Young adults through age 29 whose parent(s) are enrolled in a group health insurance policy can receive coverage under a “Young Adult Option.” Only health insurance coverage is available; dental and vision is not included. Under the law, the coverage is subject to all terms of the SWSCHP plan; however, premiums are to be paid by the young adult or his/her parent, not the employer. The cost is the full cost of individual coverage for the SWSCHP plan (the sponsoring plan member should check with a district benefit rep for current cost).

Eligibility Criteria

1. Be a child, adopted child, or stepchild of a SWSCHP enrollee (including those enrolled under COBRA).

2. Be age 29 or younger.

3. Be unmarried.

4. Not be insured by or eligible for coverage through the young adult’s own employer-sponsored health plan, whether insured or self-funded, provided that the health plan includes both hospital and medical benefits.

5. Live, work or reside in NYS or the Plan’s service area.

6. Not be covered under Medicare.

The young adult does not need to live with the parent, be financially dependent upon the parent, or be a student. A young adult’s eligibility for health insurance coverage through a former employer under federal COBRA or State continuation coverage does not disqualify the young adult from electing this option under SWSCHP. Children of the young adult are not eligible for coverage under this option, but may be eligible for health insurance coverage under other programs, such as the Child Health Plus Program. The young adult’s parent does not need to have family coverage, nor is the young adult required to have been previously covered as a dependent under SWSCHP to be eligible to enroll.

When Young Adult Children Can Enroll

1. Within 60 days of the date that his or her coverage would otherwise end due to reaching the maximum age for Dependent coverage, in which case coverage will be retroactive to the date that coverage would otherwise have terminated;

2. Within 60 days of newly meeting the eligibility requirements, in which case coverage will be prospective and start within 30 days of when the Plan receives notice of election and premium payment; or

3. During an annual 30-day open enrollment period, in which case coverage will be prospective and will start within 30 days of when the Plan receives notice of election and premium payment.

A spouse or child of a Dependent child is not eligible for coverage under the Plan. Foster children are not eligible for coverage under the Plan.

How to Enroll

Contact your school district’s Health Benefit Representative for enrollment instructions, the required application, and any questions you may have. Applicants must include the first month’s premium with the application to ensure the earliest possible effective date of coverage, as described above.

Termination of Coverage

Eligibility for SWSCHP enrollment under the Young Adult Option ends when one of the following occurs:

1. The young adult voluntarily terminates coverage.

2. The parent is no longer enrolled in SWSCHP.

3. The young adult no longer meets all of the eligibility requirements (e.g., age)

4. The SWSCHP premium for the young adult’s coverage is not paid in full within the 30-day grace period, following the premium due date.

Termination of coverage is NOT considered a ‘qualifying event’ for the purpose of qualifying for federal COBRA or State continuation of coverage programs.