How It Works
Eligibility
To participate in the Opt-Out Program:
- You must be represented by an eligible negotiating unit/union. Enrollees represented by UUP are not eligible for the Opt-Out Program
- You must have been enrolled in NYSHIP by April 1 of the current year, and remain continuously enrolled
OR
If you were not eligible for NYSHIP on April 1 but became eligible later, you must be continuously enrolled in NYSHIP since the first day you became eligible - You must be covered by other employer-sponsored group health insurance that is not NYSHIP
OR
You are a dependent on a NYSHIP policy from a Participating Employer or a Participating Agency
Payment
The incentive payment is
$1,000
for individual coverage
$3,000
for family coverage
The payment is divided throughout the plan year and added to your biweekly paychecks.
There is no lump-sum payment option.
Common situations:
- Qualifying for the family coverage incentive payment: You must have had NYSHIP family coverage since April 1. This means you were enrolled in a NYSHIP health plan with family coverage.
- Adding a dependent: You cannot switch to the Family Opt-Out payment in the middle of the year.
- Your only dependent loses NYSHIP eligibility in the middle of the year: For the remainder of the year, you will only be eligible for the Individual Opt-Out payment.
Contact your HBA or Agency Contact to discuss your specific situation.
How to Enroll in the Opt-Out Program
New Enrollees
You must choose the Out-Out Program before the end of your NYSHIP new hire waiting period. Complete the appropriate forms and submit them to your HBA or Agency Contact.
Current Enrollees
You can join the Opt-Out Program during Open Enrollment (December 1–31). Complete the appropriate forms and submit them to your HBA or Agency Contact. You do not have to reenroll in the program every year. If you remain eligible, your current enrollment will continue into the next year.
To complete enrollment in the Opt-Out Program
There are two forms required to be complete and submit to your HBA to successfully enroll:
Changing to Family Opt-Out
If you are receiving the Opt-Out incentive for Individual coverage, you may not switch directly to receiving the Family Opt-Out incentive, even if you are eligible for Family coverage. Instead, you must first enroll in Family coverage (either when newly eligible or during the Open Enrollment Period). Then, at the next Open Enrollment Period, you may reenroll in the Opt-Out Program and request the Family incentive.
Switching from Opt-Out to a NYSHIP Health Plan
There are two ways to leave the Opt-Out Program and join a NYSHIP health insurance plan.
In both cases, you must complete and submit a NYSHIP Health Insurance Transaction Form (PS-404) to your HBA.
During Open Enrollment
During the annual open enrollment, you can switch to a NYSHIP health insurance plan.
Have a Qualifying Life Event
If you experience a qualifying life event (as defined by IRS rules), you can switch to a NYSHIP health insurance plan. You must submit your request to change within 30 days of the event.
Frequently Asked Questions
No. The Opt-Out Program incentive payment applies to health coverage only. Your eligibility for dental and vision coverage will not be affected.
No. You can’t leave the Opt-Out Program and rejoin NYSHIP during the plan year unless you have a qualifying event.
You are responsible for making sure that your other coverage is in effect at the time that you opt out of NYSHIP. Your HBA or Agency Contact can help you coordinate your coverage.
Looking for more information?
If you still have questions, check out our complete FAQ page for a full comprehensive understanding of the Opt-Out Program.