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Health Benefits
Program Information > Enrollment Information


A. Cost
B. Eligibility
C. How to Enroll for Health Benefits
D. Pre-Tax Funding Programs
E. Waiver of Health Benefits
F. Effective Dates of Coverage
G. Optional Riders
H. Deductions for Basic Coverage and Optional Riders


A. Cost

There is no cost for basic coverage under some of the health plans offered through the City Health Benefits Program, but others require a payroll or pension deduction. Enrollees may purchase additional benefits through Optional Riders for all plans except for DC 37 Med-Team. Employee deductions are made on a pre-tax basis.

B. Eligibility
To be eligible for participation in City Health Benefits Program, employees and retirees must meet all of the following criteria.

Employees are eligible if:

  1. You work - on a regular schedule - at least 20 hours per week; and
  2. Your appointment is expected to last for more than six months.

Retirees are eligible if you meet all of the following criteria

a.     You have, at the time of retirement, at least ten (10) years of credited service as a member of a retirement or pension system maintained by the City (if you were an employee of the City on or before December 27, 2001, then at the time of your retirement you must have at least five (5) years of credited service as a member of a retirement or pension system maintained by the City). This requirement does not apply if you retire because of accidental disability; and

b.     You have been employed by the City immediately prior to retirement as a member of such system, and have worked regularly for at least 20 hours per week; and

c.     You receive a pension check from a retirement system maintained by the City.

EXCEPTIONS: Members of pension systems not maintained by the City may be eligible for health coverage pursuant to legislation or a collective bargaining agreement specifying such coverage.


Dependents are eligible if their relationship to the eligible participant is one of the following:

  1. A legally married husband or wife, but never an ex-spouse.
  2. A domestic partner at least 18 years of age, living together with the participant in a current continuous and committed relationship, although not related by blood to the participant in a manner that would bar marriage in New York State. More details concerning eligibility and tax consequences are available from your agency or the Office of Labor Relations Domestic Partnership Liaison Unit at 212-306-7605 (employees) or 212-513-0470 (retirees).

  3. Unmarried children under age 19. The term "children" for purposes of this and the following definitions, includes: natural children; children for whom a court has accepted a consent to adopt and for the support of whom an employee or retiree has entered into an agreement; children for whom a court of law has made an employee or retiree legally responsible for support and maintenance; and children who live with an employee or retiree in a regular parent/child relationship and are supported by the employee or retiree. Coverage will terminate for children reaching 19 at the end of the payroll period during which the age of 19 was attained.

  4. Unmarried dependent children between 19 and 23 who are full-time students at an accredited degree-granting educational institution. The student must be covered as a dependent through the City program and must receive at least 50 percent of his/her support from the employee or retiree. Coverage terminates when the student graduates or ceases to be a full-time student or on December 31 of the year of the student’s 23rd birthday, whichever is earlier. Coverage is applied from term to term as defined by the school, with coverage for a term remaining in effect up to the first day of the next term. Students who are temporarily disabled and cannot complete a term will be covered for up to a year from the original date of disability, after which COBRA or a direct payment conversion contract will be available. In the event of a documented permanent disability, the student may be added as a disabled dependent (see following paragraph).

  5. Unmarried children who cannot support themselves because of a disability, including mental illness, developmental disability, mental retardation or physical handicap, so long as their disability occurred while the dependent was covered by the City. To maintain continuous coverage, medical evidence of the disability must be provided to the plan within 31 days of the date the dependent reaches the age limitation. Contact your health plan for instructions.

Double City Coverage is Prohibited
Even if a person is eligible for the City plan as both a participant or a dependent, the person must choose one status or the other. Similarly, no person can be covered by two City health contracts at the same time. Eligible dependent children must all be enrolled as dependents of one parent. If both spouses or partners are eligible and one is enrolled as the dependent of the other, the dependent may pick up coverage in his or her own name if the other's contract is terminated.

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C.  How to Enroll for Health Benefits

  1. As an Employee:  To enroll, you must obtain and file a Health Benefits Application at your payroll or personnel office. The form must be filed within 31 days of your appointment date (for exceptions, see F, page 6). If you do not file the form on time, the start of your coverage will be delayed and you may be subject to loss of benefits.

    New employees or employees enrolling for the first time are required to provide acceptable documentation to support the eligibility status of all persons to be covered on their City health plan coverage.

  2. At Retirement:   You must file a Health Benefits Application at your payroll or personnel office prior to retirement to continue your coverage into retirement. If you are Medicare-eligible and are enrolling in an HMO you must complete an additional application form, which must be obtained directly from the health plan.
  3. After Retirement:   To enroll, you must obtain a Health Benefits Application from the Health Benefits Program. Complete the form and file it with the Health Benefits Program. You must meet the eligibility requirements for health benefits coverage. If you are retired from a cultural institution, library, or the Fashion Institute of Technology, or if you receive a TIAA/CREF pension and are eligible for City health coverage, you must file a Health Benefits Application with your former employer.
  4. Deferred Retirement:   As the result of a collective bargaining agreement, retirees who are members of the New York City Employees’ Retirement System — Pension Plan A — or the Department of Education Retirement System and have had at least 20 years of credited service are eligible for five years of additional City coverage. If you have retired but will not receive a City pension check until age 55, you may be eligible for up to an additional five years of City-paid health benefits coverage. Please contact your payroll or personnel office for details.

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D. Pre-Tax Funding Programs
The City of New York Employee Benefits Program provides two programs, the Medical Spending Conversion (MSC) and Health Care Flexible Spending Account (HCFSA) , that offer participants the opportunity to use pre-tax funds to increase take-home pay. These programs are administered through the Flexible Spending Accounts (FSA) Program.

Medical Spending Conversion (MSC) is comprised of two distinct programs:the Premium Conversion Program and the Health Benefits Buy-Out Waiver Program.

Premium Conversion Program
All employees who have payroll deductions for health benefits are automatically enrolled in the Premium Conversion Program. The Premium Conversion Program allows for premiums of health plan deductions on a pre-tax basis, thus reducing the amount of gross salary on which federal income and Social Security (FICA) taxes are calculated. The overall reduction in gross salary is shown on the Form W-2 at the end of the year, but no change is reflected in the gross salary amount on employees’ paychecks. Employees may decline enrollment in the Premium Conversion Program when they first become eligible for health plan coverage or during the FSA Open Enrollment Period, which is in the fall of each calendar year. To do so, employees must complete an MSC Form and the Health Benefits Application and submit them for approval to their personnel office. The benefits or payroll officer completes the appropriate section on the MSC Form and forwards the forms to the FSA Administrative Office.

In accordance with IRS rules, participants cannot change their Premium Coverage Plan status except during the Open Enrollment Period or when experiencing a mid-year Qualifying Event. 

To do so, an MSC Premium Conversion Program Form, with the required documentation, must be submitted to the benefits officer during the Open Enrollment Period or within 31 days of the occurrence of the Qualifying Event, which include:

  • A change in family status due to death, birth, adoption, marriage, divorce, annulment or legal separation between participant and spouse;
  • The attainment of the maximum age for coverage of a dependent child;
  • A court order requiring a recently divorced participant to provide health insurance coverage for eligible dependent children;
  • Moving out of an HMO service area;
  • A change in title that necessitates a change in health plan;
  • The termination of participant’s employment for any reason including retirement;
  • A change in the participant’s employment status that results in a health insurance coverage change;
  • A change in a spouse’s employment status or a significant change in a spouse’s health coverage that is outside the spouse’s control (e.g., benefit reduction);
  • The taking of, or returning from, an approved unpaid leave of absence by the participant or the participant’s spouse;
  •  An increase in the employee’s health plan premium deduction by more than 20%. 

Employees Who Have Previously Waived or Cancelled Health Benefits Coverage
Eligible employees who have waived health benefits coverage may enroll for coverage subject to the waiting period described in Reinstatement of Coverage, page 10. Reinstatement of coverage is only possible within 31 days of a Qualifying Event or during the Open Enrollment Period. Such enrollment will be on a pre-tax basis (unless enrollment in the Premium Conversion Program is declined).

Effect of the Premium Conversion Program on Health Benefits Program Rules and Procedures
IRS rules regarding the Premium Conversion Program require that an employee’s health premium payroll deduction remains either pre-tax or post-tax for the entire Plan Year. Therefore, no change that would affect the amount of the deduction can be made unless a Qualifying Event has occurred. As a result, the following health plan changes can only be made within 31 days of a Qualifying Event or during the Open Enrollment Period:

  • Change from family to individual coverage while an employee’s dependents are still eligible for coverage; or
  • Change from individual to family coverage if an individual’s dependents were previously eligible for coverage; or
  • Voluntary cancellation of coverage or the dropping of an Optional Rider while an employee is still eligible for such coverage or rider. 

Health Benefits Buy-Out Waiver Program (Employees Only)
The MSC Health Benefits Buy-Out Waiver Program entitles all eligible employees to receive a cash incentive payment for waiving their City health benefits if non-City group health coverage is available to them (e.g., a spouse’s/domestic partner’s plan, coverage from another employer or Medicare Part A and Part B). Annual payments, which are taxable income, are $500 for those waiving individual coverage and $1,000 for those waiving family coverage. This amount will be prorated for any period less than six months by the number of days the employee is participating in the MSC Health Benefits Buy-Out Waiver Program.

Employees may enroll in the MSC Health Benefits Buy-Out Waiver Program within 31 days of becoming eligible for benefits or during the Open Enrollment Period. Both an MSC Health Benefits Buy-Out Waiver Program Form and the Health Benefits Application must be submitted to your agency’s personnel office for approval. The benefits or payroll officer completes the appropriate section on both forms and forwards the forms to the FSA Administrative Office.

Important Note: The Internal Revenue Service does not permit any retroactive participation.

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Buy-Out Waiver Program Qualifying Events (Employees Only)
As with the MSC Premium Conversion Program, employees cannot change their decision regarding the MSC Buy-Out Waiver Program between Open Enrollment Periods, except if a Qualifying Event occurs, such as:

  • A change in family status due to death, birth, adoption, marriage, divorce, annulment or legal separation between participant and spouse;
  • The attainment of the maximum age for coverage of a dependent child;
  • A court order requiring a recently divorced participant to provide health insurance coverage for eligible dependent children;
  • The termination of participant’s employment for any reason including retirement or a change in the participant’s employment status that results in a health insurance coverage change;
  •  A change in a spouse’s employment status or a significant change in a spouse’s health coverage that is outside the spouse’s control (e.g., benefit reduction);
  • The taking of, or returning from, an approved unpaid leave of absence by the participant or the participant’s spouse;
  • A change in employment status from part-time to full-time, or vice versa, by participant or participant’s spouse.

Employees Who Return to Payroll Following Leave Without Pay (LWOP)
An employee who is on leave without pay during an Open Enrollment Period, upon return to payroll, will automatically be enrolled in the MSC Premium Conversion Program, unless declined within 31 days of such an event. To participate in the MSC Health Benefits Buy-Out Waiver Program, an eligible returning employee must complete both the MSC Health Benefits Buy-Out Waiver Program Form and the Health Benefits Application within 31 days of such an event.

Health Care Flexible Spending Account (HSCFSA)
The Health Care Flexible Spending Account (HCFSA) Program is designed to help participants pay for necessary out-of-pocket medical, dental, vision, and hearing aid expenses not covered by insurance. HCFSA is funded through pre-tax payroll deductions (minimum - $260 / maximum - $5,000), thereby effectively reducing the participant’s taxable income. Participants submit claims for eligible medical expenses to the FSA Administrative Office and receive a reimbursement check – not subject to federal income tax or Social Security tax (FICA) – from their HCFSA account. The amount of tax savings depends on the participant’s income tax bracket and the amount contributed to HCFSA.

For more information, please contact your benefits manager or call the Pre-Tax Benefits Program at (212) 306-7760. The FSA brochure and the Enrollment/Change Form are available on the FSA web site at www.nyc.gov/olr.

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E. Waiver of Health Benefits
Every employee or retiree eligible for City health benefits must either enroll for coverage or waive membership by completing the appropriate sections of the Health Benefits Application. (See Buy-Out Waiver Program, page 5). Those who waive or cancel City health plan coverage and subsequently wish to enroll or reinstate benefits will not have coverage until the beginning of the first payroll period 90 days after the submission of a Health Benefits Application, unless the participant has lost other group coverage.

F.   Effective Dates of Coverage
Coverage becomes effective according to the following:

For Employees — For Provisional employees, Temporary employees, and those Non-Competitive employees for whom there is no experience or education requirement for employment, coverage begins on the first day of the pay period following the completion of 90 days of continuous employment, provided that your Health Benefits Application has been submitted within that period.

For All Other Employees — For employees appointed from Civil Service lists, Exempt employees, and those Non-Competitive employees for whom there is an experience or education requirement, coverage begins on your appointment date, provided your Health Benefits Application has been received by your agency personnel or payroll office within 31 days of that date.

For Eligible Dependents  Coverage for eligible dependents listed on your Health Benefits Application will begin on the day that you become covered. Dependents acquired after you submit your Application will be covered from the date of marriage, domestic partnership, birth or adoption, provided that you submit the required notification and documentation within 31 days of the event (see Changes in Family Status).

For Retirees — If you file the Health Benefits Application for continuation of coverage into retirement with your agency payroll or personnel office prior to retirement (ideally provide 4 to 6 weeks notice), coverage begins on the day of retirement for most retirees. Employees who had previously waived coverage can reenroll upon retirement. The effective date of the reinstatement will be the date of retirement, or the first day of the month following the processing of the health benefits application.

Late Enrollment
An enrollment is considered late if an application is filed more than 31 days after the event that made the employee, retiree, or dependent eligible. In cases of late enrollment, coverage will begin on the first day of the payroll period following the receipt of the application (for retirees, the first day of the month following the processing of a Health Benefits Application) by the agency payroll or personnel office.

Participation in the Medical Spending Conversion (MSC) Program may limit health plan enrollment and/or status changes. If such changes affect your health plan deductions, they must be made within 31 days of the Qualifying Event or they cannot be made at all until the next Transfer Period (see Medical Spending Conversion).

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G.  Optional Riders
All health plans, except DC 37 Med-Team have an Optional Rider consisting of benefits that are not part of the basic plan. You may elect Optional Rider coverage when you enroll and pay for it through payroll or pension deductions. Each rider is a package and you may not select individual benefits from the rider.

Many employees and retirees get additional health benefits through their welfare funds. If your welfare fund is providing benefits similar to some (or all) of the benefits in your plan’s Optional Rider, those specific benefits will be provided only by your welfare fund and will not be available through your health plan rider. Pension and payroll deductions will be adjusted accordingly.

If the Optional Rider consists only of a prescription drug plan, and your union welfare fund provides prescription drug benefits, payroll or pension deductions will not be adjusted automatically to account for union welfare fund benefits if you select the optional rider. You will then pay for drug benefits through the rider and have those benefits from the rider in addition to your welfare fund. Participants in Medicare HMO plans should be aware that prescription drug benefits may be automatically included in their plan benefits.

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H. Deductions for Basic Coverage and Optional Riders
1. From Paychecks — If there is a payroll deduction for your plan’s basic coverage, or if you apply for an Optional Rider, your paycheck should reflect the deduction within two months after submitting a Health Benefits Application.

2. From Pension Checks — It may take considerable time before health plan deductions start from retirees’ pension checks. Retroactive deductions (not to exceed $35 a month in addition to the regular deduction) are then made to pay for coverage during the period from retirement to the time of the first deduction. Although deductions may not be taken for a month or more, your coverage still is in effect. When either you or a dependent becomes eligible for Medicare (by reaching age 65 or through disability), the amount deducted is adjusted after you notify the Health Benefits Program of Medicare coverage (see City Coverage for Medicare-Eligible Retirees, page 14). This adjustment may also take time to be processed.

3. Incorrect Deductions — If the deduction is incorrect, you must report the error within 31 days. Employees must contact their agency health benefits representative and retirees must contact the Health Benefits Program. Corrections will be made as quickly as possible after notification.

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