Coverage Options After 26
There are two health coverage choices for adult children under NYSHIP:
Young Adult Option (YAO)
Allows eligible adult children to purchase their own NYSHIP coverage.
Eligibility requirements:
- Under age 30
- Unmarried
- Not eligible for employer-sponsored health insurance
- Not covered by Medicare
- Living or working within the plan's service area
Enrollment must occur during Open Enrollment or within 60 days of losing dependent coverage or another qualifying event. Coverage is individual, and your child pays the full premium (100%) with no employer contribution. They may choose any available NYSHIP plan option.
| Monthly Young Adult Option Rates | |||
|---|---|---|---|
| Code | Plan | Individual | |
| 001 | The Empire Plan | For employees of the State of New York | $1,194.83 |
| For retirees of the State of New York | $1,194.83 | ||
| 066 | Blue Choice | $958.99 | |
| 063 | Capital District Physicians' Health Plan (CDPHP) (Capital Region) | $1,175.99 | |
| 300 | Capital District Physicians’ Health Plan (CDPHP) (Central New York) | $1,253.09 | |
| 310 | Capital District Physicians’ Health Plan (CDPHP) (Hudson Valley) | $1,428.16 | |
| 050 | EmblemHealth – HIP (Downstate) | $1,491.14 | |
| 220 | EmblemHealth – HIP (Capital Region) | $1,667.93 | |
| 350 | EmblemHealth – HIP (Hudson Valley) | $1,455.83 | |
| 067 | Highmark Blue Cross Blue Shield | $1,089.68 | |
| 069 | Highmark Blue Shield | $1,160.02 | |
| 072 | HMOBlue (Central New York Region) | $1,122.95 | |
| 160 | HMOBlue (Utica Region) | $1,221.80 | |
| 059 | Independent Health | $1,094.83 | |
| 058 | MVP Health Care (Rochester) | $1,083.68 | |
| 060 | MVP Health Care (East) | $1,129.28 | |
| 330 | MVP Health Care (Central New York) | $1,308.06 | |
| 340 | MVP Health Care (Mid-Hudson) | $1,267.96 | |
| 360 | MVP Health Care (North) | $1,276.68 | |
COBRA/Continuation of Coverage
Your child may continue their existing NYSHIP coverage for a limited time under COBRA.
Key details:
- Coverage is available for up to 36 months
- Must enroll within 60 days of losing dependent coverage
- Coverage remains in the same plan initially
- Your child pays 100% of the premium plus 2% administrative fee
COBRA coverage ends early if premiums are not paid or if the enrollee becomes eligible for Medicare.
Special Circumstances
In certain cases, coverage may continue beyond age 26.
Disabled Dependents
Coverage may continue if the child is unmarried and unable to support themselves due to a qualifying disability that began before age 26. Submit a NYSHIP Statement of Disability for Dependents (PS-451) to your HBA or Agency Contact before your child turns 26.
Military Service
Eligible children who served in the U.S. military may receive additional coverage for up to four years. They must meet specific requirements to qualify. Talk to your HBA or Agency Contact for details.
Dental and Vision Coverage
Dental and vision benefits are not included in the Young Adult Option but may be available under COBRA.
Plan Ahead
To avoid gaps in coverage, it’s important to act within required timeframes to understand your options.
- Submit enrollment requests within required deadlines (often within 60 days)
- Review all eligibility requirements
- Compare plan options, costs and coverage
- Check provider networks and access to care
- Make sure preferred doctors and services are covered