Title: 2022 Annual Option Transfer Period & Pre-Tax Contribution Program (PTCP): Health Insurance Premiums & Copays Released

Date: December 01, 2021
Summary: The 2022 “Choices” and “Rates” information are now available. Information on the new health choices (co-payments) and health rates (premiums) are linked below and are being updated on the Benefits webpage under the heading “Health Insurance.”

It is imperative you review your current coverage to ensure you wish to remain with your current plan. The new plan year begins on 1/6/2022.

Quick Facts:

Below you will find links to:

Opt-out Program:

Eligible employees who have other employer sponsored group health insurance may Opt-out of their NYSHIP coverage in exchange for an incentive payment. The incentive payment is $1,000 for waiving Individual coverage or $3,000 for waiving Family coverage on an annual basis. The incentive payments will be prorated and reimbursed through your biweekly paycheck throughout the year (payable only when an employee is on the payroll). Note: The payments will be taxable income.

To elect the Opt-out Program, you must complete a NYS Health Insurance Transaction Form (PS-404) and an Opt-out Attestation Form (PS-409) and submit both to your HBA. Your NYSHIP coverage will terminate at the end of the current plan year, and the incentive payments will begin with the first pay period affecting coverage for 2022.

Eligibility to enroll in Opt-out during Annual Option Transfer:

Reminder: If you are currently enrolled in the Opt-out Program, you may continue your enrollment (no need to complete new forms) or choose other NYSHIP coverage for 2022 during the Option Transfer Period.

Pre-Tax Contribution Program (PTCP):

PTCP allows enrollees to have NYSHIP premiums for health insurance deducted from their wages before taxes are withheld. Each year employees can change their election to participate or decline in the PTCP during the Annual Option Transfer period. No action is required if you plan to keep your current PTCP status.

You can check your current PTCP status by looking at your paycheck. If you are enrolled your paycheck stub will show “Regular Before-Tax Health” in the Before-Tax Deductions section. If you are not enrolled in PTCP, your paycheck stub will show “Regular After-Tax Health” in the After-Tax Deductions Section.

If you would like to change your PTCP selection for 2022, you will need to submit a NYS Health Insurance Transaction Form (PS-404) You can obtain this form from the Office of Human Resources or through the link provided below.


All changes must be requested by 12/31/2021. It is recommended that any carrier change requests be sent to the Office of Human Resources or processing them through MyNYSHIP as soon as possible. It can take several pay periods before your records are updated in all systems.

Requests must be received by noon on 12/17/21 in order to be processed prior to shutdown. You may fax requests to (585) 395-5275. You may scan and email requests to or

Requests received after shutdown with a signature date on or prior to 12/31/21 will be honored and a retro-active request will be processed.

Please note: Copies of the Summary of Benefits and Coverage as required by the Patient Protection and Affordable Care Act (PPACA) can be obtained by calling 877-769-7447 to request a copy, or by visiting the link below to print a copy.

Contacts:  Michelle DeMonte: (585) 395-5136, or Serena Starr: (585) 395-2995,

2022 Health Insurance Choices booklet

2022 Rates Booklet

NYSHIP – to make changes online

PTCP Quick Facts

Health Transaction form (PS-404):  INSTRUCTIONS: READ BOTH SIDES (

Opt-out Program Attestation form (PS-409):  INSTRUCTIONS: READ BOTH SIDES (

Summary of Benefits and Coverage as required by the Patient Protection and Affordable Care Act (PPACA)

Related Content:
Contact Info: Office of Human Resources: (585) 395-2126
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