N.Y. Comp. Codes R. & Regs. tit. 4 § 75.2

Current through Register Vol. 46, No. 51, December 18, 2024

Section 75.2 - Eligibility

(a) Employees.

(1) An employee shall be eligible for coverage under the plan for himself and for his dependents, if any, subject to the provisions of this Part and to the plan.

(2) Coverage for any employee and his dependents shall cease without notice upon termination of his status as an employee as defined in section 75.1 of this Part. The status of any person as an employee shall be deemed to terminate upon his severance from the payroll, except that for the purpose of continuing his coverage under the plan, the status of such person as an employee shall be deemed to continue:

(i) during any period of authorized leave without pay; and

(ii) in the event of the employee's retirement.

(3) In the event both husband and wife are covered under the plan as employees or retirees or both, they both shall be eligible for coverage as dependents.

(i) Cessation of eligibility. Upon the termination of the plan by the State, or by an employee or retiree by reason of default in the payment of premiums or by withdrawal or expulsion or otherwise, the coverage and eligibility for coverage shall cease as of the last day for which the required premiums have been paid to the carrier.

(ii) Disqualification. The president may disqualify from participation in the plan any employee or retired employee who has secured or attempted to secure participation in the plan for himself or another by fraud, deception or a false statement of a material fact. No employee or retiree shall be disqualified or denied benefits pursuant to this subdivision until he is given a written statement by the president of the reasons therefor and afforded an opportunity to make an explanation and submit facts in opposition to such action, such explanation to be submitted to the president by the employee or retiree not later than 10 days following the issuance of the notice by the president required by this subdivision. Such employee may be restored to the plan on approval of the president and subject to such conditions as may be imposed by the president.

N.Y. Comp. Codes R. & Regs. Tit. 4 § 75.2