NYC Health Benefits Program


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Enrolling in Health Benefits


Eligibility

Learn about eligibility requirements for participation in the HBP.Read More

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To be eligible for participation in the City Health Benefits Program, employees must meet all of the following criteria:

 

  • You work -- on a regular schedule -- at least 20 hours per week; and
  • Your appointment is expected to last for more than six months.

 

Dependents are eligible if their relationship to the eligible participant is one of the following:


  1. A legally married spouse, but never an ex-spouse.
  2. A domestic partner at least 18 years of age, living together with the participant in a current continuous and committed relationship, although not related by blood to the participant in a manner that would bar marriage in New York State. More details concerning eligibility and tax consequences are available from your agency or the Office of Labor Relations Domestic Partnership Liaison Unit at 212-306-7605.
  3. Children under age 26 (whether married or unmarried):

    1. natural children
    2. children for whom a court has accepted a consent to adopt and for the support of whom an employee has entered into an agreement
    3. children required to be covered under a qualified medical child support order until the court order expires, at which time the child may continue to be eligible for coverage under (a) or (b) above;
    4. children for whom a court of law has named the employee as legal guardian;
    5. any other child who lives with an employee in a regular parent/child relationship and is the employee’s tax dependent. A child is the employee’s tax dependent if the employee claims the child on his/her income tax return as a dependent.

Coverage will terminate for children (other than eligible disabled children) at the end of the month in which the child reaches age 26.

 

Exception: Unmarried, disabled children age 26 and older, who cannot support themselves, are eligible for continued coverage if the following criteria are met:

  • the disability occurred before the age at which the dependent coverage would otherwise terminate, and
  • the proof of disability was approved by the health plan at least 31 days before the date the dependent reached age 26.

 

NOTE - The eligibility for such dependents only applies to current employees whose disabled dependent children reach the age limitation while covered by a City health plan. New employees with disabled dependent children, already over the age limitation, may not include such children as dependents on their City health plan coverage. In addition, employees may not add disabled dependent children to their health plan coverage, if the child is already over age 26.


How to Enroll For Health Benefits

Find out how to enroll as an active employee.Read More

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1. As an Employee

To enroll, you must obtain and file a Health Benefits Application at your payroll or personnel office or NYCAPS Central. The form must be filed within 30 days of your appointment date (for exceptions, see Effective Dates of Coverage section). If you do not file the form on time, the start of your coverage will be delayed and you may be subject to loss of benefits.

New employees, employees enrolling for the first time or current employees requesting to add dependents are required to provide acceptable documentation to support the eligibility status of all persons to be covered on their City health plan coverage.


  1. If you are including a spouse on your coverage, and you have been married for more than one year, you must submit a Government issued Marriage Certificate AND Federal Tax Return from the last two years, (only send the first page of your tax return which shows your spouse) OR Proof of Joint Ownership issued within the last six months (with both names) such as a mortgage statement, lease agreement, utility bills, bank statement, credit card statements and property tax statements.

  2. If you are including a domestic partner on your coverage, and you have been registered for more than one year, you must submit a Government issued Certificate of Domestic Partnership AND Proof of Joint Ownership issued within the last six months (with both names) such as a mortgage statement, lease agreement, utility bills, bank statement, credit card statements and property tax statements. 

 

Find out how to enroll at retirement.Read More

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2. At Retirement

You must file a Health Benefits Application at your payroll or personnel office prior to retirement to continue your coverage into retirement. If you are Medicare-eligible and are enrolling in an HMO you must complete an additional application form, which must be obtained directly from the health plan. If you are retired from a cultural institution, library, or the Fashion Institute of Technology, or if you receive a TIAA/CREF pension and are eligible for City health coverage, you must file a Health Benefits Application with your former employer. 


  1. If you are adding a spouse to your coverage, and you have been married for more than one year, you must submit a Government issued Marriage Certificate AND Federal Tax Return from the last two years, (only send the first page of your tax return which shows your spouse) OR Proof of Joint Ownership issued within the last six months (with both names) such as a mortgage statement, lease agreement, utility bills, bank statement, credit card statements and property tax statements.

  2. If you are adding a domestic partner to your coverage, and you have been registered for more than one year, you must submit a Government issued Certificate of Domestic Partnership AND Proof of Joint Ownership issued within the last six months (with both names) such as a mortgage statement, lease agreement, utility bills, bank statement, credit card statements and property tax statements.

 

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Watch the Video for how to enroll

 

Find out how to add your domestic partner to your health benefits coverage. Read more


Waiver of Health Benefits

Every employee or retiree eligible for City health benefits must either enroll for coverage or waive membership.Read More

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Every employee or retiree eligible for City health benefits must either enroll for coverage or waive membership by completing the appropriate sections of the Health Benefits Application. Those who waive or cancel City health plan coverage and subsequently wish to enroll or reinstate benefits will not have coverage until the beginning of the first payroll period 90 days after the submission of a Health Benefits Application, unless the participant has lost other coverage.

 

The MSC Buyout-Waiver Program

Allows eligible employees who can obtain non-City group health benefits to waive their New York City health benefits in return for an annual cash incentive payment.    Learn More