Coverage terminates:

• for an employee or retiree and covered dependents, the day after the employee’s last day of employment with the City or Participating Employer or when a retiree stops receiving a pension check (with the exception of employees on FMLA or SLOAC).
• for an employee and covered dependents, the day after the employee no longer meets the eligibility criteria for participation in the City Health Benefits Program.
• for a spouse, when divorced from an employee or retiree.
• for a domestic partner, when partnership terminates.
• for dependent children (other than eligible disabled children) at the end of the month in which the child reaches age 26.
• for all dependents, unless otherwise eligible, when the City employee or retiree dies.

If your spouse, or your domestic partner, is eligible for City health coverage as either an employee or a retiree, and is enrolled as your dependent, the person enrolled as dependent may pick up coverage in his/her own name within 30 days if the employee’s City coverage terminates.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that the plan administrator issue certificates of 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 coverage from the plan administrator.

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 health benefits or payroll office or NYCAPS Central at (212) 487-0500 (Department of Education employees should contact HR Connect at (718) 935-4000) within 31 days of your return to work.

• 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 work.
• If you were not on an approved leave of absence or if your coverage has been terminated for more than 90 days, your coverage may not become effective until the pay period following the submission of your Health Benefits Application.

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 Benefits Application unless the enrollment or reinstatement is the result of a loss of other group coverage. For an application, contact your agency health benefits or payroll office or NYCAPS Central at (212) 487-0500 (Department of Education employees should contact HR Connect at (718) 935-4000).

Conversion Option

Employees and covered dependents may purchase individual health coverage through their health plan if their City group coverage ceases for any of the following reasons:

• an employee leaves City employment;
• an employee loses City coverage due to a reduction in the work schedule;
• an employee or retiree dies;
• a dependent spouse is divorced from the employee or retiree;
• a domestic partnership terminates;
• dependent children exceed the age limits established under the group contract;
• coverage under the provisions of COBRA expires.

Unlike COBRA, benefits under this type of policy do not automatically terminate after a limited time, and may vary from the City’s “basic” benefits package in both the scope of benefits and in cost.