WebReview NYSHIP Enrollment, Qualifying Event and Plan Change Information Download pdf (1.2 MB) Contact the Benefits Team The State Benefit Services Team is available to answer your questions. Use our contact information below to access all team members for the fastest response. UB HR Benefits State Benefit Services Phone: 716-645-7777 WebApplication for Enrolling Domestic Partners In NYS Health Insurance Program (PS-425) Use this form for enrolling a domestic partner in the NYS Health Insurance Program. …
Government of New York
WebMar 1, 2024 · Download Fillable Form Ps-425.4 In Pdf - The Latest Version Applicable For 2024. Fill Out The Termination Of Domestic Partnership For Nyship - New York Online And Print It Out For Free. Form Ps-425.4 Is Often Used In New York State Department Of Civil Service, New York Legal Forms, Legal And United States Legal Forms. Webdownload the Dual Annuitant Sick Leave Credit Election Form (ps-405) Where to Submit These Forms: Email: [email protected] Fax: 518-457-1879 Mail: BSC Benefits Administration W. Averell Harriman State Office Campus 1220 Washington Avenue Building 5, Floor 4 Albany, NY 12226-1900 Next Section Deferring Your Coverage Deferring Your … golf cart rebuild
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WebNYSHIP Termination of Domestic Partnership (PS-425.4) Forms Catalog NYSHIP Termination of Domestic Partnership (PS-425.4) State employee submits application to terminate domestic partner from NYSHIP plan. Download the Form NYSHIP Termination of Domestic Partnership (PS-425.4) Using Firefox with PDF forms? Make Adobe Acrobat the … Weba NYSHIP HMO, contact the HMO directly. Important Dates for Your Benefit Choices If you want to make a change for 2024 December 30, 2024 Deadline for submitting a signed NYSHIP Health Insurance Transaction Form (PS-404) to your HBA if you want to change your health insurance option and/or Pre-Tax election for the 2024 plan year. Employees … http://uupinfo.org/benefits/pdf/NYSHIPEligibilityAudit160517.pdf golf cart redding ca