You can download the directly from official New York State resources. This form is used by eligible employees to officially opt out of the New York State Health Insurance Program (NYSHIP) in exchange for a taxable payment ($1,000 for Individual or $3,000 for Family coverage). Download Links
: To enroll in the Opt-out program if you already have alternative employer-sponsored health insurance. Download ps409 zip
: Provides a direct PDF download of the PS-409 Health Benefits Opt-Out Election. Submission Details You can download the directly from official New