New York Codes, Rules and Regulations › Title 4 - DEPARTMENT OF CIVIL SERVICE › Chapter V - Regulations Of The Department Of Civil Service (president's Regulations) › Part 73 - State Health Insurance Plan › Section 73.2 - Eligibility

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Employees.
(1) An employee shall be eligible for
				coverage under the plan for himself and for his dependents, if any, subject to
				the provisions of this Part and of the appropriate contracts applicable to
				employees and their dependents.
(2)
				Coverage for any employee or any employee's dependents may be effective on the
				first day of employment. However, a participating employer may require the
				employee to complete up to six months of service before coverage for the
				employee and the employee's eligible dependents becomes effective.
(3) Coverage for any employee and his
				dependents shall cease without notice on the date of termination of his status
				as an employee as defined in section
				73.1 of this Part. The status of
				any person as an employee shall be deemed to terminate upon his severance from
				the payroll, except that, for the purpose of continuing his coverage under the
				plan, the status of such person as an employee shall be deemed to continue:
(i) during any period of authorized leave
				without pay or while a vested employee;
(ii) during any period for which payment of
				benefits is made under a State income protection plan;
(iii) during any period, not to exceed one
				year or until reemployment by the State or reemployment by another employer,
				whichever first occurs, or such shorter period as may be established by
				collective negotiations, in which the employee is suspended and his name is
				placed on a preferred list for reinstatement; provided, however, that such
				continuance shall be permissive for any participating employer;
(iv) in the event of the employee's
				retirement, if the employee has completed at least five years of service with
				the employer from whose service the employee has retired if such employee was
				hired prior to April 1, 1975 and such employer elected to participate in the
				plan prior to March 1, 1972; provided further that an employer may establish a
				service requirement greater than five years for purposes of determining
				eligibility for retirement for any employee hired after April 1, 1975 and may
				elect not to provide continuance of coverage for any employee hired on or after
				April 1, 1977. An employer so electing shall agree to do so for all employees
				or all employees in a class or category who, on retirement, meet the conditions
				specified;
(v) in the event of the
				retirement of an employee who has met the conditions specified in subparagraph
				(iv) of this paragraph from the service of an employer which elected to
				participate in the plan on or after March 1, 1972, if such employer elects, at
				its option, to treat such retiree as an employee. An employer so electing shall
				agree to do so for all employees who, on retirement, meet the conditions
				specified in subparagraph (iv) of this paragraph;
(vi) in the event of the employee's
				retirement with less than five years of service with the employer from whose
				service the employee has retired, or less service than established by such
				employer, pursuant to subparagraph (iv) of this paragraph, such employer, at
				its option, may provide for the continuance of coverage for such employee,
				provided that the applicable period of required service has been met through
				employment with one or more public employers and such employee has served a
				minimum of one year with the employer from whose service the employee has
				retired. An employer so electing to provide continuance of coverage shall agree
				to do so for all employees or all employees in a class or category who, on
				retirement, meet the conditions specified;
(vii) in the event the employee is, or has
				been, granted a service-connected disability retirement by a retirement or
				pension plan or system administered and operated by the State of New York or a
				civil division thereof, including the New York State Teachers' Retirement
				System, regardless of the employee's service with the employer;
(viii) in the event of the retirement of an
				unpaid local elective official with 20 years or more service in such position
				with a participating employer that elects to permit enrollment for such
				officials, or an unpaid local elective official who has at least five or more
				years service with a participating employer and who also meets or exceeds a
				locally established service requirement which is not less than that established
				for other employees of that locality; or
(ix) in the event of the retirement of a
				publicly elected member of a school board with 20 years' or more service in
				such position with a participating employer that elects to permit enrollment
				for such members.
(4)
				Notwithstanding the foregoing provisions, coverage under the plan for any
				person whose status as an employee terminates may continue for the period for
				which the required contributions of both the employee and the employer on
				account of such coverage were made, provided such contributions were payable to
				the Health Insurance Fund on or prior to the date of the termination of the
				status of such person as an employee. However, a participating employer may
				establish that coverage for any category of employees will cease on the last
				day of the month during which status as an employee terminates. In the event
				that no contributions are required of an employee for such coverage, coverage
				under the plan may continue, in the case of an employee paid on a biweekly
				basis, through the 28th day following the last day of the last payroll period
				during which the employee was employed and, in the case of an employee paid on
				a monthly basis, through the last day of the calendar month next following the
				last month during which the employee was employed, unless an earlier
				termination date for a particular category of employees has been
				established.
(5) Notwithstanding
				any of the foregoing provisions of this section, if the regular work schedule
				of an employee has been not less than 20 hours per week for at least one year
				and then is reduced to less than 20 hours per week under circumstances not
				expressly excepted under section
				73.1(c)(1) of this
				Part, the president may, in his discretion and upon the request of the
				employer, deem such person's status as an employee to continue for a period not
				exceeding one year for the purpose of continuing his coverage under the plan.
				Thereafter, if the regular work schedule of such employee continues to be less
				than 20 hours per week, the president may, from time to time, review the case
				and, in his discretion, grant extensions not exceeding one year each during
				which such person's status as an employee may be deemed to continue.
(6)
(i) In
				the event both husband and wife elect coverage under the plan as employees as
				defined in section
				73.1 of this Part, there shall be
				coordination of benefits.
(ii) No
				employee may elect coverage under the plan with more than one employer. A
				person having elected coverage with two or more employers shall terminate
				coverage with all but one of such employers. If the employee does not do so
				forthwith, the employee shall be deemed to terminate coverage with all but the
				employer with whom coverage was first acquired.
(7) Notwithstanding any other provisions of
				this Part for the purpose of determining an employee's eligibility to apply
				accumulated but unused sick leave credits against the employee's cost of health
				insurance in retirement, an employee whose services are terminated on account
				of the abolition of positions in the State service and who retires within one
				year following such termination, shall be deemed to have been on leave without
				pay and thus eligible to have such credits applied.