WHEN COVERAGE BEGINS
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Family Plan
If you qualify for Family Health Plan coverage, you will need to pay a quarterly premium for yourself, your spouse and/or dependents to become (or remain) enrolled in the Family Health Plan as follows:
When a Dependent’s Coverage Begins
Coverage for your dependents (which includes a domestic partner) under the Family Health Plan will begin, provided the required premium payment is paid on a timely basis, on the later of:
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Family Plan
If you qualify for Family Health Plan coverage, you will need to pay a quarterly premium for yourself, your spouse and/or dependents to become (or remain) enrolled in the Family Health Plan as follows:
- Participant only—$300 per quarter;
- Participant and spouse—$551 per quarter;
- Participant with children—$551 per quarter, regardless of the number of dependent children you cover;
- Participant with spouse and dependent children—$603 per quarter, regardless of the number of dependent children you cover.
When a Dependent’s Coverage Begins
Coverage for your dependents (which includes a domestic partner) under the Family Health Plan will begin, provided the required premium payment is paid on a timely basis, on the later of:
- the day your Family Health Plan coverage becomes effective;
- the day a person becomes a dependent (if you acquire a dependent, inform the New York Fund office within 30 days or you will lose the opportunity to enroll your dependent until the beginning of your next eligibility period);
- any anniversary of the day your Family Health Plan coverage first became effective, you previously had chosen not to cover your dependent and then elect to do so; or
- the day your dependent loses coverage under another plan provided you notify the Fund office within 30 days of the loss.
Remember, coverage does not begin when your eligibility begins. It begins when the required premium is paid in a timely manner.
| IMPORTANT: |
| If you begin to pay the required premium but then fail to make a quarterly premium payment during an eligibility period you cannot enroll again until at least one year following the end of that eligibility period. If you do not pay the premium at the beginning of your eligibility period you cannot enroll until the next time you qualify for Plan benefits. |
You may elect to cover all, some, or none of your dependents, but the election choices you make at the beginning of your eligibility year cannot be changed for the duration of that year. If you elect coverage for your dependents but then stop paying the required premium before the end of your eligibility year, coverage for your dependents will cease for the remainder of that year and will not be available again until the end of your following eligibility year. Once you have elected any dependent, you must continue paying for that dependent. Ceasing payment for one will be considered ceasing for all and will result in the loss of dependent coverage described previously. If you decline coverage for your spouse or any dependent at the start of your eligibility year, you cannot enroll that dependent until the start of the next year for which you qualify for Family Plan benefits.
An exception to this rule will be made if you elect not to pay the premium at the beginning of your eligibility period because you, your spouse or dependents had coverage under another plan, but you (or your dependents) then lose that coverage because employer contributions cease or because of a loss of eligibility resulting from a change in family status (i.e., legal separation, divorce, termination of employment, reduction in hours, exhaustion of COBRA, children’s aging out of coverage, or moving out of an HMO service area) other than a failure to pay participant premiums or termination of coverage for cause (such as fraud). In that event, you will be given the opportunity to purchase coverage for them and you provided that you notify the Fund in writing within 30 days of the change in family status. If you both provide this notice and pay the required premium on time, the coverage will begin on the date of the change. If the other coverage was COBRA coverage, this exception only applies after the COBRA coverage is exhausted.
Finally, an exception may also be made if you acquire a new dependent through marriage, birth, adoption, or the placement of a child for adoption. In that event, you may add the new dependent to coverage by providing written notice to the Fund within 30 days of the marriage, birth, adoption or placement for adoption. (This does not apply to domestic partner coverage. See Glossary for eligibility requirements for a domestic partner.) If you provide this notice and pay the required premium on time, the coverage will become effective on the date of the event. The following chart illustrates the premium requirements. These premiums are subject to change.
An exception to this rule will be made if you elect not to pay the premium at the beginning of your eligibility period because you, your spouse or dependents had coverage under another plan, but you (or your dependents) then lose that coverage because employer contributions cease or because of a loss of eligibility resulting from a change in family status (i.e., legal separation, divorce, termination of employment, reduction in hours, exhaustion of COBRA, children’s aging out of coverage, or moving out of an HMO service area) other than a failure to pay participant premiums or termination of coverage for cause (such as fraud). In that event, you will be given the opportunity to purchase coverage for them and you provided that you notify the Fund in writing within 30 days of the change in family status. If you both provide this notice and pay the required premium on time, the coverage will begin on the date of the change. If the other coverage was COBRA coverage, this exception only applies after the COBRA coverage is exhausted.
Finally, an exception may also be made if you acquire a new dependent through marriage, birth, adoption, or the placement of a child for adoption. In that event, you may add the new dependent to coverage by providing written notice to the Fund within 30 days of the marriage, birth, adoption or placement for adoption. (This does not apply to domestic partner coverage. See Glossary for eligibility requirements for a domestic partner.) If you provide this notice and pay the required premium on time, the coverage will become effective on the date of the event. The following chart illustrates the premium requirements. These premiums are subject to change.
Individual Plan
(Covered Earnings of at least $10,000, but less than $30,000)
(Covered Earnings of at least $10,000, but less than $30,000)
| Who Is Covered | Premium Required |
| Participant only | $300 per quarter |
| Participant plus one or more dependents | $300 plus a buy-up premium per quarter |
Family Plan
(Covered Earnings of $30,000 or more)
(Covered Earnings of $30,000 or more)
| Who Is Covered | Premium Required |
| Participant only | $315 per quarter |
| Participant plus spouse or same-sex domestic partner | $551 per quarter |
| Participant with children | $551 per quarter |
| Participant with spouse and children | $603 per quarter |
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