Frequently Asked Questions

What is considered other employer-sponsored group health insurance coverage for the purpose of qualifying for the Opt-Out Program?
To qualify for the Program you must be covered under an employer-sponsored group health insurance plan through other employment of your own or a plan that your spouse, domestic partner or parent has as the result of his or her employment. The other coverage cannot be NYSHIP coverage provided through employment with the State of New York (except CSEA Employees). However, NYSHIP coverage through another employer such as a municipality, school district or public benefit corporation qualifies as other coverage.
The State and CSEA have reached agreement on the details of the Opt-Out Program for CSEA represented employees, which will allow a CSEA represented employee to opt out of coverage when the "other" coverage is provided by a New York State employee.

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Will I qualify for Opt-Out Program incentive payments if I change from Family to Individual coverage?
No. If you are enrolled for NYSHIP coverage you will not qualify for the incentive payment.

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If I elect the Opt-Out Program for 2012, will I automatically be enrolled in the Program for the following plan year?
No. Unlike other NYSHIP options, you must elect the Opt-Out Program on an annual basis. If you do not make an election for the next plan year, your enrollment in the Opt-Out Program will end and the incentive payment credited to your paycheck check will stop.

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If I opt out and I find that I don't like my alternate coverage (for instance, my doctor does not participate) can I withdraw my enrollment in the Opt-Out Program and reenroll in NYSHIP coverage?
No. This is not a qualifying event. During the year you can terminate your enrollment in the Opt-Out Program and reenroll in NYSHIP benefits only if you experience a qualifying event (according to federal Internal Revenue Service (IRS) rules), such as a change in family status or loss of other coverage.

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If my spouse's (domestic partner's or parent's) employer has its open enrollment period (or option transfer period) at a different time of the year, how can I coordinate the effective date of my other coverage with the start of the Opt-Out Program?
Under IRS rules, if an employee's spouse drops coverage under his or her employer plan during Option Transfer, the employee can be permitted to enroll the spouse mid-year in his or her employer plan as long as the plans have different open enrollment periods. You should check to see whether your spouse's employer will permit your spouse to enroll you as a dependent. You are responsible for making sure your other coverage is in effect.

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What if I lose my other coverage and do not request enrollment for NYSHIP benefits with The Empire Plan or a NYSHIP HMO within 30 days of losing that coverage?
If you fail to make a timely request, you will be subject to NYSHIP's late enrollment waiting period, which is five biweekly pay periods. You will not be eligible for NYSHIP coverage during the waiting period.

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Can I get a lump sum payment if I elect the Opt-Out Program?
No. The Opt-Out Program incentive payment is prorated and reimbursed through your biweekly paycheck throughout the year.

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If I am eligible for health, dental and vision coverage as a State employee, do I have to opt out of all three benefits to receive the incentive payment?
No. The Opt-Out Program incentive payment applies to health insurance coverage only. If you enroll in the Program, your eligibility for dental and vision coverage will not be affected.

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When I enroll in the Opt-Out Program, what information will I need to provide about the other employer-sponsored group health coverage I will be covered by?
To enroll you must complete a PS-409. You will be required to attest that you are covered by other employer-sponsored group health coverage and provide information regarding the person that carries that coverage, as well as the name of the other employer and other health plan.

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I had Individual NYSHIP coverage prior to April 1, 2011, and changed to Family coverage when I got married in July. Will I qualify for the $3,000 family incentive payment even though I did not have Family coverage as of April 1?
Employees who enrolled in Family coverage due to a qualifying event and did so on a timely basis between April 1, 2011 and the end of 2011 are eligible for the higher incentive payment. You will not be eligible for the higher incentive payment if you enrolled for Family coverage after April 1 and were subject to a late enrollment waiting period.

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Will participating in the Opt-Out Program affect my eligibility for NYSHIP coverage in retirement?
No. Participation in the Opt-Out Program satisfies the requirement of enrollment in NYSHIP at the time of your retirement.

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