N.Y. Comp. Codes R. & Regs. tit. 4 § 73.1

Current through Register Vol. 46, No. 45, November 2, 2024

Section 73.1 - Definitions

(a) The term plan or health insurance plan means the group hospitalization, surgical and medical insurance provided under the various contracts entered into pursuant to article XI of the Civil Service Law, and any amendments thereto, including all the benefits provided thereunder, and all conditions and limitations applicable thereto pursuant to such contracts or as prescribed by the President of the Civil Service Commission.

(b) The term employer or an employer shall include the State of New York (in all its departments and agencies and those departments and agencies of the State maintained and financed from special or administrative funds) and any participating employer. The term participating employer shall mean any public authority, public benefit corporation, school district, district corporation, municipal corporation or other public agency, subdivision or quasi-public organization which elects, with the approval of the President of the Civil Service Commission, to include its employees and/or retired employees in the plan.

(c) The term employee means any person in the service of an employer, except:

(1) any person whose regular work schedule is less than 20 hours a week, other than:

(i) a person paid on an annual salary basis whose salary rate is $2,000 per year or more; provided, however, that for purposes of this definition a participating employer may establish a minimum in excess of 20 hours per week and/or a salary basis higher than $2,000 per year for purposes of determining eligibility under the plan;

(ii) a paid elective official of the State or paid member of a public legislative body or other local elective official, including a publicly elected member of a school board; provided, however, that the determination of eligibility under the plan for such official or member and employer contributions, if any, shall be permissive for any participating employer, except that any unpaid local elective official who occupies a position which by statute, local law, ordinance or resolution is expressly prohibited from receiving compensation or school board member electing to participate by reason of such membership shall be required to pay both the employer and the employee contribution for any coverage elected under the plan;

(iii) a person whose major source of income is from his employment with the employer; or

(iv) an unpaid board member of a public authority, provided he or she has six months or more of service in such position;

(2) any person appointed or elected for a term of less than six payroll periods, or, in the case of a person paid other than biweekly, for less than three months; provided, however, that for the purposes of this definition a participating employer may require a higher anticipated employment requirement, not to exceed six months for seasonal and/or temporary, or all employees;

(3) any person whose employment is scheduled for termination, other than by retirement, within three months after the effective date of the extension of the plan to employees of a participating employer;

(4) any person who is employed by a public educational institution on other than full-time basis and who is a student therein enrolled for a degree; or

(5) any person who retired prior to the effective date of the plan or of the extension of the plan to employees of his participating employer and who is subsequently reemployed on a temporary, seasonal or occasional basis.

(d) The term prior retiree means a person who has withdrawn from the active service of the employer prior to the effective date of the extension of the plan to employees of such employer and (1) was an employee of the employer as defined in subdivision (c) of this section for a total of not less than five years and (2) is receiving a retirement allowance or pension from any retirement or pension plan or system administered and operated by the State of New York, or a civil division thereof, including the New York State Teachers' Retirement System, but this last condition shall not serve to exclude from this definition any retired person whose retirement allowance is suspended by virtue of further government employment described in paragraph (5) of subdivision (c) of this section.

(e) The term post retiree shall mean a person who has become enrolled in the plan as an employee and whose coverage is being continued after his withdrawal from the active service of the employer under the eligibility privileges of the plan and who either:

(1) has retired as a member of a retirement or pension plan or system administered and operated by the State of New York, or a civil division thereof, including the New York State Teachers' Retirement System;

(2) was not a member of a retirement or pension plan or system referred to in paragraph (1) of this subdivision, and is withdrawn or does withdraw from the active service of an employer after attaining such age as would have been required to retire as a member of the New York State and Local Employees' Retirement System;

(3) was an unpaid elective official, and is withdrawn or does withdraw from active service after attaining such age as would have been required to retire as a member of the New York State and Local Employees' Retirement System;

(4) was a publicly elected member of a school board with 20 years or more of service in such position with such participating employer that elects to permit enrollment for such members; or

(5) was an unpaid board member of a public authority with 20 years or more of service in such position.

(f) The term retired employee shall include prior retiree and post retiree.

(g) The term vested employee means a person who (1) while enrolled in the plan as an employee discontinues from the service of an employer, other than by death or retirement, on or after October 1, 1966, (2) is and remains entitled to receive at a future time a retirement allowance or pension from a retirement or pension plan or system administered and operated by the State of New York or a civil division thereof, including the New York State Teachers' Retirement System, the State University Optional Retirement Program established under article 8-B of the Education Law and the Education Department Optional Retirement Program established under article 3, part V, of the Education Law in which latter two cases such person must have had at least 10 years of State service, and (3) at the time of such discontinuance of service meets all conditions, including length of service with the employer and length of coverage under the plan, necessary under these regulations for the continuance of coverage after retirement, and (4) in the case of an employee who discontinues from the service of a participating employer, the participating employer may establish an additional requirement that the employee's discontinuance be within five years of their entitlement to receive such retirement allowance or pension. Such person shall remain a vested employee until his entitlement to such future retirement allowance or pension is terminated or until he commences to receive such retirement allowance or pension, in which latter case he shall become a post retiree.

(h) The term dependent shall include the spouse of an employee or retired employee. It shall also include such person's unmarried child under 19 years of age, any unmarried child 19 years of age or older who is incapable of self-support by reason of mental or physical disability and who became so incapable before reaching the age at which dependent coverage would otherwise terminate, and any student dependent as hereinafter defined. The term child shall be deemed to include any natural born child, any legally adopted child and any stepchild dependent upon the employee or retired employee, any child dependent upon the employee or retired employee during any waiting period prior to the finalization of the child's adoption by the employee or retired employee, and any child chiefly dependent on the employee or retired employee and permanently residing in the household of the employee or retired employee. Dependent shall not include, however:

(1) any person who is covered as an employee or retired employee or as a dependent of another employee or retired employee under the health insurance plan;

(2) any person who is in the armed forces of any country;

(3) any person for whom evidence of acceptability for coverage furnished in accordance with the provisions of the health insurance plan is not accepted as satisfactory.

(i) The term student dependent means an employee's or retired employee's unmarried child 19 years of age or older but not yet 25 years of age; provided, however, that the time spent on military duty as defined in paragraph (b) of subdivision 1 of section 243 of the Military Law, not to exceed four years, shall be subtracted from the age of such child for purposes of determining the maximum age for eligibility as a student dependent who:

(1) receives more than half of his support from the employee or retired employee and is a full-time student at an accredited secondary or preparatory school or college; and

(2) is not otherwise eligible for employer group coverage.

N.Y. Comp. Codes R. & Regs. Tit. 4 § 73.1