If you and your spouse both have access to NYSHIP coverage as employees, you may wonder whether it makes more sense to enroll together in Family coverage or maintain separate plans. NYSHIP has rules that impact how married couples can coordinate their coverage. Whether you are about to enroll in coverage for the first time, recently married, or simply reviewing your options, understanding these rules now will help you choose the coverage that best meets your needs and help you avoid surprises down the road.
One Family Policy
New York State allows only one Family health insurance policy per married couple. If both you and your spouse are eligible for NYSHIP health coverage as employees, and at least one of you works for a NYS agency, you must choose one of the following coverage scenarios:
| Coverage Scenarios | |
|---|---|
| Two Individual policies | You and your spouse may each enroll in Individual NYSHIP coverage and maintain separate policies. |
| One Family policy | You may enroll in Family NYSHIP coverage and add your spouse to your policy as a dependent—or vice-versa. Additional dependents may be added to the policy as needed. |
| One Family policy + one Individual policy | You may enroll in Family NYSHIP coverage and your spouse may enroll in separate Individual NYSHIP coverage—or vice-versa. Additional dependents may be added to the Family policy as needed. |
This rule still applies if one of you is enrolled in NYSHIP as an employee of a NYS agency and the other is enrolled in NYSHIP as an employee of a Participating Employer (PE) or Participating Agency (PA).
Dental and Vision
NYS Dental Plan and NYS Vision Plan rules are different from NYSHIP health insurance rules. Dual coverage is allowed for dental and vision, potentially offering your family more flexibility and reducing your out-of-pocket costs. If both you and your spouse are eligible for NYS Dental Plan and/or NYS Vision Plan benefits, your coverage choices include:
| Coverage Choices | |
|---|---|
| Two Individual policies | You and your spouse may each enroll in Individual NYS Dental Plan and/or NYS Vision Plan coverage and maintain separate policies. |
| One Family policy | You may enroll in Family dental/vision coverage and add your spouse to your policy as a dependent—or vice-versa. Additional dependents may be added to the policy as needed. |
| One Family policy + one Individual policy | You may enroll in Family dental/vision coverage and your spouse may enroll in separate Individual dental/vision coverage—or vice-versa. Additional dependents may be added to the Family policy as needed. |
| Two Family policies (dual coverage) | You and your spouse may each enroll in Family dental/vision coverage and add each other to these policies as dependents. Additional dependents may be added to one or both Family policies as needed. |
The NYS Dental Plan and NYS Vision Plan are not available to all NYS employees. If you are unsure whether you are eligible for these benefits, ask your health benefits administrator.
Opt-Out Program
The Opt-Out Program allows eligible, active NYS enrollees who have other employer-sponsored group health coverage to decline NYSHIP coverage in exchange for an incentive payment ($1,000 per year for opting out of Individual coverage or $3,000 per year for opting out of Family coverage). This program is not available to PE employees.
To qualify for the program, your "other" coverage cannot be NYSHIP coverage provided by NYS to an employee or retiree. However, NYSHIP coverage provided to an employee through a PE or a PA does qualify as "other" coverage.
This means that if both you and your spouse work for a NYS agency and are both enrolled in NYSHIP, neither of you can participate in the Opt-Out Program.
However, if one spouse works for a NYS agency and the other works for a PE or PA and you are both enrolled in NYSHIP, the NYS employee may opt out, but only as an individual. The spouse who works for the PE or PA must have Family coverage.
Example: Bob and his spouse, Linda, are eligible for NYSHIP as the result of their active employment. Bob is an employee of New York State. Linda works for a Participating Employer. Linda enrolls for Family coverage, with Bob as her dependent. Bob enrolls in the Opt-out Program, but may only opt out as an individual, because two Family policies are not allowed under NYSHIP.
Reviewing the rules and planning ahead can help you avoid unexpected issues and choose your NYSHIP coverage with confidence. For additional information, see your General Information Book.
