When Coverage Begins

Active City Employees: On the date of appointment to an approved title or on the date the employee's title is approved for inclusion in the Fund.

Retired City Employees: On the effective date of retirement (the first day of the period covered by the initial pension check).

Deferred Retirees: On the day the deferred retiree becomes pension payable.

Eligible Dependents
Fund Member's Spouse: Covered unless legally separated from the member. An eligible spouse is covered on the same day the member's coverage begins. If you are married after you become a Fund member, your spouse's coverage commences on the date of your marriage provided the Fund receives the necessary documentation within 31 days of your marriage.

Fund Member's Domestic Partner: Covered if approved as an eligible domestic partner under the City of New York's Employee Health Benefits Program or New York State Health Insurance Program (either plan referred to as the Basic plan). A qualified domestic partner is eligible for Fund Superimposed Major Medical, Dental, Vision Care, and Survivor's benefits as described in those sections of the Fund Booklet.

A qualified domestic partner becomes eligible on the date he or she is approved by the Basic plan, provided that notification has been sent to the Fund within 31 days of the date the member receives Basic plan approval of domestic partner coverage. If the Fund receives a late request with documentation for the addition of a domestic partner, the effective date of coverage, if approved, is the date the Fund membership application form is signed by the member.

A domestic partner is defined as a person of the same or opposite sex who:

• Shares the member's permanent residence;
• Has resided with the member for no less than one year;
• Is no less than 18 years of age;
• Is financially interdependent with the member and has proven such interdependence by providing documentation of at least two of the following arrangements:
  • Common ownership of real property or a common leasehold interest in such property;
  • Community ownership of a motor vehicle;
  • A joint bank account or a joint credit account;
  • Designation as a beneficiary for life insurance or retirement benefits or under the partner's will;
  • Assignment of a durable power of attorney or health care power of attorney;
  • Or such other proof as is considered by the Fund to be sufficient to establish financial interdependency under the circumstances of the member's particular case;
• Is not a blood relative any closer than would prohibit legal marriage; and
• Has signed jointly with the member, a notarized affidavit that can be made available to the Fund upon request.

In addition, the member and the domestic partner will be considered to have met the terms of this definition as long as neither the member nor the domestic partner:

• Has signed a domestic partner affidavit or declaration with any other person within six months prior to designating each other as domestic partners hereunder;
• Is currently legally married to another person; or
• Has any other domestic partner, spouse, or spouse equivalent of the same or opposite sex.

The member and the domestic partner must have registered as domestic partners, if they reside in a state that provides for such registration.

Fund Member's unmarried dependent children (natural or adopted) under age 19: Covered on the same day the member's coverage begins. However, a dependent child who is not the member's natural child is covered at the earliest of the following dates:

• The date the child starts living with the member in a regular parent-child relationship and is primarily supported by the member.
• From and after the moment the child is placed in the physical custody of the member when a court of law accepts a consent to adopt and the member enters into an agreement to support the child. However, coverage for the child's initial hospital stay is not provided if the natural parent has insurance coverage available for the child's care.
• A court of law makes the member legally responsible for the support and maintenance of the child.

Fund Member's unmarried dependent children age 19 and over: Dependent child coverage terminates at attainment of age 19. Coverage may be extended, as noted in (1) and (2) below, if the requirements specified are met.

(1) Full-Time Students, to age 23: Covered up to their 23rd birthday for Superimposed Major Medical, Dental, and Vision Care benefits if the following criteria are met:

• The student must be enrolled in an educational institution (college, university, trade, or secondary school) licensed and accredited in the state in which it is situated; and
• The institution must grant a degree or diploma; and
• The student must be in attendance full-time as determined by the educational institution; and
• The member must supply at least 50% of the student's support and the student must be covered by the member's Basic City health plan.

To ensure coverage of unmarried full-time students between the ages of 19 and 23, the member must complete a Dependent Student Certification Form every semester.
Download the Student Certification Form (PDF)

(2) Unmarried Disabled Dependent Children: If the member's child is unable to support himself/herself due to mental illness, developmental disability, mental retardation, or physical handicap when insurance would end due to the child's age, insurance may be continued. This continuation applies only to children continuously covered by the Fund prior to attainment of age 19.

The Fund office should be contacted to obtain the appropriate continuation of coverage form for completion by the member and physician at least 31 days before the date the child's insurance would normally end. The determination of approval or denial of coverage continuation for disabled dependents is made by the Fund's Superimposed Major Medical carrier.

Dependents Who Are City Employees
If any dependent is eligible for Fund benefits as an employee or retiree, that person is not eligible for coverage as a dependent. If both the member and his or her spouse are covered for Fund benefits as employees or retirees, their children may only be enrolled as dependents of either member.

Changes in Dependent Status
The Fund must be notified if a member acquires a dependent through marriage, domestic partnership, birth or adoption, or loses a dependent due to death, divorce, legal separation, or termination of domestic partnership.

Active employees should submit written notice of such changes to their personnel office along with the required documentation. Retirees should write to the Management Benefits Fund Office regarding any changes in dependent status and include the necessary documentation.

When Coverage Terminates

Active employee or retiree coverage ends for a member when any of the following events occur:

• The member goes off pay status and is not eligible for, or does not apply for, coverage as a deferred retiree.
• The member is appointed to a title that is eligible for collective bargaining.
• The member's title is made eligible for collective bargaining (active employees only).
• The Group Policy ceases.

Dependent coverage ends for dependents when any of the following events occur:

• The member's coverage ends as defined above.
• The member dies (see the "Survivor Benefits" section).
• A dependent no longer qualifies as an eligible dependent.

Where applicable, special provisions for extension of benefits or conversion to private coverage are specified in the individual benefit sections of the Fund Booklet.
Learn more about survivor benefits
See the Management Benefits Fund FAQ
Read the MBF Voice Newsletter