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Keeping your college student covered

By ERIKA FRASIER

PEF members with students attending college during the pandemic may be wondering how the confusion at schools about how in-person or virtual/online instruction and on-campus or off-campus living will affect their child’s health coverage.

With regard to dependent student coverage under The Empire Plan, HMO’s, and the NYS Dental and Vision Plans, the same eligibility rules apply during the pandemic as applied before it.

There is no distinction between a full-time student taking on-line courses, versus a full-time student attending classes in person on campus. If your dependent returns to school as a full-time student taking online courses, the same benefit eligibility guidelines apply.

Emblem Health, which administers the NYS Dental Plan, verifies full-time student status via direct outreach to enrollees.

Effective July 1, Davis Vision, administrator of the NYS Vision Plan, ceased to require student verification paper work from enrollees.

There will be no change regarding premium rates until at least the start of the 2021 plan year, following the standard rate renewal process and negotiations.

Losing  eligibility

If your child is age 19 or older, but under age 25, and has completed or is completing his or her studies, then he or she may lose eligibility for coverage as a dependent child under your dental and vision plans for the upcoming semester.

You must notify your state agency’s health benefits administrator (HBA) of your child’s change in student status, and you should request information about how to continue their dental and vision coverage, with completing a Student Verification Form if necessary. The form can be submitted directly to your HBA and/or carrier.

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 United Health Care (UHC) Empire Plan or any of the HMO Plans your unmarried dependent children until age 26, are eligible for coverage whether they attend college or not. For families enrolled in an HMO who have a student attending college outside of their HMOs service area, the HMO still covers that college student. Enrollees need to contact the HMO to get details on how to access care and any referrals needed. They continue to be eligible until the end of the month in which they reach age 26.

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.

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 web site at 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.