Download Ps409 Zip 🔖 ✨

: This is often submitted alongside the PS-404 Health Insurance Transaction Form to declare your change in coverage status.

You can download the directly from official New York State resources. This form is used by eligible employees to officially opt out of the New York State Health Insurance Program (NYSHIP) in exchange for a taxable payment ($1,000 for Individual or $3,000 for Family coverage). Download Links Download ps409 zip

: You must provide proof of other employer-sponsored coverage to qualify for the incentive payment. Benefits Forms - Business Services Center : This is often submitted alongside the PS-404