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Dental and Vision Student Verification Information Fact Sheet

If you have dependents who are students and covered under the NYS Health Insurance Program (NYSHIP), you may need to verify their eligibility for dental and vision coverage.  Their coverage depends on verifying their full-time student status during the period after they reach age 19 and before they reach age 25.

The Student Verification Process is now an automated process for NYSHIP Dental and Vision coverage. Enrollees are required to contact the dental program administrator, Emblem Health, to submit the Student Verification Form to ensure claims are processed.

Notification responsibility

Throughout the year, it is the member’s responsibility to ensure their college-aged dependents’ profile and eligibility are current to the most up-to-date information so coverage is not terminated. This information needs to be relayed to your health benefit administrator (HBA) to be updated in the New York Benefits Eligibility and Accounting System (NYBEAS).

Eligibility

The federal Patient Protection and Affordable Care Act (ACA) 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.

Dependents who are at least age 19, but under age 25 are eligible under NYSHIP to be covered on your dental and vision benefits if they are full-time students at an accredited secondary or preparatory school, college or other educational institution that grants a degree or diploma. Full-time criteria includes on campus, online or a combination of both. They must also not be otherwise eligible for employer group coverage. They continue to be eligible until the first of the following dates: 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.

COBRA allows you to extend a benefit beyond the time coverage would otherwise end.  You would receive a letter from the Employee Benefit Division (EBD) if your dependent exhausts the plan’s age limit, becomes ineligible for benefits or undergoes a qualifying event resulting in losing the benefit.  The letter notifies you of the impending loss of coverage and offers you the option to extend it through COBRA.

If you received this letter and have already submitted the updated and completed Student Verification Form for the 2021 Plan Year to Emblem, you should contact your HBA and/or Emblem to check on the status of your form.

If you received this letter and have not submitted the updated and completed the Student Verification Form for the 2021 Plan Year to Emblem, you must contact your HBA and/or Emblem to have this updated. You will need to complete the Student Verification Form in order to have your dependent reinstated with no lapse in coverage.

Emblem sends out a mass mailing yearly to all members who currently have college-aged dependents on their plan, requesting Student Verification for the upcoming year. If Student Verification was not submitted by the March 31 deadline, the dependent was dropped from coverage.

An additional outreach is done by mail for dependents who will soon be 19. If student status is confirmed, further outreach will be performed.

Removing Dependents

After the first Friday of each month, dependents that have not been confirmed as having full-time student status are removed from NYBEAS. The dependent whose full-time student status is not verified, is removed the first of the month following their 19th birthday.

If no response to Emblem Student Verification Form for the current semester is received, the dependent is removed the first of the month following a 3-month extension beyond the last semester full-time student status was confirmed.

Dependents who have confirmed full-time student status with Emblem Health since the previous monthly update, are restored to NYBEAS retroactive to the date they were originally removed with confirmation of continuous full-time student status.

The dependent is restored as of the first day of the month in which classes began.

There is a break in coverage when there is a break in student status between semesters, such as when a dependent skips a semester and then returns to student status.

Age 25 Removals

The Employee Benefit Division automated process removes all children from NYSHIP dental and vision coverage effective the first of the month following their 25th birthday.  Dependents being removed from the file will automatically receive a COBRA application. You must adhere to the deadlines noted on the application.  To continue coverage under COBRA, the enrollee and/or their dependent must contact the EBD at 1-800-833-4344 and select menu options for COBRA.

Contact Emblem Health

You should contact Emblem Health at (1-800-947-0101) for:

  • All ID Card requests and/or replacement ID Card requests or ID numbers; and for
  • Submission of the Student Verification Form when requested from Emblem.

Members are required to submit the requested “Dependent Student Certification Form” to Emblem Health each time it is requested. This form is located on Emblem Health’s website at https://www.emblemhealth.com/resources/forms. Enrollees should select “Student Verification Form for NYS Enrollees Only – GHI”. Once the enrollee submits this form, Emblem Health will reinstate the coverage and begin processing claims again. Emblem Health will send the update to the EBD, and NYBEAS will be updated within 60 days of receiving the information.

Contact your HBA

Contact your HBA for:

  • Any ID Card requests and/or replacement ID Card requests or ID numbers;
  • Any demographic, eligibility or qualifying event information for processing;
  • You submitted the Student Verification Form more than 2 weeks ago and Emblem is not honoring claims;
  • You submitted the Student Verification Form more than 60 days ago, and NYBEAS has not been updated.

Contact PEF

Please contact PEF if you are encountering problems getting your HBA to submit eligibility and update NYBEAS or if you are encountering any problems directly with Emblem.  Keep in mind that federal law (HIPPA) does not give your union representatives access to health benefits ID numbers, replacement ID cards, updating eligibility or demographic profiles for members.