New Hire Opt Out Program for NSHIP Enrollees in CSEA, PEF, and MC

Effective January 1, 2012, NYSHIP will offer the Opt-out Program, which will allow eligible employees who have other employer sponsored group health insurance, to opt out of their NYSHIP coverage in exchange for an incentive payment. The incentive payment is $1,000 for waiving Individual coverage or $3,000 for waiving Family coverage on an annual basis. The incentive payments will be prorated and reimbursed through your biweekly paycheck throughout the year (payable only when an employee is on the payroll). Note: The payments will be taxable income.

Eligibility
- Be classified in the bargaining unit CSEA, MC, or PEF
- Must make the election no later than their enrollment period (30 days depending on bargaining unit)
- The employee must provide information and attest to having other employer sponsored group health insurance in effect for the Opt-Out period. (you may not opt out to go without health insurance coverage)

Process
1. Complete a PS-404 form indicating you wish to cancel your coverage
2. Complete a PS-409 (opt out) form and attach to the PS-404
3. Submit to The Office of Human Resources by 12/30/11

Frequently Asked Questions
Q. What is considered other employer-sponsored group health insurance coverage for the purpose of qualifying for the Opt-Out Program?
A. 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, domestic partner or parent has as the result of his or her employment. The other coverage cannot be NYSHIP coverage provided through employment with the State of New York.

Q. If I elect the Opt-Out Program for 2012, will I automatically be enrolled in the Program for the following plan year?
A. No. Unlike other NYSHIP options, you must elect the Opt-Out Program on an annual basis. If you do not make an election for the next plan year, your enrollment in the Opt-Out Program will end and the incentive payment credited to your paycheck check will stop.

Q. If I opt out and I find that I don't like my alternate coverage (for instance, my doctor does not participate) can I withdraw my enrollment in the Opt-Out Program and reenroll in NYSHIP coverage?
A. No. This is not a qualifying event. During the year you can terminate your enrollment in the Opt-Out Program and reenroll in NYSHIP benefits only if you experience a qualifying event (according to federal Internal Revenue Service (IRS) rules), such as a change in family status or loss of other coverage.

Q. If my spouse's (domestic partner's or parent's) employer has its open enrollment period (or option transfer period) at a different time of the year, how can I coordinate the effective date of my other coverage with the start of the Opt-Out Program?
A. Under IRS rules, if an employee's spouse drops coverage under his or her employer plan during Option Transfer, the employee can be permitted to enroll the spouse mid-year in his or her employer plan as long as the plans have different open enrollment periods. You should check to see whether your spouse's employer will permit your spouse to enroll you as a dependent. You are responsible for making sure your other coverage is in effect.

Q. What if I lose my other coverage and do not request enrollment for NYSHIP benefits with The Empire Plan or a NYSHIP HMO within 30 days of losing that coverage?
A. If you fail to make a timely request, you 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.

Q. Can I get a lump sum payment if I elect the Opt-Out Program?
A. No. The Opt-Out Program incentive payment is prorated and reimbursed through your biweekly paycheck throughout the year.

Q. If I am eligible for health, dental and vision coverage as a State employee, do I have to opt out of all three benefits to receive the incentive payment?
A. No. The Opt-Out Program incentive payment applies to health insurance coverage only. If you enroll in the Program, your eligibility for dental and vision coverage will not be affected.

Q. When I enroll in the Opt-Out Program, what information will I need to provide about the other employer-sponsored group health coverage I will be covered by?
A. To enroll you must complete a PS-409. 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.

Q. Will participating in the Opt-Out Program affect my eligibility for NYSHIP coverage in retirement?
A. No. Participation in the Opt-Out Program satisfies the requirement of enrollment in NYSHIP at the time of your retirement.

Thank you.