The following summarizes eligibility policy as referenced in the Summary Plan Description, dated July 1, 2017. Your actual eligibility for benefits will be determined by the City policy in place at the time you retire, and the benefits applicable to you should be ascertained at that time. You should speak with your current employer to ascertain your eligibility.

Retirees are eligible (if you meet all of the criteria):

1. You have at least ten (10) years of credited service as a member of a retirement system maintained by the City or the Department of Education (if you were an employee of the City on or before December 27, 2001, then you must have at least five (5) years of credited service as a member of a retirement system maintained by the City);

OR

2. You have at least fifteen (15) years of credited service as a member of either the Teachers’ Retirement System or the Board of Education Retirement System if you were an employee of the City or the Department of Education appointed on or after April 28, 2010, and held a position represented by the recognized teacher organization on the last day of paid service.  Where this paragraph and paragraph (1) both apply, this paragraph controls.

AND

3. During the minimum period of credited service required for eligibility under paragraph (1) or (2) above, or at the time of separation from employment with the City or the Department of Education, you were working regularly for twenty (20) or more hours a week and eligible for City health benefits as an employee of the City or the Department of Education.

AND

4. You receive a pension check from a retirement system maintained by the City or the Department of Education.

EXCEPTIONS: Accidental disability retirement: If you retire from the City or the Department of Education because of an accidental disability, as a current or former member of a retirement system maintained by the City or the Department of Education, and you receive a pension check from such system, you are eligible for retiree health benefits.

Other Participating Employers in the City’s Health Benefits Program
Members of retirement systems not maintained by the City or the Department of Education, such as former employees of some institutions or entities participating in the Cultural Institutions Retirement System and former employees participating in the Optional Retirement Program of the City University of New York, may be eligible for health coverage.  In addition, former employees of certain non-City employers that participate in retirement systems maintained by the City or the Department of Education, such as the NYC School Construction Authority, the NYC Transit Authority, New York City Housing Authority and the NYC Health + Hospitals Corporation, may be eligible for retiree health insurance coverage.  Former employees of the foregoing types of employers should confirm eligibility with the personnel offices of their former employers.

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 relationship. More details concerning eligibility and tax consequences are available from the Office of Labor Relations Domestic Partnership Liaison Unit at 212-306-7605 or online at nyc.gov/olr.
3. Children under age 26 (whether married or unmarried):

a) natural children;
b) children for whom a court has accepted a consent to adopt and for the support of whom a retiree has entered into an agreement;
c) 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;
d) children for whom a court of law has named the retiree as legal guardian;
e) any other child who lives with a retiree in a regular parent/child relationship and is the retiree’s tax dependent.  A child is the retiree’s tax dependent if the retiree 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:
1. the disability occurred before the age at which the dependent coverage would otherwise terminate, and
2. the proof of disability was approved by the health plan at least 30 days before the date the dependent reached age 26.

The eligibility for such dependents only applies to current retirees whose disabled dependent children reach the age limitation while covered by a City health plan. Retirees may not add disabled dependent children to their health plan coverage, if the child is already over age 26.

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.

a. 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. 

 b. 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.  

Every 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 first of the month following 90 days after the Health Benefits Application is processed, unless the retiree has lost other coverage.