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West Campus, Health Sciences, and School of Medicine

Opt-Out Program


Current CSEA, PEF, PBANYS, NYSCOPBA, and M/C employees  who can demonstrate and attest to having other employer-sponsored group health insurance may elect to opt out of NYSHIP's Empire Plan or Health Maintenance Organizations.

Employees who elect to opt out of NYSHIP will receive $1,000 for waiving Individual Coverage or $3,000 for waiving Family Coverage. This amount will be credited to your bi-weekly paycheck as taxable income over the plan year.



There are two times a year when employees may elect to opt out of coverage.

1. As newly eligible for health benefits. New Employees must enroll no later than their first date of NYSHIP eligibility.

2. During the option transfer period for currently enrolled employees


Submit your completed  State Opt-Out Packet, which includes the PS-409 Opt-Out Attestation Form* and the PS404 Enrollment Form, to

Once signed up, employees are automatically enrolled for the following plan year.

• Opt out during the first 30 days of employment

• Opt out payments will begin 43 days from your hire date

• Additional application and proof required (proof of other coverage)

*By signing the PS-409 Opt-out Attestation Form,you elect to receive $3,000 (Family coverage waived), or $1,000 (Individual coverage waived); this amount will be credited to your bi-weekly paycheck as taxable income over the plan year.


Current CSEA, PEF, PBANYS, NYSCOPBA, and M/C Employees

Employees  must be enrolled in NYSHIP Individual or Family Coverage prior to April 1st of the previous plan year to be eligible to opt out of that coverage the following calendar year.

⇒Employees must be covered under an employer-sponsored group health insurance plan through other employment of their own or a plan that their spouse, domestic partner or parent has as the result of their employment.

⇒If your alternate insurance coverage is NYSHIP and is through SUNY, you are not eligible for the opt out incentive

⇒If your alternate insurance coverage is NYSHIP and is through a Participating Agency, you are only eligible for the Individual opt-out.


⇒Only employees who experience a Qualifying Event (QE) will be allowed to withdraw their opt-out election and enroll in a health insurance plan mid-year.

⇒Employees who experience a QE must notify their personnel office within thirty (30) days of the QE date in order to enroll in a health insurance plan without a waiting period.

⇒Employees must complete a PS404 Enrollment Form.


Personal Privacy Protection Law

Section 96 (1)

The information you provide on this application is requested in accordance with Section 163 of New York State Civil Service Law for the principal purpose of enabling the Department of Civil Service to process your request concerning health insurance coverage. This information will be used in accordance with Section 96 (1) of the Personal Privacy Protection Law, particularly subdivisions (b), (e) and (f). Failure to provide the information requested may interfere with our ability to comply with your request. This information will be maintained by the Director of the Employee Benefits Division, NYS Department of Civil Service, and Albany, NY 12239.

MORE INFO? For information concerning the Personal Protection Law, call (518) 457-9375. For information related to the Health Insurance Program, contact your Agency Health Benefits Administrator. If, after calling your Agency Health Benefits Administrator, you need more information, please call (518) 457-5754 or 1-800-833-4344 between the hours of 9:00 AM and 3:00 PM

Frequently Asked Questions