Health Insurance Transaction Forms (PS-404 & PS-409) Use to enroll, decline, change, or opt-out of coverage.
card image New York State Health Insurance Transaction Form (PS-404) Sign up for health insurance or make changes to your existing benefits. Is This Form Mandatory?When to SubmitHow to Complete This Form LEARN MORE
card image New York State Health Insurance Program Opt-out Form (PS-409) To enroll in the NYSHIP Opt-out program. What Is This Form For?Is This Form Mandatory?When to Submit LEARN MORE
