Eligibility

Welcome to the New York State Health Insurance Program or NYSHIP. As an enrollee of NYSHIP, you have several health insurance options available for you to select. We will explore enrollment, eligibility and changes to your NYSHIP options as active employees of New York State. To be eligible for NYSHIP coverage, you must be appointed or elected to a position in State service and fulfill eligibility requirements for your employee group. When newly eligible, you'll be subject to a 28-day waiting period before coverage begins.

To enroll in NYSHIP, you need to choose The Empire Plan, a NYSHIP-approved HMO in the geographic area you live or work in, the Opt-Out Program, or decline coverage. If you do not enroll when newly eligible, you will be subject to a late enrollment waiting period. For more information on eligibility requirements, refer to your General Information Book available on the NYSHIP website or through your health benefits administrator or HBA.

NYSHIP does not offer an Open Enrollment Period. During the annual Option Transfer Period, usually in November or December, you may change your NYSHIP option to any NYSHIP option for which you are eligible for any reason. To change your options during this period, contact your HBA. You may change options outside the designated Option Transfer Period only for the following qualifying life events: 

• you add a newly eligible dependent to your coverage in a timely manner, including marriage, domestic partnership, birth, adoption or other child eligibility
• you are no longer eligible to continue coverage in your HMO or a new HMO is now available to you because you moved or your job location has changed
• your dependent moves permanently and is no longer in your HMO service area
• you return to State payroll after military leave or after a break in State service
• you retire or vest your health insurance

All requests must be made no later than 30 days after the qualifying life event to ensure continued access to benefits.

If you do not enroll in NYSHIP coverage when newly eligible, you will be subject to a late enrolment waiting period of five biweekly pay periods. This late enrollment waiting period may also apply if you do not add a newly eligible dependent within 30 days or if you want to add a previously eligible dependent to your coverage. You should always contact your HBA when something changes in your enrollment information.

For more information on enrollment and eligibility, refer to your General Information Book available on the NYSHIP website or through your HBA.