City health plan FAQ for new members

Learn more about city health benefits for new members who are DOE employees by reading our FAQ below.

Plan options for new members

Am I required to choose a specific city health plan?

If you were hired by the DOE on or after Oct. 1, 2022, you and your dependents will only be eligible to enroll in the EmblemHealth HIP HMO Preferred Plan, and must remain in that plan for the first 365 days of your employment.

Can I choose a different city health plan after 365 days?

Yes. As you move into the last 30 days of the 365-day period, you will have the ability to select a different city health plan. Your new plan will become effective for you and any eligible dependents on your 366th day of employment.

Can I request an exemption from the required HIP-HMO enrollment?

You can request an exemption if you meet either of the below requirements:

You live outside of the HIP-HMO service area and are unable to access primary care with an HMO provider. The service areas for HIP-HMO include: all of New York City, Nassau, Suffolk, Rockland and Westchester counties, New Jersey and Connecticut.
You or your eligible dependent/s are being treated by a non-network provider for a life-threatening or disabling condition, receiving ongoing treatment for a catastrophic or terminal illness, or have a condition that requires complex case management.

You must submit an opt-out request form and will be notified of the decision 7-10 business days later.

If I was not eligible for health benefits at my date of hire, will I have to wait longer than 365 days to change plans?

No. The 365-day count always begins on your "initial effective date," which is the day you first became an employee of the DOE, whether you were eligible for benefits on that date or not.

Does this requirement apply to employees who are returning as rehires to the DOE, or who have transferred to the DOE from another city agency?

No. As long as the rehired employee or transfer employee has an initial effective date prior to Oct. 1, 2022. Rehires or transfer employees hired after Oct. 1, 2022 will be exempt only if 365 days have passed since their date of hire, either with the DOE or another city agency.

Rehires or transfer employees who are still within 365 days of their initial effective hire date will be subject to this requirement.

If I wish to remain in the HIP-HMO plan after 365 days of my employment, do I need to take any action?

No, you will remain as a member of HIP-HMO if you do not choose another plan after 365 days.

Can I transfer out of HIP-HMO during the city's annual health benefits transfer period?

Only if you have been employed longer than 365 days. After that first year, you can make changes during that annual period (usually the month of November), which would then take effect the following January.

Enrollment

Is enrollment in HIP-HMO automatic?

No. To enroll, you must obtain and file a Health Benefits Application at your payroll or personnel office or enroll online via the city portal, NYCAPS ESS. See instructions on how to enroll using ESS. Your enrollments must be filed within 30 days of your appointment date, or the start of your coverage may be delayed.

Do I have other options instead of enrolling in HIP-HMO?

If you already receive health benefits from a non-city group health plan (such as through a spouse or domestic partner), you may elect to use the health benefits buyout waiver, or you may also waive your health benefits if you are already an eligible dependent through another city health plan.

When will my benefits become effective?

Effective dates depend upon two criteria:

Your title: Appointed teachers, specified school-based personnel, and all permanently appointed DOE employees are covered retroactively to their first date of employment. Provisional and temporary employees, who have no experience or education requirements, are entitled to coverage that begins on the first day of the pay period following 90 days of continuous DOE employment.
When your application was submitted: If you submitted your application within 31 days of your hire date, your benefits will start on the effective date appropriate to your title (as listed above). If more than 31 days have passed, your benefits will begin on the first day of the payroll period following the submission of your application (not the first day of eligibility).

Do I need to enroll in benefits every year?

No. Once you are enrolled in a plan and your benefits are active, your coverage will remain in effect continuously for you and any dependents covered under your policy.

Which family members can be added as dependents to my health plan?

You may add your:

spouse or registered domestic partner
children under the age of 26, which may be biological, adopted, a foster child or the child of a covered spouse or registered domestic partner
disabled adult children over the age of 26 who are unable to work

Documentation is required to determine eligibility and may vary both by dependent type and the length of your relationship. See a list of required documents necessary to verify the dependents you wish to add to your city health plan.

How do I submit supporting documents for my eligible dependents?

First, submit your NYCAPS ESS application. You must do so before submitting documents. To submit supporting documents to the DOE, use your DOE email address and email the documents to: HRconnectBenefax@schools.nyc.gov.

If I get married or have a child in the future, how will I add new dependents to my existing health care plan?

Once your benefits are active, you can add eligible dependents to your health plan when your dependent experiences a "qualifying life event." You must add the dependent within 31 days of that qualifying life event to ensure coverage will be retroactive to the date of the event.

What is considered to be a qualifying life event?

Life events which would allow a dependent to be added to your health benefits include marriage or domestic partnership, birth or adoption of a child, or a court order requiring a member to provide health insurance coverage.