Opt-Out Program

CURRENT CSEA, PEF, PBANYS, NYSCOPBA, and M/C EMPLOYEES

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.

SIGNING UP

ELECT TO OPT-OUT

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 PACKET

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

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.

ELIGIBILITY

⇒ 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.

NEED TO CANCEL MID-YEAR?

⇒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

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.
During the year, you can terminate your enrollment in the Opt-out Program and re-enroll 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.

During the option transfer period you can opt into NYSHIP coverage - During the plan year, if you are losing your other health coverage, you must contact hrs_benefits@stonybrook.edu within 30 days of the event date to opt into the health plan.
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.
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.

Opt-Out Program

CURRENT CSEA, PEF, PBANYS, NYSCOPBA, and M/C EMPLOYEES

SIGNING UP

ELECT TO OPT-OUT

SUBMIT YOUR PACKET

ELIGIBILITY

NEED TO CANCEL MID-YEAR?

Personal Privacy Protection Law

Frequently Asked Questions

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