WebHealth Insurance Transaction Form (PS-404) to your HBA by December 30, 2024. For more information about the PTCP, see Planning for Option Transfer or your General Information Book. NO ACTION IS REQUIRED IF YOU WISH TO KEEP YOUR CURRENT HEALTH INSURANCE OPTION OR PRE-TAX STATUS AND STILL QUALIFY FOR THEM. (SEE … WebINSTRUCTIONS for PS-404. NYS HEALTH INSURANCE TRANSACTION FORM. State of New York Department of Civil Service Albany, NY 12239. Boxes 1 – 9 . You must complete boxes 1 – 9 with your personal information. Note: Use the Marital Status Date to show the date of marriage, separation or divorce when those marital statuses are selected.
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WebNYS Department of Civil Service Health Insurance Transaction Form Albany, NY 12239 Page 2 - PS-404 (9/16) 13. ENTER ANNUAL OPTION TRANSFER REQUEST(S) … WebFilling out PS-404 - NYS Department Of Civil Service - New York State - Cs Ny does not have to be perplexing any longer. From now on comfortably get through it from home or at the workplace from your mobile or desktop computer. Get form Experience a faster way to fill out and sign forms on the web. old wedgwood plates
INSTRUCTIONS: READ BOTH SIDES - University at Albany, …
Webform requesting Individual coverage with the date of event and the reason for the change. If the spouse is an employee or retiree of a Participating Agency, have them submit a Health Insurance Transaction Form (PS-503.1) requesting Individual coverage. (Note: If the spouse had previous coverage under NYSHIP, please note on transaction form.) 2. WebTherefore, the signNow web application is a must-have for completing and signing hEvalth insurance transaction form PS 404 on the go. In a matter of seconds, receive an … WebHealth Insurance Transaction Form Student Employee Health Plan (SEHP) PS-404G (8/18) INSTRUCTIONS: READ AND COMPLETE BOTH SIDES/PAGES. PLEASE PRINT AND … old weed eater brands