WebDepartment of Civil Service Instructions for NYSHIP Health Insurance Transaction Form Albany, NY 12239 for NYS & PE Employees PS-404 (1/2024) DEPENDENT INFORMATION Box 14 Dependent Information . Check the box to add or delete a dependent or to change a dependent’s information. Check the Medical box as the coverage being changed. WebTransaction Forms (PS forms) PS-404 Health Insurance Transaction (pdf); PS-404 Instructions (pdf) PS-405 NYSHIP Sick Leave Credit Option Election Form (pdf) PS-406.2 NYSHIP Health Insurance Deferral Election Form (pdf) PS-410 NYSHIP Sick Leave Credit Preservation Form (pdf) PS-425 Domestic Partner Enrollment (pdf)
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WebTo enroll in the New York State Health Insurance Program (NYSHIP) or to make changes to your existing benefits. Download the forms: Health Insurance Transaction Form (PS-404) WebAlbany, NY 12239 Page 2 - PS-404g (8/18) 14. PREVIOUS COVERAGE INFORMATION Complete this section if you are requesting new enrollment or a change to family … primary aggressive aphasia
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WebKeep to these simple actions to get Nys Civil Service Ps 404r completely ready for submitting: Choose the document you want in the library of templates. Open the template in the online editing tool. Go through the instructions to learn which information you will need to give. Click the fillable fields and put the required info. WebTransfer Period (No longer includes UUP represented employee). To re-enroll in NYSHIP coverage at any other time, employees must experience a qualifying event, such as a change in family status (e.g. death or divorce) or loss of the other employer sponsored group health insurance. Employees must complete a PS-404 and provide proof of the Web2 days ago · Apr 13 2024 / 5:10 AM EDT. 2. Milestone has announced motorcycle racing game RIDE 5 for PlayStation 5, Xbox Series, and PC ( Steam, Epic Games Store ). It will launch on August 24. Here is an ... primary aging includes changes caused by