Form ps 404 2014-2025

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The document is the NYS Health Insurance Transaction Form (PS-404) from the New York State Department of Civil Service, which employees must complete to manage their health insurance coverage. It includes sections for personal information, enrollment requests for medical, dental, and vision coverage, options for opting out or changing coverage, and instructions for dependent information. The form also addresses procedures for leave without pay and retirement coverage continuation. Additionally, it outlines required documentation for processing transactions.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (221 Votes)
2019	4.3 Satisfied (52 Votes)
2017	4.2 Satisfied (78 Votes)
2017	4.4 Satisfied (129 Votes)
2014	4.3 Satisfied (76 Votes)
2011	4.8 Satisfied (49 Votes)
2007	4.6 Satisfied (43 Votes)
2006	4 Satisfied (54 Votes)
2001	4.1 Satisfied (28 Votes)

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