MetroPlus Gold Family Coverage

SPOUSE AND DEPENDENTS
MetroPlus Gold health benefits are available to employees of NYC Health and Hospitals Corporation (HHC), non-Medicare eligible HHC retirees, their spouse or qualified domestic partner and any eligible unmarried dependent children. You will find the definitions of qualified domestic partner and dependent children in the NYC Health Benefits Summary Program Description.

CHILDREN
If you are an employee enrolled in MetroPlus Gold, your children up to age 26 are eligible for MetroPlus Gold except for a child eligible for employee sponsored coverage. The following are considered children:
• Natural children
• Legally adopted children
• Children whom the employee proposes to adopt and who are dependent upon the employee during the waiting period prior to adoption
• Newly born infants adopted by the employee if:

- The employee takes physical custody of the infant upon the infant's release from the Hospital and the employee files a petition pursuant to New York State Domestic Relations Law, Section 115 c, within thirty (30) days of birth, and - Provided that no notice of revocation to the adoption has been filed pursuant to New York State Domestic Relations Law, Section 115 b, and - Consent to the adoption has not been revoked. Please note: MetroPlus will not cover the infant's initial Hospital stay when a natural parent has insurance coverage available for the infant's care.

• Children for whom the employee is the court appointed legal guardian and who are chiefly dependent upon the employee for support and maintenance
• Stepchildren who are dependent upon the employee for support and maintenance
• Natural children of the employee's covered Dependent ("grandchildren") if his/her grandchild is dependent upon the Employee for support and maintenance; the employee's grandchild may remain covered only while his/her parent is covered as a Dependent
• Children of domestic partners as long as the domestic partner is covered as a Dependent
• Unmarried children age 26 and older who cannot support themselves because of a disability, including mental illness, developmental disability, mental retardation or physical handicap are eligible for coverage if the disability occurred before the age at which the dependent coverage would otherwise terminate

The employee must add their newborn or newly eligible dependent to their coverage within 31 days of birth of becoming eligible. To do this, contact your Benefits Manager where you work or call MetroPlus Gold Customer Services at 877-475-3795, Monday - Saturday, 8 am - 8 pm.

YOUNG ADULT OPTION
Unmarried children, who exceed the age limit for coverage as a dependent, may be eligible to purchase a separate policy which continues coverage under the parent's health plan. To be eligible for this policy, the child must be 29 years of age or younger, unmarried, not eligible for health insurance coverage through his/her own employer, live , work or reside in the plan's service area, and not be covered by Medicare. Click here for enrollment information and rates.

For current information on Eligibility, Enrollment Processes or Effective Dates of Coverage, please refer to the MetroPlus Gold Certificate of Coverage.