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State of New York Department of Civil Service Alfred E. Smith State Office Bldg. Albany, NY 12239 EMPLOYEE BENEFITS DIVISION 2012 OPT OUT ATTESTATION FORM PS 409 (12/11) INSTRUCTIONS: READ To OPT-

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How to fill out nyship opt out period

How to fill out NYSHIP opt out period:

01

Visit the official NYSHIP website or contact your employer's benefits office to obtain the necessary forms and information.

02

Carefully review the eligibility requirements for opting out of NYSHIP coverage. Ensure that you meet the criteria.

03

Complete the opt out form accurately and provide all required information, such as your personal details, employment information, and reason for opting out.

04

If applicable, gather any supporting documentation required for the opt out process, such as proof of alternative coverage.

05

Double-check all the information provided on the form, ensuring there are no errors or missing details.

06

Submit the completed opt out form and any supporting documents according to the specified instructions, such as submitting it online or mailing it to the appropriate address.

07

Keep a copy of the completed form and any related documents for your records.

Who needs NYSHIP opt out period:

01

Employees who have alternative health insurance coverage, such as through a spouse's employer, may choose to opt out of NYSHIP to avoid paying duplicate premiums.

02

Individuals who are eligible for other government-provided health coverage, such as Medicare or Medicaid, may opt out of NYSHIP to avoid unnecessary costs.

03

Employees who no longer meet the eligibility requirements for NYSHIP coverage may need to opt out to avoid any penalties or provide notification to their employer.

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What is nyship opt out period?

The NYSHIP opt out period is a specific time frame in which eligible employees can opt out of the New York State Health Insurance Program.

Who is required to file nyship opt out period?

All eligible employees who wish to opt out of the NYSHIP program are required to file during the opt out period.

How to fill out nyship opt out period?

Employees can fill out the NYSHIP opt out form provided by their employer during the designated opt out period.

What is the purpose of nyship opt out period?

The purpose of the NYSHIP opt out period is to allow eligible employees to opt out of the state health insurance program if they have alternate coverage.

What information must be reported on nyship opt out period?

Employees must report their alternate health insurance coverage information and certify that it meets certain requirements.

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