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Get Ny Ps-404 2017
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How to fill out the NY PS-404 online
This guide provides detailed instructions for completing the NY PS-404 health insurance transaction form online. By following these steps, users will ensure that they properly fill out the required information and make informed choices regarding their health insurance coverage.
Follow the steps to successfully complete the NY PS-404 form.
- Click ‘Get Form’ button to acquire the NY PS-404 form and open it in your preferred online editor.
- Begin by filling out the employee information section (Boxes 1-10) with your last name, first name, social security number, sex, permanent address, mailing address, work location, date of birth, marital status, and telephone numbers.
- In the ‘Elect or Decline Coverage’ section (Boxes 11 A-B), choose between Pre-Tax or After-Tax status for premium deductions and select your desired NYSHIP coverage option. Make sure to check the appropriate boxes for Individual Enrollment, Family Enrollment, Opt-out Program, or Declining Coverage.
- If you are changing or canceling existing coverage (Box 12), indicate the nature of the change and provide the date of the relevant event. Be sure to check the coverage type (Medical, Dental, Vision) that applies to the change.
- In the Dependent Information section (Box 13), provide necessary details if enrolling or opting out of family coverage. Indicate whether you are adding, deleting, or changing dependent information and fill in the required details.
- If you are making an Annual Option Transfer request (Box 14), complete the details based on the current plan year and any applicable qualifying events.
- Finally, review all the information you have entered for accuracy. Ensure to sign and date the authorization section to validate the form before submission.
- Once completed, you can save your changes, download the form, print it, or share it according to your needs.
Start filling out your NY PS-404 form online today to manage your health insurance options effectively.
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The opt-out program for NYSHIP allows employees to decline health insurance coverage if they have alternative qualifying coverage. This can provide employees flexibility while still complying with NY PS-404 regulations. Ensure that you understand the terms of the program, as it can affect your future health insurance options.
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