Continuation Assistance Demonstration Program for Entertainment Industry Employees
The program has a 12 month lifetime maximum on premium assistance. Applicants who are accepted into this program shall receive assistance equal to fifty percent of their COBRA/continuation premiums for a lifetime total of up to 12 months. Applicants cannot receive more than 12 months of premium assistance in a lifetime.
Federal COBRA Premium Assistance and the NYS Continuation Assistance
In February of this year, President Obama signed the American Recovery and Reinvestment Act (ARRA), which authorized the payment of a subsidy for certain individuals who need to continue their group health insurance after termination of employment. The ARRA provides for a payment of a subsidy equal to 65% of the COBRA premium for assistance eligible individuals for fifteen months. The statute defines an assistance eligible individual as one who:
- Has been involuntarily terminated at any time between 9/1/08 and 5/31/10; and
- Elects COBRA in a timely manner.
Individuals employed in the entertainment industry may be eligible for both the ARRA COBRA subsidy and the NYS Continuation Assistance program, which provides for the payment of a subsidy equal to 50% of the COBRA premium for eligible employees of the entertainment industry.
Individuals who are eligible for both subsidies may choose to access both subsidies at the same time, or they may choose to defer the New York State subsidy until they have accessed the full fifteen months of the Federal subsidy. We recommend that individuals evaluate their personal circumstances when making this choice. The Continuation Assistance Program is able to accommodate both scenarios as follows:
- If an eligible individual would like to access both subsidies at the same time, we will pay the 35% premium that remains after the 65% Federal subsidy has been applied for up to 12 months or until the individual goes off of COBRA, whichever comes first.
- If an eligible individual accesses the Federal subsidy for the full fifteen month period, and then applies for and is accepted into the NYS program, we will pay the 50% subsidy for up to 12 months, or until they go off of COBRA, whichever comes first.
To participate in this program, you must meet all of the following requirements:
- you must be a New York State resident;
- you must be eligible for, or already covered by, COBRA/continuation coverage through a collectively bargained plan covering entertainment industry employees;
- you must not already be receiving continuation assistance through a Department of Health program;
- you must not be eligible for Medicare;
- you must not be eligible for employer sponsored coverage; and
- you must meet the household income limitation, as set forth below:
Amounts updated annually. Pregnant women count as 2 people.
|Family Size||Monthly Household Income|
|1||Up to $2,327|
|2||Up to $3,152|
|3||Up to $3,977|
|4||Up to $4,802|
|5||Up to $5,627|
|6||Up to $6,452|
|Extra Person||Add $825|
Once you are accepted into the program, you will not lose your eligibility if your income increases above the household income limitation during the time you are receiving assistance through this program.
However, you will lose your eligibility for the premium subsidy if any of the following were to occur:
- your continuation coverage/COBRA ends;
- you move out of New York State;
- you become eligible for Medicare; or
- you become eligible for employer insurance.
Please also note that, as part of your application, you will be required to sign an acknowledgment that if you become eligible for employer insurance, you will lose your eligibility for the premium subsidy as of that date and the state may seek to recover any monies paid by the state on your behalf for the period you were eligible for employer insurance.
Due to the limited funding available for this program, applications will be accepted on a first come, first serve basis. If the Department of Financial Services does not have enough funding available to ensure 12 months of assistance for an applicant, we will be required under the law to deny your application.
If you meet the eligibility criteria outlined above and would like to apply to receive premium subsidies through this program, please download the standard application form for the NYS Continuation Assistance Program, complete the application and send it, with the appropriate documentation, to the address identified below:
NYS Continuation Assistance Program
New York State Department of Financial Services
P.O. Box 7184
Albany, New York 12224-0184
Note: This application form is in PDF Format and requires the free Adobe Acrobat Reader. PDF Assistance
If you cannot download this form, please call the Albany Health Bureau of the NYS Department of Financial Services at (518) 486-7815.
Please be aware that this legislation does not permit the Department of Financial Services to apply premium subsidies retroactively.
What this means is that if you are eligible for premium subsidies through this program in January, but you do not apply for subsidies through this program until April, the Department of Financial Services cannot reimburse you for premiums in January, February or March. To that effect, if you are interested in receiving this subsidy, you may want to apply to the Department of Financial Services as soon as you become aware that you are eligible for continuation coverage or when you begin receiving continuation coverage.
If you have questions on the application process or the program in general, please call the Albany Health Bureau of the NYS Department of Financial Services at (518) 486-7815.
What will happen when I apply?
Upon receipt of your application for acceptance into the NYS Continuation Assistance Program, the Department of Financial Services will review your application for completeness and eligibility. If you are determined to be eligible for this program, you will be notified in writing. Your union fund will also be notified so that they can seek direct payment from the New York State Department of Financial Services. Continuation assistance in the amount of a fifty percent premium subsidy will be paid directly to your union fund, on your behalf, for the period you are enrolled in COBRA continuation coverage and continue to meet the criteria of this program.
How will subsidy payments be paid?
Once your union’s request for payment is accepted and processed by the Department of Financial Services, continuation assistance in the amount of a fifty percent premium subsidy will be paid directly to your union fund, on your behalf, for the period you are enrolled in COBRA continuation coverage and continue to meet the criteria of this program. Your continued responsibility for the remaining 50% premium amount will be paid directly to your union by you. Therefore, any questions and/or concerns regarding your payment amount and/or due date should be directed to your union.
What is COBRA/continuation coverage?
In general, most employers or unions who provide group health plans must offer each individual covered under a group health plan, who would otherwise lose coverage under the plan because of a "qualifying event", an opportunity to elect continuation of the coverage, otherwise known as COBRA benefits or self-pay benefits.
The member’s union will have the responsibility of notifying the member of their right to elect continuation of coverage. If the member chooses to elect continuation of coverage, he or she must request their continuation of coverage in writing within 60 days following the later of: (1) the date of termination; or (2) the date he or she is given notice of the right of continuation by either his or her employer, union or the plan.
If the member is electing continuation of coverage, he or she must pay up to 102% of the premium at the group rate for the benefits being continued under the group contract. The maximum continuation coverage is 18 months after the qualifying event. However, the COBRA Subsidy Program will pay half the premium payment for a period of 12 months (lifetime maximum). Therefore, if the member elects continuation of coverage for the full period of 18 months, he or she can only qualify for 12 months of premium assistance.
Frequently Asked Questions about the NYS Continuation Assistance Program for Entertainment Industry Employees.