Get Young Adult Option Form - View Website - New York State

Completing the Young Adult Option Form can be a straightforward process with the right guidance. This document helps individuals navigate the necessary steps to ensure proper completion and submission of the form, ultimately securing health coverage under the Young Adult Option in New York State.

Follow the steps to successfully complete the Young Adult Option Form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by providing the young adult's personal information. Fill in their name, mailing address, social security number, and telephone number with area code.
3. Next, fill out the parent enrollee's information. Enter their name, mailing address, social security number, and telephone number with area code.
4. To demonstrate eligibility, the young adult must confirm the statements listed on the form. It requires checking 'True' for each statement regarding their relationship to the parent enrollee and other eligibility criteria.
5. Provide required proofs of eligibility. If the young adult is a child, include a copy of the birth certificate. For a step-child, the birth certificate of the step-child and the marriage certificate of the parent enrollee must be included.
6. Indicate the plan selection by electing to enroll in the Young Adult Option. Verify that all information provided is true and correct, and note that either the young adult or the parent enrollee can sign the form.
7. Print the name of the signer and the date of signing. Specify whether billing should be sent to the parent enrollee or the young adult.
8. If applicable, include a signed HIPAA Release Form so the Employee Benefits Division can discuss coverage specifics with the parent enrollee.
9. Review the form for any errors or omissions before submission.
10. Submit the completed form along with full payment for the first month’s premium to the address provided on the form and ensure that all necessary documentation is included.

Complete your Young Adult Option Form online today and secure your health coverage!