Spousal Eligibility:  Revised NYSHIP Policy*

Effective May 1, 2007, the New York State Department of Civil Service will alter its prior policy and afford recognition to any same-sex marriage that is legal in the jurisdiction where it was performed, for purposes of providing spousal benefits eligibility in the New York State Health Insurance Program (NYSHIP) and for all other benefit programs administered by the Department’s Employee Benefits Division, including the New York State Vision Program, the New York Public Employee and Retiree Long Term Care Program (NYPERL) and the New York State Dental Insurance Program (including the Retiree Dental Plan administered by GHI).  

At this time, a same sex marriage from the following jurisdictions will be recognized if it is legal in the jurisdiction itself: Massachusetts, Canada, including all its provinces, Spain, South Africa, the Netherlands, and Belgium. Please note that the laws governing the legality of same-sex marriages in these jurisdictions vary. In general, NYSHIP will assume, absent any indication to the contrary, that the possession of a marriage certificate from the jurisdiction is proof that the marriage is legally recognized there.

Civil unions will continue to be acceptable as part of proof requirements for domestic partner coverage.  

To implement this change, there will be a special enrollment period, from May 1, 2007 through May 31, 2007 during which enrollees may enroll same-sex spouses in NYSHIP without regard to the usual enrollment effective date rules.  This enrollment period applies to Health Insurance, Dental and Vision coverage.

In order to cover a spouse, the enrollee must complete a PS-404 and provide to the agency Health Benefits Administrator written, official documentation (i.e., a marriage certificate) to show that a formal legal marriage has occurred. In addition, the enrollee must provide the usual proofs required to enroll a dependent.

A change of coverage request due to a same sex marriage is a qualifying event for purposes of the Pre-Tax Premium Contribution Program (PTCP) and will be allowed on the same basis as any other change requested due to the addition of a new dependent. These spouses will be entitled to all the usual COBRA continuation rights upon loss of eligibility.

Although these dependents are recognized as spouses by NYSHIP, enrollees may still be subject to imputed income for the value of the benefits provided to the spouse, if the spouse does not meet the qualifications as a dependent under IRS Code Section 152. In cases where a spouse does meet these qualifications, a Dependent Tax Affidavit (PS 425.3) must be completed by the enrollee and submitted with the application in order to avoid tax on the value of the benefit.

Since the federal government does not recognize same-sex marriage, Medicare and plan primacy rules for same-sex spouses of active enrollees will remain the same as the rules for Domestic Partners.

Enrollment of children of a same-sex spouse who are not the children of the enrollee will no longer be based on the Program’s eligibility criteria for “other children,” but will now be subject to the eligibility criteria for stepchildren.  To change the status of an “other child” to a stepchild, the enrollee should submit a written request to the HBA requesting the change. 

This change will be communicated to all enrollees as soon as possible through the normal communication methods, such as Empire Plan Reports and the “What’s New” section of the public web site.

*Source: NYS Dept. of Civil Service, hba_online Memo 07-18, April 27, 2007, "Spousal Eligibility: Revised NYSHIP Policy."