The New York State Health Insurance Program (NYSHIP) offers the
Opt-Out Program to CSEA, NYSCOPBA, PEF, PBANYS and MC employees.
This program allows eligible employees who have other
employer-sponsored group health insurance, to opt out of their
NYSHIP coverage in exchange for an incentive payment. On an
annual basis, the incentive payment is $1,000 for opting out of
individual coverage or $3,000 for opting out of family coverage.
To qualify for the 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 or domestic
partner has as the result of his or her employment. If the other
coverage is through a NYS retiree, the employee is not eligible
for the Opt-Out Program.
To be eligible for the Program for
2013, you must have been enrolled in NYSHIP by April 1, 2012, or
on the date first eligible for NYSHIP if that date is later than
April 1, and remain enrolled through the end of the 2012 plan
year, or you must currently participate in the Opt-Out Program.
NYSCOPBA, PEF, PBANYS
and MC Employees: The other coverage cannot be
NYSHIP coverage provided through employment with the State of
New York. However, coverage through another employer such as a
municipality, school district or public benefit corporation
qualifies as other coverage.
Employees Only: CSEA Represented Employees Only:
A CSEA represented employee who has a spouse or domestic partner
who is a State employee also enrolled in NYSHIP (dual
enrollment), may elect to opt out and receive $1,000 (whether
opting out of individual or family coverage) for calendar year
2013. Both employees must have been enrolled in a State plan by
April 1, 2012, for the CSEA represented employee to elect the
Opt-Out Program for calendar year 2013.
Once you enroll in the Opt-Out Program, during any period that
your employment status changes and, as a result, you leave the
payroll and/or do not meet the requirements for the State
contribution to the cost of your NYSHIP coverage, you are not
eligible for the incentive payment. Also, if you are receiving
the incentive for opting out of family coverage and during the
year your last dependent loses NYSHIP eligibility, you will be
eligible for only the individual payment.
Electing to Opt Out
If you are currently enrolled in NYSHIP and wish to participate
in the OPT-Out Program, you must elect to opt out during the
annual Option Transfer Period and attest to having other
employer-sponsored group health insurance each year. You must
complete the NYS Health Insurance Transaction Form (PS-404)
and the 2013 Opt-Out Attestation Form (PS-409).
If you enroll in the Program and you are eligible for dental and
vision coverage under the State plan, your eligibility for
dental and vision coverage will not be affected.
You will be required to attest that you are covered by other
employer-sponsored group health coverage and provide information
regarding the person that carries that coverage, as well as the
name of the other employer and other health plan.
You should check to see
whether the other employer-sponsored plan will permit you to
enroll as a dependent. You are responsible for making
sure your other coverage is in effect during the period you are
opting out of NYSHIP. Your NYSHIP coverage will terminate at the
end of the plan year and the incentive payments will begin after
January 1 (the new plan year).
If you currently participate in the Opt-Out Program, and wish to
participate in the program for 2013, you must complete a Health
Insurance Transaction Form (PS-404),
electing the Opt-Out Program for 2013, and the Opt-Out
Attestation Form (PS-409). If you do not
make the election for the next year, your enrollment in the
Opt-Out Program will end and the incentive payment credited to
your paycheck will stop.
You must elect the Opt-Out Program on an annual basis, during
the Option Transfer Period.
If you are a new hire or newly-eligible employee who has other
employer-sponsored group health insurance and wish to
participate in the Opt-Out program, you must make your election
no later than the first date of your eligibility for NYSHIP
If you are newly eligible as a result of a change in bargaining
unit, you may elect to participate in the program within 30 days
of the effective date of the bargaining unit change.
If you are transferring from one State agency to another, you
are not newly eligible unless you were previously working in a
non-benefits eligible position or in a bargaining unit not
eligible for the Opt-Out program.
The annual incentive amount for opting out of NYSHIP coverage is
$1,000 for Individual coverage or $3,000 for Family coverage.
The incentive payments will be prorated and reimbursed through
the employee’s biweekly paychecks throughout the year (payable
only when an employee is on the payroll and meets the
requirements to be eligible for the State to contribute to the
cost of NYSHIP coverage.)
The incentive amount will be credited to the employee’s
bi-weekly paycheck and will be treated as taxable income. The
bi-weekly incentive amounts will be $38.47 for opting out of
Individual coverage ($1,000/26 paychecks) or $115.39 for opting
out of Family coverage ($3,000/26 paychecks).
Please Note: A CSEA
represented employee who has a spouse or domestic partner who is
a State employee also enrolled in NYSHIP (dual enrollment), and
elects to opt out of NYSHIP coverage, will receive $1,000,
whether opting out of individual or family coverage, for
calendar year 2013.
Reenrollment in NYSHIP
Employees who participate in the Opt-Out Program may reenroll in
NYSHIP during the next annual Option Transfer Period. To
reenroll in NYSHIP coverage any other time, employees must
experience a qualifying event like a change in family status
(e.g.; marriage, birth, death, or divorce) or loss in coverage.
Employees must complete a PS-404 and
provide proof of the qualifying event within 30 days or any
change in enrollment 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.
Retirement while in the Opt-Out Program
Participation in the Opt-Out Program is considered participation
in NYSHIP for purposes of establishing eligibility for NYSHIP
coverage in retirement. Retirees are not eligible for the
Opt-Out Program, so participation terminates when the employee’s
eligibility for NYSHIP coverage as an active employee ends.