Who is Eligible For NYSHIP?

If you or a loved one is experiencing orthopedic issues and needs help, you might be concerned if your New York State Health Insurance Program (NYSHIP) insurance will cover the visit to an orthopedic specialist, any tests or imaging scans needed, and treatments. If you or a loved one are experiencing neck, back, shoulder, hip, knee, or ankle issues that are causing pain or a disability, you may be concerned about the heavy financial burden you may incur due to treatment.
When you learn everything you need to know about NYSHIP coverage, you’ll have peace of mind when visiting one of our orthopedic specialists at NJ Spine & Orthopedic. Our skilled staff and compassionate Concierge Team can help you through every step of the treatment process, including figuring out insurance or NYSHIP concerns.

The Dependability of NYSHIP

The New York State Health Insurance Program (NYSHIP), later called the Empire Plan, was established in 1957 for state employees. A year later, the plan became available to local governments and school districts and is one of the most extensive public employer health insurance programs in the United States. The plan has all-inclusive service coverage that also includes orthopedic services. Some orthopedic services that are covered include:

  • Chiropractic and physical therapy
  • Home care services, medical equipment, and medical supplies
  • Prostheses and orthotic devices
  • Minimally-invasive surgery

If you or your dependents are suffering from orthopedic pain and disabilities, you can depend on NYSHIP to help take some of the financial burden out of the equation. NYSHIP coverage will allow you to focus on recovery without added stress. 

Are Spouses and Domestic Partners Covered?

Your spouse can be eligible for coverage under the NYSHIP plan on the day of the wedding when you submit a completed application within 30 days of the marriage. Employees are encouraged to contact their HR department before the wedding to avoid a waiting period. You can add a spouse after the 30-day period, but you will have to provide additional documentation, such as:

  • A joint account bank statement
  • A mortgage statement
  • Homeowners insurance documentation
  • A joint tax return from the previous year.

Your domestic partner is also eligible for coverage. NYSHIP defines a domestic partnership as a lifetime relationship with both parties being 18 years old or older who are living together. Both parties should be unmarried and financially interdependent to be domestic partners. 

Documentation needed for proof is listed on the PS-425 form. Some of the necessary documentation to prove joint responsibility for basic financial obligations is the same as proof of marriage, but other documents can be submitted as proof also, including:

  • Joint ownership or lease of a car
  • Health care power of attorney
  • A joint obligation of a loan
  • Designation of the domestic partner as executor or primary beneficiary in a will

You’ll also have to submit documentation proving cohabitation. These could include bank statements, utility bills, or joint membership statements mailed to the residential address. Driver’s licenses showing the residential address or proof of domestic partnership registration in a New York state municipality will also work.

Coverage For Your Children

Your children are covered until the end of their birth month when they turn the age of 26. Military service can extend this coverage when the individual returns from service or if they enroll as a full-time student. In addition, the state legislature offers extended coverage to adult, unmarried children up to age 30. They can purchase their own medical coverage through the Young Adult Option during the open enrollment period.

Children considered dependents and eligible to be on the NYSHIP plan are your natural children, stepchildren, and legally adopted children. Even children of domestic partners and children waiting before the adoption is finalized are eligible for coverage under the NYSHIP plan.

Consult With NJ Spine & Orthopedic About Using NYSHIP for Orthopedic Treatment

Knowing that NYSHIP will allow you or your loved ones to receive the care they need from the NJ Spine & Orthopedic doctors without a heavy financial burden should give you peace of mind. With NYSHIP, you or your dependents can get the exams, imaging scans, and treatments to get on the road to recovery.

NJ Spine & Orthopedic specialists specialize in debilitating orthopedic pain and disabilities. If you are experiencing orthopedic issues that are causing pain or movement problems, call NJ Spine & Orthopedic at (866) 553-0612 or complete our contact form to get on the path to recovery.

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