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Health Notes

College-age students’ dental, vision coverage may end with school year


If your child is age 19 or older, but not yet 25, and is completing his or her studies in May or June, then he or she may lose eligibility for coverage as a dependent child under your dental and vision plans.

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You must notify your state agency’s health benefits administrator of your child’s change in student status, and you should request information about how to continue their dental and vision coverage.

The federal Patient Protection and Affordable Care Act requires insurers to offer children coverage as dependents on their parents’ health insurance plan up to age 26, but that only applies to medical care, not to dental or vision care.

When coverage ends

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. They continue to be eligible until the first of the following dates:

• The end of the third month following the month in which they completed the semester as a full-time student;

• The end of the month in which attendance at school ends, if the semester is not completed and proof of the last day of attendance for the semester is provided, or the end of the third month following the month that the last semester was completed, whichever is later;

• The starting date of the semester if the semester is not completed and no proof of attendance is provided, or the end of the third month following the month that the last semester was completed, whichever is later;

• The end of the third month following the month in which they complete course requirements for graduation; or

• The end of the month in which they reach age 25.

How to extend coverage

The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) requires most employers sponsoring group health plans to offer employees and their covered dependents the opportunity for temporary “continuation coverage” at group rates in certain instances where coverage under the employer-sponsored plan would otherwise end.

The dental and vision care benefits your dependent may continue are the same benefits you receive as an active employee. COBRA requires that your child have the opportunity to continue coverage for up to 36 months. The cost of COBRA coverage is the full premium (both the employer and employee shares) plus a 2 percent administrative fee. The 2017 monthly COBRA rates for individual coverage are: $27.76 for dental and $3.45 for vision.

Under COBRA, the employee or dependent is responsible for informing the Employee Benefits Division (EBD) of the state Department of Civil Service (DCS) within 60 days of when the dependent loses eligibility. If you do not notify EBD within that time, regardless of the reason, the dependent will not be entitled to COBRA continuation coverage.

For more information about COBRA continuation coverage, visit the DCS website at https://www.cs.ny.gov/employee-benefits. Follow the prompts to NYSHIP Online, and then select Other Benefits to access the Dental Plan Certificate Book and NYS Vision Plan Book, or you may call the DCS at 518-457-5754 or 1-800-833-4344.

Enhanced mammography now covered

Under a new NYS law that took effect January 1, the Empire Plan and all HMOs participating in the NYS Health Insurance Program may not require cost-sharing for breast cancer screening and diagnostic imaging services when you use a provider in your health plan’s network.

No cost-sharing means your health plan may not apply covered charges against an annual deductible and it also may not charge patients a copayment or coinsurance.

Covered services

The law eliminates cost-sharing for screening mammograms, including:

• A single, baseline mammogram for women 35 to 39 years old;

• Yearly mammograms for women 40 years of age or older; and

• Mammograms for women at any age who are at an increased risk of breast cancer because they have a prior history of breast cancer, or they have a first-degree relative (e.g., parent, sibling, child) with breast cancer.

The law also eliminates cost-sharing for medically necessary diagnostic imaging tests for breast cancer other than standard mammograms, such as diagnostic mammograms, breast ultrasounds and breast magnetic resonance imaging (MRI).

3-D mammograms

Both Empire BlueCross BlueShield and UnitedHealthcare now consider 3-D mammograms medically necessary for the screening and diagnosis of breast cancer. This change, which took effect February 20, means 3-D mammograms are covered with no copayment when you use an in-network provider. In addition, 3-D mammograms are covered when you use an out-of-network provider, but they are subject to deductible and coinsurance. — Lorraine Simpkins

Table of Contents – May 2017


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