A. When Coverage Terminates
If both husband and wife, or domestic partner, are eligible for City health coverage as either an employee or a retiree, and one is enrolled as the dependent of the other, the person enrolled as dependent may pick up coverage in his/her own name within 31 days if the participant leaves City employment or dies.
- for an employee or retiree and covered dependents, when the employee or retiree stops receiving a paycheck or pension check (with an exception for people eligible for SLOAC or FMLA).
- for a spouse, when divorced from an employee or retiree.
- for a domestic partner, when partnership terminates.
- for a child, upon marriage or reaching an ineligible age, except for unmarried dependent full-time students who are covered on all plans up to age 23. See Enrollment Eligibility for special provisions for disabled children who reach age 19 or 23.)
- for all dependents, unless otherwise eligible, when the City employee or retiree dies.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that the plan administrator issue certificates or group health plan coverage to employees upon termination of employment that results in the termination of group health coverage. Each individual, upon termination, will receive a certificate of credible coverage from the plan administrator. This certificate provides the necessary information to certify coverage that will be credited against any pre-existing condition exclusion period provided under a new health plan.
B. Reinstatement of Coverage
If you have been on approved leave without pay, or have been removed from active pay status for any other reason, your health coverage may have been interrupted. Contact your agency benefits representative within 31 days of your return to duty in order to complete a new Health Benefits Application. If you are returning from an approved leave of absence or your coverage has been terminated for less than 90 days, coverage resumes on the date you return to duty. If you were not on an approved leave of absence or if your coverage has been terminated for more than 90 days, see effective date of coverage rules
If you have waived or cancelled your City health plan coverage and subsequently wish to enroll or reinstate your benefits, your coverage will not start until the beginning of the first payroll period 90 days following the date you submit your Health Benefit Application unless the enrollment or reinstatement is the result of a loss of other group coverage.