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 Opt-out 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 group health coverage cannot be provided through a NYSHIP policy through your/their employment with New York State or your own NYSHIP policy through a Participating Agency (PA) or Participating Employer (PE).If you are covered as a dependent on another NYSHIP policy through a PA or PE, you are eligible to receive the Individual incentive payment, but not the Family incentive payment.

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If I am enrolled in the Opt-out Program, 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 will cease.

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If I currently participate in the Opt-out Program and do not reenroll for the next calendar year, will I automatically be enrolled for NYSHIP coverage?
No, enrollment in coverage is not automatic. The incentive payment credited to your paycheck will stop and you will notbe enrolled in coverage unless you complete a NYS Health Insurance Transaction Form (PS-404) requesting enrollment in a NYSHIP health plan. You may have a late enrollment waiting period before coverage takes effect.

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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. The qualifying event must satisfy the IRS consistency rule and the request must be submitted timely.

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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 or dependent drops coverage under his or her employer plan during Option Transfer, the employee can be permitted to enroll the spouse or dependent 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, domestic partner's or parent's employer will permit you to be enrolled as a dependent. You are responsible for making sure that your other coverage is in effect during the period you opt out of NYSHIP.

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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, and you will not be eligible to elect pretax health insurance deductions until the following November for the new plan year. Your incentive payments will stop when you are no longer eligible for other employer coverage. Note:You may also be subject to a federal penalty if you do not have health insurance coverage for any portion of the tax year.

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