or as a dependent of an active NYS employee (i.e. spouse), you are NOT required to enroll in Medicare (Parts A or B). This exemption also includes eligible dependents (i.e. spouse) of NYSHIP enrollees.  However, in most cases you should at least enroll in Part A (hospital insurance) as for most people, Part A is free. NYSHIP would still be your "primary" insurer under hospital benefits as an active employee or dependent of an active employee with Medicare being your "secondary" payor.

Q. How to apply for Medicare if I want to enroll in just Part A as an active benefits eligible employee?

A. About three months before you turn 65, contact the Social Security Office to arrange for enrollment in Medicare Part A. Visit your local Social Security office or call Social Security at 1-800-772-1213. Additionally, information about applying for Medicare is available on the web at http://www.ssa.gov/

Q. I am an active employee with a domestic partner who is enrolled in NYSHIP as my dependent and who is turning 65. Are the Medicare rules different for domestic partners?

A. Yes. Because Medicare is a federal program that does not recognize domestic partners as Internal Revenue Service-eligible dependents, Medicare becomes primary for your domestic partner at age 65 even though you are still working and he/she is enrolled in NYSHIP as a dependent. Regardless of your employment status, your domestic partner must have Medicare Parts A and B in place when first eligible due to age for Medicare. Please note that your domestic partner would retain NYSHIP as secondary coverage and he/she would be eligible for Medicare Part B reimbursement from the NYS Department of Civil Service. Please call (1-800-833-4344) for further details.

Q. When I retire do I have to enroll in Medicare even if I am enrolled in NYSHIP?

A. Yes, NYSHIP requires retirees to enroll in Medicare Parts A and B once you are retired and eligible for Medicare. Medicare becomes your primary insurance (Medicare pays first) at that point. Your covered dependents must also enroll when eligible (i.e. they turn age 65). NYSHIP will not provide any benefits for coverage available under Medicare if you or a dependent are eligible for Medicare coverage that is primary but fail to enroll when eligible. You will then be responsible for the full cost of services that Medicare would have covered.

Q. Can I enroll in multiple Medicare Plan’s (i.e., a spouse’s coverage)?

A. If an inactive Medicare eligible employee (and/or their dependent) enroll in other parts of Medicare may negative impact an enrollee’s NYSHIP retirement coverage.

When enrollees are no longer active employees and become eligible for Medicare, the combination of their health insurance benefits under Medicare and NYSHIP provides them with comprehensive coverage. Medicare has several parts, including Parts A, B, C and D. NYSHIP requires enrollment in Medicare Parts A and B ONLY.

Medicare allows enrollment in only one Medicare product at a time. Therefore, enrolling in a Part D plan or a Medicare Advantage Plan (MAP) in addition to NYSHIP will result in the cancellation of a NYSHIP enrollee’s coverage. This includes Medicare products that the enrollee or covered dependents may be enrolled in through another employer. 

Medicare Parts A and B  
Together, Parts A and B are a fee-for-service plan. NYSHIP supplements this coverage and requires the enrollee and eligible dependents to enroll in both Part A and B when Medicare is primary to NYSHIP. Medicare Part A covers inpatient care in hospitals or skilled nursing facilities, hospice care and home health care. Medicare Part B covers doctors’ services, outpatient hospital services, preventive services, durable medical equipment and some other services and supplies not covered by Part A. 

Medicare Advantage Plans (Medicare Part C)  
MAPs replace the enrollee's original fee-for-service Medicare Parts A and B coverage. The benefits offered by the plan and all medical care (except for emergency or out-of-area urgent care) must be provided, arranged or authorized by the MAP.  

All NYSHIP HMOs provide Medicare Advantage coverage to Medicare-primary enrollees and dependents. If the enrollee is enrolled in Medicare Parts A and B, their NYSHIP HMO will automatically enroll them and their covered dependents in the HMO’s MAP. This means their HMO will provide both their Medicare and NYSHIP benefits. 

Medicare Part D 
Medicare Part D provides prescription drug benefits. Medicare-primary enrollees and dependents enrolled in The Empire Plan have prescription drug coverage under Empire Plan Medicare Rx. If the enrollee and their dependent(s) are Medicare primary and enrolled in a NYSHIP HMO, the HMO provides their Medicare Part D prescription drug coverage. 

For more information on Medicare and NYSHIP, review the Medicare and NYSHIP publication, or contact the Employee Benefits Division (EBD) Call Center at 518-457-5754 or 1-800-833-4344.