NYSHIP Eligibility
This section provides answers for both active enrollees and retirees.
Download a NYSHIP Change of Address Form (PS-850), or change your address online using MyNYSHIP.
For active employees: Submit the completed form to your health benefits administrator (HBA) or agency contact.
For retirees: Submit the completed form to the Employee Benefits Division (EBD). You can also call EBD at 518-457-5754 or 1-800-833-4344 (U.S., Canada, Puerto Rico, Virgin Islands). Representatives are available Monday through Friday between 9 a.m. and 4 p.m., Eastern time.
NYSHIP offers several health plan options to choose from.
For active employees of NYS: You can switch plans during the annual Open Enrollment period, if you lose other employer-sponsored health coverage, or when you experience a qualifying life event.
For retirees: You can change once during a 12-month period.
If you are enrolled through a Participating Agency (PA) or Participating Employer (PE) as either an active employee or a retiree, contact them for more information.
HBA stands for health benefits administrator. They handle your enrollment record and give you important information about your employer’s rules. This includes what you need to know for NYSHIP eligibility and enrollment.
For active employees: Your HBA can be found in your personnel office, or the New York State Business Services Center (BSC).
For retirees: The Employee Benefits Division (EBD) serves as your HBA. You can EBD at 518-457-5754 or 1-800-833-4344 (U.S., Canada, Puerto Rico, Virgin Islands). Representatives are available Monday through Friday between 9 a.m. and 4 p.m., Eastern time.
If you are enrolled through a Participating Agency (PA) or Participating Employer (PE) as either an active employee or a retiree, contact them for HBA information.
NYSHIP Benefits and Coverage
This section provides answers for both active enrollees and retirees.
The Empire Plan provides worldwide coverage, including when you travel or live outside the United States. You can receive care anywhere but there are key differences in how the coverage works abroad.
For details about reimbursement, billing, preauthorization, emergency vs non-emergency, how to file claims and the BCBS Global Core network, see The Empire Plan Worldwide and Empire Plan Certificate.
NYSHIP HMOs are limited to their service areas. Please contact your HMO for more information.
The Empire Plan does not offer a gym reimbursement program.
Some NYSHIP HMO plans available for NYS and PE employees may offer gym memberships as part of their NYSHIP Medicare Advantage Plan.
The Empire Plan Mental Health and Substance Use (MHSU) Program covers outpatient therapy, psychiatric care, medication management, inpatient and substance use/addiction treatment, emergency services and other medically necessary specialized therapies.
Learn more by calling The Empire Plan at 1-877-769-7447 (select MHSU) or review the Reporting On Mental Health and Substance Use Program publication.
If you are enrolled in a NYSHIP HMO, contact your HMO directly for more information.
If you are enrolled in The Empire Plan, you can view the Formulary Drug List and additional information on the Prescription Drug Information page.
If you are enrolled in a NYSHIP HMO, contact your HMO directly.
Pre-Retirement and Retirement
The New York State Department of Civil Service does not administer retiree pensions. If you are looking for information about your pension, please contact the New York State & Local Retirement System (NYSLRS) or Teachers Retirement System (TRS).
In general, NYSHIP does not offer a retiree Dental or Vision plan. You may be eligible to enroll in a direct-pay plan for dental coverage through Anthem. Contact Anthem for more information at 1-800-947-0101. There is no direct-pay conversion plan available for vision benefits from Davis Vision.
If you are a recent retiree of NYS, you may be within the 60-day timeframe during which you are eligible to apply for an extension of your active dental and vision coverage through COBRA. You may also contact your former employer union for information on possible dental or vision benefits for retirees offered by the union.
If you are a retiree of a NYSHIP Participating Agency or Participating Employer, please contact your former employer directly for information regarding retiree dental and vision coverage and/or COBRA.
Eligible dependents who are covered when the enrollee dies will keep the same coverage. They will not have to pay for three months after the month of the enrollee's death. This is called the extended benefits period.
After the extended benefits period, your dependents can choose to stay in NYSHIP with Dependent Survivor coverage if they qualify.
Medicare
You will receive a 65th birthday letter several months before you turn 65. This letter informs you of important deadlines and requirements. The most important step you need to take is to enroll in Medicare Part A and Part B three months before your 65th birthday.
Enclosed with the letter is the Medicare and NYSHIP publication which provides more detailed information on the steps you need to take.
Your NYSHIP coverage isn’t affected until you are Medicare-primary as long as you remain enrolled in NYSHIP. However, you must be enrolled in Medicare Part A and Part B three months before your 65th birthday to keep your NYSHIP coverage. If you fail to do so, you will lose your coverage.