Get the free PS-404 Health Insurance Transaction Form - Civil Service Department

EMPLOYEE BENEFITS DIVISION HEALTH INSURANCE TRANSACTION FORM FOR NYS & PE EMPLOYEESPS404 (9/17)INSTRUCTIONS: READ AND COMPLETE BOTH SIDES/PAGES. PLEASE PRINT AND CHECK THE APPROPRIATE CHOICES.EMPLOYEE

How to fill out ps-404 health insurance transaction

How to fill out ps-404 health insurance transaction

1. To fill out PS-404 health insurance transaction, follow these steps:
2. Provide personal information such as name, date of birth, and social security number.
3. Fill in details of your current health insurance plan, including the policy number and name of the insurance company.
4. Indicate the effective date of your health insurance coverage.
5. Specify the reason for the health insurance transaction, such as adding a dependent or changing coverage options.
6. Provide supporting documentation if required, such as birth certificates or marriage certificates.
7. Sign and date the form to certify its accuracy.
8. Submit the completed PS-404 form to the appropriate health insurance authority.

Who needs ps-404 health insurance transaction?

1. Anyone who wants to make a health insurance transaction, such as adding a dependent or changing coverage options, needs the PS-404 health insurance transaction form.

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What is ps-404 health insurance transaction?

PS-404 health insurance transaction is a form used to report health insurance information to the relevant authorities.

Who is required to file ps-404 health insurance transaction?

Insurance companies and employers who provide health insurance coverage to their employees are required to file PS-404 health insurance transaction.

How to fill out ps-404 health insurance transaction?

PS-404 health insurance transaction can be filled out online or submitted through mail. The form requires information such as policy numbers, covered individuals, and total premiums paid.

What is the purpose of ps-404 health insurance transaction?

The purpose of PS-404 health insurance transaction is to provide accurate information about health insurance coverage for tax and regulatory purposes.

What information must be reported on ps-404 health insurance transaction?

Information such as policy numbers, covered individuals, total premiums paid, and any changes to the coverage during the reporting period must be reported on PS-404 health insurance transaction.