Form PS-409 Nyship Opt-Out Program Attestation Form - New York

What Is Form PS-409?

This is a legal form that was released by the New York State Department of Civil Service - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the Form PS-409?
A: The Form PS-409 is the Nyship Opt-Out Program Attestation Form for New York.

Q: What is the Nyship Opt-Out Program?
A: The Nyship Opt-Out Program is a program that allows eligible New York State employees to opt out of the New York State Health Insurance Program (NYSHIP) in exchange for a cash payment.

Q: Who is eligible for the Nyship Opt-Out Program?
A: Eligible employees are those who have other non-Medicare health insurance coverage through a spouse, domestic partner, or other source.

Q: What is the purpose of the attestation form?
A: The attestation form is used to verify that the employee has other non-Medicare health insurance coverage and is eligible for the Nyship Opt-Out Program.

Q: Do I need to submit this form every year?
A: No, you only need to submit the Form PS-409 once unless there are changes to your health insurance coverage.