Do you have a student age 19 or older? You’ll need to submit verification.
Under the EmblemHealth (formerly GHI) Preferred Dental Plan and the NYS Vision Plan, your unmarried dependent children age 19 or older, but under age 25, are eligible for coverage if they are full-time students.
For the dental plan, EmblemHealth is responsible for determining eligibility as a full-time student. For the vision plan, Davis Vision is responsible for determining eligibility as a full-time student.
Before paying a claim, both carriers require the employee to verify that his or her dependent child was a full-time student at the time the child received services. It is best to submit the forms used to verify student status at the beginning of each semester. The forms are available at: https://www.emblemhealth.com/Members/Forms. and https://www.cs.ny.gov/employee-benefits/nyship/shared/forms/Davis-Vision-Student-Verfication-Form.pdf.
The NYS Department of Civil Service recently implemented a new procedure to ensure that the state is not providing dental and vision coverage to dependent children for which the carriers have not received verification of student status. Each month, EmblemHealth and Davis Vision will provide Civil Service with a list identifying those dependent children age 19 or older, but under age 25, for which the carrier has not received a current student verification form. Civil Service will terminate the dental and vision coverage for these dependents effective the end of the month in which the dependent turned 19, or three months after the most recent semester for which a student verification form was received.
If the dependent’s coverage should not have been terminated because he or she is a full-time student, then the employee will need to submit student verification forms to both EmblemHealth and Davis Vision. The carriers will then notify Civil Service to reinstate coverage. The forms must be submitted within 90 days of the termination to avoid a break (or gap) in the dependent’s coverage. Civil Service will send a letter to the employee when the dependent’s coverage is reinstated.
If you have any questions regarding the student verification forms or the eligibility of your dependent child, contact the carrier directly. Call the carriers before scheduling an appointment for a dependent student, to confirm that the carrier’s enrollment records indicate the student is eligible. You don’t want your dependent student to arrive at his or her appointment only to find out he or she is no longer covered.
Call EmblemHealth at 800-947-0101, and Davis Vision at-888-588-4823.