Download Ps409 Zip Apr 2026

: Provides a direct PDF download of the PS-409 Health Benefits Opt-Out Election. Submission Details

: This is often submitted alongside the PS-404 Health Insurance Transaction Form to declare your change in coverage status. Download ps409 zip

: You must provide proof of other employer-sponsored coverage to qualify for the incentive payment. Benefits Forms - Business Services Center : Provides a direct PDF download of the

: Access the most current version of the PS-409 and related transaction forms like the PS-404 . 000 for Individual or $3

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