Title 4 Part 74

plan or dental insurance plan means the group dental insurance provided under the contract or contracts entered into pursuant to article XI of the Civil Service Law, and any amendments thereto, including all the benefits provided thereunder, and all conditions and limitations applicable thereto pursuant to such contracts or as prescribed by the President of the Civil Service Commission.

employer or an employer shall include the State of New York (in all its branches, departments and agencies and certain departments and agencies of the State maintained and financed from special or administrative funds) and any participating employer. The term participating employer shall mean the public authorities, public benefit corporations and quasi-public organizations of the State which elect, with the approval of the President of the Civil Service Commission, to include their employees in the plan.

employee means any person in the service of the employer:

provided, however, the term employee shall not include any person whose regular work schedule is less than half-time, unless such person is a paid elected official or a paid member of a public legislative body; and further provided that no person shall be deemed to be an employee for the purposes of this plan who is employed by a public educational institution on other than a full-time basis and who is a student therein enrolled for a degree.

dependent shall include the spouse of an employee. It shall also include such person's unmarried child under 19 years of age, any unmarried child 19 years of age or older who is incapable of self-support by reason of mental or physical disability and who became so incapable before reaching the age at which dependent coverage would otherwise terminate, and any student dependent as hereinafter defined, excluding, however, any person who is in the Armed Forces of any country. The term child shall be deemed to include any natural born child, any legally adopted child and any stepchild dependent upon the employee, any child dependent upon the employee during any waiting period prior to the finalization of the child's adoption by the employee, and any child chiefly dependent on the employee and permanently residing in the household of the employee.

student dependent means an employee's unmarried child 19 years of age or older but not yet 25 years of age who receives more than half of his support from the employee and is a full-time student at an accredited secondary or preparatory school or college and is not otherwise eligible for employer group coverage; provided, however, that any time spent on military duty as defined in paragraph (b) of subdivision 1 of section 243 of the Military Law, not to exceed four years, shall be subtracted from the age of such child for purposes of determining the maximum age for eligibility as a student dependent.

Upon the termination of the plan by the State, the coverage and eligibility for coverage of its employees shall cease as of the end of the last period for which the required contributions have been paid to the insurance carrier.

The president may disqualify from participation in the dental insurance plan and from receiving benefits thereunder any employee who has secured or attempted to secure participation in the dental insurance plan or benefits under the plan for himself or another by fraud, deception or a false statement of a material fact, or who has accepted benefits for himself or another knowing he was not entitled thereto. No person shall be disqualified or denied benefits pursuant to this subdivision unless he is first given a written statement of the reasons therefor and afforded an opportunity to make an explanation and submit facts in opposition to such action. Such employees may be restored to eligibility for coverage under the plan only on approval of the president and subject to such conditions as may be imposed by the president, including repayment of sums expended for benefits obtained by fraud, deception or false statement of a material fact, or accepted by the employee with knowledge that he was not entitled thereto.

The rate of contribution of the State on account of the coverage of its employees and their dependents shall be 100 percent of the charge on account of individual coverage and 100 percent of the charge on account of dependent coverage. Notwithstanding the foregoing provisions an employee on leave without pay, whose coverage is continued pursuant to this Part shall be required to pay the entire charge on account of such coverage for each full month of absence.

Any public authority, public benefit corporation, or quasi-public organization of the State may apply for the inclusion of its employees in the plan by submitting to the president a certified copy of a resolution of its governing body electing such inclusion, which resolution shall be in a form approved by the president.

Upon the approval of the application of any public authority, public benefit corporation, or quasi-public organization of the State for the inclusion of its employees in the plan, it shall become a participating employer and the president shall thereupon fix an effective date for the commencement of coverage of such employees. Such effective date shall be fixed with due regard to a reasonable time allowance needed for educational, promotional and enrollment purposes and other administrative requirements. The president may, in his discretion, fix a schedule of effective dates of coverage with respect to newly approved participating employers.

All records in the possession of the participating employer of its officers or agents which have a bearing on the participation of employees in the dental insurance plan, or which otherwise have any bearing on the administration or operation of the dental insurance plan, shall be open to the inspection of representatives of the president and the insurers at all reasonable times.

Notice of intention to withdraw from the plan shall be given to the president and to the employer's employees at least 60 days in advance of the last date for which coverage will be provided. An employer who withdraws or is expelled from the plan shall not be eligible to rejoin the plan for one year thereafter unless, in the exercise of the president's discretion, for good cause shown, such period is reduced or waived.

The president may expel a participating employer from the plan upon finding that fraud or abuses in the administration of the plan have been committed or permitted by the acts or neglect of its officers or agents, or that the participating employer has failed to carry out satisfactorily its duties and responsibilities as required under the plan and by this Part. Such expulsion shall be effective not sooner than two months after notice thereof has been given by the president to the governing body of the participating employer.

The provisions of this Chapter, insofar as they apply to employees in the negotiating units established pursuant to article 14 of the Civil Service Law and their dependents, shall be continued; provided, however, that during periods of time when there is in effect an agreement between the State and an employee organization reached pursuant to the provisions of said article 14, the provisions of such agreement and the provisions of this Chapter shall both be applicable. In the event the provisions of the agreement are different from the provisions of this Chapter, the provisions of the agreement shall be controlling. The president may, upon certification by the Director of Employee Relations, provide for the supplementation of benefits provided hereinabove for officers and employees not in a negotiating unit within the meaning of article 14 of the Civil Service Law.