NYSHIP Eligibility

Some New York State Participating Employers offer NYSHIP health insurance options to their employees. Review the eligibility rules to see if you qualify.

This page provides an overview of eligibility requirements. For specific information, speak with your HBA or refer to your General Information Book.

Employee Eligibility

Minimum eligibility requirements for coverage are established by New York State Law. Participating Employer eligibility requirements may exceed NYSHIP minimum eligibility requirements. For information about your employer’s specific eligibility requirements, contact your HBA.

When newly eligible for coverage, you may be subject to a waiting period before coverage begins. If you do not enroll when newly eligible, you may be subject to a late enrollment waiting period.

To be eligible for NYSHIP coverage, you must meet the following requirements:

  • You must be appointed/elected to a benefits-eligible position with a NYSHIP Participating Employer.
  • You must be on the payroll at the time you enroll. If you begin work, then take an unpaid leave of absence, you are ineligible until you return to the payroll and complete any waiting period established by your employer, including days worked before your leave began.
  • You are expected to work at least three months. (This requirement does not apply to paid elected officials.)
  • You meet one of the following:
    • You work a regular schedule of 20 hours or more per week
    • You are paid an annual salary at a rate of $2,000 or more per year
    • You meet one of the following criteria:
      • You are a local elected official
      • You are a paid member of a public legislative body
      • You are an unpaid board member of a public authority with at least six months’ service as a board member
      • Your public employment provides the major source of your family’s income
  • You are not already enrolled in NYSHIP as the result of your current or former employment.

In addition, employers may adopt or expand on certain requirements, such as:

  • A longer anticipated term of employment up to a maximum of six months, or
  • A regular schedule of more than 20 hours per week, or
  • A required minimum annual salary of more than $2,000 per year, or
  • Work week or annual salary eligibility requirements for local elected officials, paid members of public legislative bodies or elected members of school boards

Employer discretion based on class or category of employee

Your employer may determine which classes or categories of employees are eligible for NYSHIP coverage. For example, a Participating Employer may offer NYSHIP coverage to active employees, but not retirees.

Dual Coverage in NYSHIP

NYSHIP prohibits dual coverage as the enrollee. If you are already enrolled in NYSHIP as an employee or retiree, you cannot enroll again through a different employer as an employee or retiree. You must choose the employer through which you wish to be enrolled.

You can have dual NYSHIP coverage if you are covered under your own Individual coverage and also as a dependent on your partner’s Family coverage. However, New York State does not permit two Family coverages.

Refer to your General Information Book for more details.

Dependent Eligibility

You may cover your eligible dependents under NYSHIP by enrolling in Family coverage or adding eligible dependents to existing Family coverage. Dependents who meet the requirements described in this section are eligible for NYSHIP coverage. To enroll your dependent who is eligible for NYSHIP but not yet enrolled, contact your HBA.

Spouse, Domestic Partner and Divorce Coverage   Dependent Children Coverage

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