Ps 404 pe form 2025

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The document is a New York State Health Insurance Transaction Form (PS-404 PE) for employees, detailing instructions for completing the form to request health insurance coverage changes, enrollments, or cancellations. It includes sections for employee information, dependent details, previous coverage information, and options for health plan selection. Additionally, it outlines the process for continuing coverage during leave or retirement and emphasizes the importance of providing accurate information to avoid penalties.

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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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