Eligibility Requirements

Active City employees may enroll for coverage if their:

• Position title is ineligible for collective bargaining and is approved by the Department of Citywide Administrative Services for inclusion in the Fund, and
  
• Position duties are managerial/confidential, and
  
• Regular work schedule is at least 20 hours per week.

Retired City employees may enroll for coverage if they:

• Retired after June 30, 1970 ("Retirement" means cessation of active City employment and eligibility in and current receipt of pension payments from an approved retirement system), and
• Were eligible for coverage (in an eligible title) in the Fund at the time of retirement or at cessation of active employment pending receipt of deferred payment of retirement benefits, and
• Are currently eligible for coverage under the City Health Benefits Program or New York State Health Insurance Program.

Active City Employees
Active City Employees must submit a completed Application for Membership (Form 1060) to their agency personnel office within 31 days of their appointment. Prompt submission of this application form is required.

Retiring Employees
The Employer Agency will submit notification to the Fund on behalf of Retiring Employees within 31 days of the employee's retirement by completing Form 1061.

Deferred Retirees
Deferred Retirees must submit a completed Membership Application for Reinstatement, Form 1063, to the Fund office after deferred retirement, within 31 days of becoming pension payable. At which point the Deferred Retirees will be reinstated for retiree fund benefits.

Adding and Removing Dependents
When requesting the addition or deletion of dependents, members must complete a Form 1060 (Application for Membership) and submit necessary documentation within 31 days of the change in dependent status.

When Coverage Begins

Coverage start date varies depending on the member's status:

Active City Employees: On the date of appointment to an approved title or on the date the employee's title is approved for inclusion in the Fund.

Retired City Employees: On the effective date of retirement (the first day of the period covered by the initial pension check).

Deferred Retirees: On the day the deferred retiree becomes pension payable.

Eligible Dependents
Fund Member's Spouse: Covered unless legally separated from the member. An eligible spouse is covered on the same day the member's coverage begins. If you are married after you become a Fund member, your spouse's coverage commences on the date of your marriage provided the Fund receives the necessary documentation within 31 days of your marriage.

Fund Member's Domestic Partner: Covered if approved as an eligible domestic partner under the City of New York's Employee Health Benefits Program or New York State Health Insurance Program (either plan referred to as the Basic plan). A qualified domestic partner is eligible for Fund Superimposed Major Medical, Dental, Vision Care, and Survivor's benefits as described in those sections of the Fund Booklet.

A qualified domestic partner becomes eligible on the date he or she is approved by the Basic plan, provided that notification has been sent to the Fund within 31 days of the date the member receives Basic plan approval of domestic partner coverage. If the Fund receives a late request with documentation for the addition of a domestic partner, the effective date of coverage, if approved, is the date the Fund membership application form is signed by the member.

A domestic partner is defined as a person of the same or opposite sex who:

In addition, the member and the domestic partner will be considered to have met the terms of this definition as long as neither the member nor the domestic partner: 

• Has signed a domestic partner affidavit or declaration with any other person within six months prior to designating each other as domestic partners hereunder;
• Is currently legally married to another person; or
• Has any other domestic partner, spouse, or spouse equivalent of the same or opposite sex.

The member and the domestic partner must have registered as domestic partners, if they reside in a state that provides for such registration.

Fund Member's dependent children (natural or adopted) to age 26 (effective January 1, 2011): Dependent children include natural or adopted children, and children for whom you are the legal guardian.  Please note there are no financial dependency, residency students status or marital status requirement for dependents.  Dependent children are covered on the same day the member's coverage begins. However, a dependent child who is not the member's natural child is covered at the earliest of the following dates:

From and after the moment the child is placed in the physical custody of the member when a court of law accepts a consent to adopt and the member enters into an agreement to support the child. However, coverage for the child's initial hospital stay is not provided if the natural parent has insurance coverage available for the child's care.

When A court of law makes the member legally responsible for the support and maintenance of the child.

Unmarried Disabled Dependent Children: If the member's child is unable to support himself/herself due to mental illness, developmental disability, mental retardation, or physical handicap when insurance would end due to the child's age, insurance may be continued. This continuation applies only to children continuously covered by the Fund prior to attainment of age 26.

The Fund office should be contacted to obtain the appropriate continuation of coverage form for completion by the member and physician at least 31 days before the date the child's insurance would normally end. The determination of approval or denial of coverage continuation for disabled dependents is made by the Fund's Superimposed Major Medical Plan Administrator.

Unmarried dependent children age 26 through age 29: Dependent coverage terminates at attainment of age 26.  Coverage may be extended through age 29 under the Direct Pay Coverage Continuation (DPCC) for eligible dependent children of MBF members through age 29 (Young Adult Dependent) for the continuation of (1) Superimposed Major Medical Plan (SMMP), and Dental & Vision Care Programs, (2) Dental & Vision Care Programs only, or (3) SMMP only.  MBF will charge a monthly premium based on the type of coverage that the Young Adult Dependent elects. 

To be eligible for MBF DPCC, the Young Adult Dependent does not have to live with an MBF Member, be financially dependent on an MBF Member, or be a student. However, the Young Adult Dependent must meet the following requirements:

• Be unmarried
• Be 29 years or younger
• Not be covered by Medicare
• Live, work or reside in New York State, or the health insurance, dental or vision care program service area

You must be an active MBF member in order for your Young Adult Dependent to be eligible for DPCC.

If you would like to enroll your Young Adult Dependent to receive DPCC, you must complete a DPCC Enrollment Form within 60 days following the date coverage would otherwise terminate due to age or within 60 days after meeting the definition of dependent child.

Dependents Who Are City Employees
If any dependent is eligible for Fund benefits as an employee or retiree, that person is not eligible for coverage as a dependent. If both the member and his or her spouse are covered for Fund benefits as employees or retirees, their children may only be enrolled as dependents of either member.

Changes in Dependent Status
The Fund must be notified if a member acquires a dependent through marriage, domestic partnership, birth or adoption, or loses a dependent due to death, divorce, legal separation, or termination of domestic partnership.

Active employees should submit written notice of such changes to their personnel office along with the required documentation. Retirees should write to the Management Benefits Fund Office regarding any changes in dependent status and include the necessary documentation.

When Coverage Terminates

Active employee or retiree coverage ends for a member when any of the following events occur:

• The member goes off pay status and is not eligible for, or does not apply for, coverage as a deferred retiree.
• The member is appointed to a title that is eligible for collective bargaining.
• The member's title is made eligible for collective bargaining (active employees only).
• The Group Policy ceases.

Dependent coverage ends for dependents when any of the following events occur:

• The member's coverage ends as defined above.
• The member dies (see the "Survivor Benefits" section).
• A dependent no longer qualifies as an eligible dependent.

Where applicable, special provisions for extension of benefits or conversion to private coverage are specified in the individual benefit sections of the Fund Booklet. 

Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985, called COBRA, a Management Benefits Fund member and his/her spouse or domestic partner and dependent children have the right to continue Fund benefits in certain instances where the coverage would otherwise terminate.

Fund members are eligible for coverage under COBRA if their benefits terminate due to a reduction in hours of employment, termination of employment for reasons other than gross misconduct.

On termination of Fund membership, members have the option to continue medical coverage under COBRA.